Presentation
Enlarging nasal mass.
Patient Data
Age: 72
Gender: Female
From the case:
Paranasal sinus squamous cell carcinoma
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- Soft tissue mass centered within the right nasal cavity/maxillary sinus (4x4x3cm), which destroys the medial maxillary sinus wall, extending into the sinus, and involves the right nasolacrimal duct.
- Bony destruction of medial wall of the orbit and orbital floor.
- Soft tissue is seen at the inferior aspect of the orbit and there is likely involvement of the infraorbital nerve and inferior rectus muscle.
- The lesion extends into the right pterygopalatine fossa and infratemporal fossa.
- Opacification of the right frontal, right ethmoid sinuses and right sphenoid sinus. It appears to be tumor in the ethmoid air cells and may be due to either tumor involvement or secondary to sinonasal obstruction.
- Prominent 8mm right level 2 lymph node. Three mildly enlarged (12mm) left supraclavicular lymph nodes.
From the case:
Paranasal sinus squamous cell carcinoma
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- Large destructive mass involving the right nasal cavity, maxillary sinus and ethmoid air cells.
- Extension into the inferior and medial right orbit.
- Also intracranial extension into infratemporal masticator space, around the posterolateral aspects of the right maxillary sinus.
- Direct invasion into pterygopalatine fossa and along the right V2 nerve.
- Internal increased T1 signal within the tumor is consistent with post surgical packing.
- Small adjacent lymph nodes.
Case Discussion
A case of right paranasal sinus squamous cell carcinoma. Staging (using the system for tumors of the maxillary sinus):
- T4a: tumor invasion of the orbit and infratemporal fossa WITHOUT extension into the orbital apex, dura, brain, middle cranial fossa, nasopharynx, clivus or cranial nerves other than V2.
- N0: no nodal metastasis.
The patient went on to have extensive craniofacial resection which revealed a poorly differentiated basaloid SCC involving maxillary, sphenoid and ethmoid sinuses. Bony, perineural and lymphovascular invasion was identified.
Case submitted by Dr Smita Deb and A/Prof Pramit Phal.