A 54-year-old woman with a history of recurrent left-sided lower motor neuron facial palsy presented with left-sided atypical facial pain and gradual hearing impairment. Examination of the cranial nerves showed no abnormalities. There were no cerebellar or pyramidal signs. Endoscopic examination of the left nostril revealed a medial bulging, friable mass and thinning of the posterior maxillary wall. An audiogram demonstrated bilateral mild to moderate sensorineural hearing loss with a maximum hearing loss threshold of 50 dB. Magnetic resonance imaging revealed a 2.0×1.5×2.0-cm well-circumscribed heterogeneous mass in the left pterygopalatine fossa that bowed the posterior wall of the maxillary sinus anteriorly. The signal intensity of the mass was predominantly low on T1-weighted images (Figure 1) and intermediate to low on fluid-attenuated inversion recovery images (Figure 2), but it was high on T2-weighted images (Figure 3 and Figure 4). The paranasal sinuses were clear. The patient underwent an endoscopic biopsy of the mass. An immunohistochemical stain (S100 protein) confirmed the diagnosis, and the lesion was excised.
Keh SM, Lim M, Lingam R. Radiology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2007;133(4):407. doi:10.1001/archotol.133.4.407