A 16-year-old girl presented with an incidentally noted abnormality in the paranasal sinuses. Computed tomography revealed a soft-tissue mass in the right midanterior ethmoidal region and sphenoidal rostrum (Figure 1). There were also 2 separate right ethmoidal mucoceles and a single large sphenoidal mucocele, with evidence of sphenoidal expansion and erosion into the clivus. The skull base and lamina papyracea were intact. The patient reported some nasal congestion, frontal headaches, and 1 episode of mild epistaxis. She denied any vision changes. Endoscopic examination showed an erythematous mass in the right sphenoethmoidal recess. Nasal endoscopy with biopsy was performed. The biopsy specimen showed a mixture of spindled stroma with variable cellularity and well-formed bony trabeculae with noticeable osteoblastic rimming (Figure 2). Other areas with abundant, small, round to oval to irregular calcified ossicles resembling cementum with osteoid rimming were noted (Figure 3).
Manes P, Fang YV, Ryan MW. Pathology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2010;136(11):1145. doi:10.1001/archoto.2010.198-a