PMC5155101_01
(a) Coronal image of CT paranasal sinuses in bone window showing soft tissue density mass lesion in inferior portion of right eye with extension into nasolacrimal duct. Nasolacrimal duct is expanded with rarefaction of its walls. Mass is reaching up to inferior turbinate. (b) CT postcontrast axial view in soft tissue window at the level of maxillary antrum showing well-defined, intensely enhancing mass lesion anteroinferior to right globe. (c) CT coronal image in maximum intensity projection showing abnormally hypertrophied vessels originating from nasopharyngeal mucosa and supplying the lesion. (d) CT postcontrast sagittal view in soft tissue window showing extension of the lesion through the expanded nasolacrimal duct into inferior turbinate.
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fig1
There was a leash of blood vessels seen originating from the nasopharyngeal wall and supplying the mass (Figure 1).
(a) T2-weighted MRI sagittal section showing heterogeneously hyperintense multilobulated mass originating from nasal cavity and nasopharynx and extending into oropharynx. Lesion shows few flow voids within. (b) Postcontrast T1-weighted MRI coronal section showing enhancing mass lesion in inferior portion of right orbit. There are few nonenhancing areas within. Lesion is extending into the inferior turbinate via nasolacrimal duct. (c) Postcontrast T1-weighted MRI sagittal section showing intensely enhancing multilobulated mass originating from nasal cavity and nasopharynx and extending into oropharynx. Lesion shows few nonenhancing areas within. Lesion shows multilobulated external surface mimicking cerebriform appearance of inverted papilloma. (d) Postcontrast T1-weighted MRI sagittal section showing extraconal, intraorbital, intensely enhancing mass extending into the nasal cavity via nasolacrimal duct. The mass is protruding outside of the orbital margins causing proptosis.
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H&E slide prepared by fine-needle aspiration cytology from the lesion showing groups of spore of rhinosporidium of varying sizes.
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FNAC (H&E staining) of the orbital lesion was done, which showed groups of spore of rhinosporidium of varying sizes (Figure 3). Following this, wide excision of the nasolacrimal duct/orbital lesion and electric cauterization of the base of the orbital lesion were done.