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Clinical Problem Solving: Pathology
April 2008

Pathology Quiz Case 2

Author Affiliations



Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Otolaryngol Head Neck Surg. 2008;134(4):447. doi:10.1001/archotol.134.4.447

A 39-year-old man who was congenitally blind in his left eye presented with a 2-month history of progressive headaches, proptosis of the right eye, visual loss, anosmia, and double vision on superior gaze. Nasal endoscopy revealed submucosal swelling that had caused lateral displacement of the uncinate process. A gadolinium-enhanced magnetic resonance image (Figure 1) showed a large mass lesion arising from the floor of the anterior fossa, with extension into the right frontal lobe, paranasal sinuses, nasal cavity, and right orbit. The patient was taken to the operating room for nasal endoscopy with biopsy. After the uncinate process was removed, a large, whitish mass was observed completely replacing the ethmoid cells. Biopsy specimens were obtained. After a diagnosis was established, the patient underwent a craniofacial approach to the lesion via bifrontal craniotomy with orbital and nasal osteotomy for resection of the intracranial, paranasal sinus, and orbital tumor followed by anterior cranial fossa floor reconstruction with dural repair and pericranial flap.

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