CASE 138 Published on 27.11.1999

Teaching Case

Section

Head & neck imaging

Case Type

Clinical Cases

Authors

R Sigal, F Janot

Patient

54 years, male

Categories

No Area of Interest ; Imaging Technique CT, MR ;

No Procedure ; No Special Focus ;

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Clinical History

Chronic nasal obtruction

Differential Diagnosis List

Squamous cell carcinoma of the nasal cavity and left maxillary sinus

Imaging Findings

Middle age patient with chronic nasal obtruction. Physical examination evidenced a mass in the nasal fossa. MR was requested. The patient was operated, and histologic diagnosis was obtained.

Discussion

Cancer of the nasal acavity and paranasal sinuses is relatively rare, ocurs more often in men (2:1) and usually appears after 40 years, (except minor salivary gland origin, lymphoma, or esthesioneuroblastoma). Squamous cell carcinoma is the most common type, followed by adenocarcinoma. These tumors have a propensity to grow slowly, insidiously towards the anterior skull base and orbit. Imaging is essential since it allows a precise tumor mapping, a key element for therapeutic planning. CT allows to visualize the bony structures, particularly the internal orbital wall and cribriborm plate. MR permits to differentiate between the tumor, which most often is seen as a T2 weighted low signal intensity area, and inflammatory tissue which shows up bright. In addition it can displays meningeal and intracerebral involvement. MR information can help selecting the correct surgical approach, particularly a combined neurosurgical-ENT approach if the anterior cranial fossa has to be removed.

References

[1] Som PM, Shapiro MD, Biller HF, Sasaki C, Lawson W (1988)
Sinonasal tumors and inflammatory tissues: differentiation with MR
imaging.
Radiology Jun;167(3):803-8. (PMID: 3363145)

[2] Mafee MF (1993)
Nonepithelial tumors of the paranasal sinuses and nasal cavity.
Role of CT and MR imaging.
Radiol Clin North Am Jan;31(1):75-90. (PMID: 8419981)

[3] Parsons JT, Stringer SP, Mancuso AA, Million RR (1994)
Nasal vestibule, nasal cavity, and paranasal sinuses.
In: Management of head and neck cancer. A multidisciplinary approach.
2nd ed. Philadelphia, JB Lippincott Cie, , p 551-598.

[4] Som PM, Curtin HD (1994)
Inflammatory lesions and tumors of the nasal cavities and paranasal sinuses
with skull base involvement.
Neuroimaging Clin N Am Aug;4(3):499-513. (PMID: 7952952)

[5] Phillips CD (1997)
Current status and new developments in techniques for imaging the nose and
sinuses.
Otolaryngol Clin North Am Jun;30(3):371-87. (PMID: 9162123)

Case information