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Clinical Challenge
April 2015

Ethmoid Sinus Mass

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport
  • 2Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
  • 3Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri
JAMA Otolaryngol Head Neck Surg. 2015;141(4):389-390. doi:10.1001/jamaoto.2015.22

A man in his 50s presented with a 7-month history of worsening, primarily left-sided, sinus obstruction and congestion with associated hyposmia, facial pressure, and headaches. He had no history of sinus disease or surgery and had no epistaxis, weight loss, or visual symptoms. Computed tomography showed a 3.1-cm mass in the left ethmoid sinus and nasal cavity (Figure, A). Positron emission tomographic scanning showed no evidence of metastasis. Nasal endoscopy revealed a friable, polypoid mass in the ethmoid sinus with extension into the nasal cavity and superiorly to the skull base. A biopsy specimen showed a heterogeneous tumor with small, angulated, blue cells with hyperchromatic nuclei, apoptosis, and mitosis, malignant glands lined by cuboidal cells with round nuclei, prominent nucleoli, and eosinophilic cytoplasm. The glands had luminal mucin production (Figure, B). Focally, there were also scattered round cells with abundant eosinophilic, refractile cytoplasm, features of rhabdomyoblasts (Figure, C). These latter cells were strongly positive for desmin (Figure, D) and myogenin.

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