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Clinical Problem Solving: Pathology
February 21, 2011

Pathology Quiz Case 2

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Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Otolaryngol Head Neck Surg. 2011;137(2):198-202. doi:10.1001/archoto.2010.248-a

A 20-year-old man presented with a 7-month history of worsening left-sided nasal airway obstruction. He was otherwise healthy and denied any epistaxis, headaches, diplopia, or facial numbness. The results of a biopsy performed by an outside otolaryngologist were remarkable for a spindle cell neoplasm; the patient was subsequently referred for definitive treatment.

Diagnostic endoscopy demonstrated a tan-to-green soft-tissue mass emanating from the sphenoethmoid recess. Computed tomography of the paranasal sinuses revealed a soft-tissue mass in the epicenter of the left posterior ethmoid region, with bony remodeling of the ethmoid roof and extension into the sphenoethmoid recess. Magnetic resonance imaging showed a hypointense mass involving the posterior ethmoid sinuses on T1-weighted images, with uniform enhancement after gadolinium administration (Figure 1). T2-weighted images also showed the mass to be hyperintense (Figure 2). No dural or orbital involvement was noted. A complete metastatic workup revealed no abnormalities.

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