Rare giant frontal sinus osteoma mimicking fibrous dysplasia

Evaluation of the Association between Paranasal Sinus Osteomas and Anatomic Variations Using Computed Tomography

Objective:

The pathogenesis of paranasal sinus osteoma (PSO) has not been fully elucidated. It is thought that both embryological and developmental factors play a role in the etiology. The aim of the present study was to investigate the association of frequency and localization of PSOs detected on computed tomography (CT) examination with osteoma presence.

Methods:

In this retrospective study conducted in December 2017 through March 2020 in Gaziosmanpaşa University Faculty of Medicine, images of a total of 18,867 patients who underwent paranasal sinus, maxillofacial CT and brain CT angiography were reviewed for the presence of PSOs. Sizes of PSOs and accompanying mucosal pathologies were identified. Associations between PSOs and paranasal sinus variations were evaluated statistically compared to the control group (200 patients without PSO).

Results:

A total of 176 patients (0.92%) were found to have PSO. Average age of the patients with PSO was 59.9 years (range: 18–93). PSOs were unilateral in 152 patients while 24 patients had multiple osteomas. Female/male ratio was 1.1/1. PSOs were most commonly located in the frontal sinuses. Frequencies of vertical concha bullosa, secondary middle turbinate, twisted uncinate, supraorbital ethmoid cell, intersinus septal cell, ethmoidomaxillary cell, Haller’s cell, frontal sinus hypoplasia and sphenoid sinus hypoplasia were significantly higher in the patient group compared to the control group.

Conclusion:

Higher or lower incidence rates of some anatomic variations in the patients with PSO could be explained by the possible effects of genetic and/or environmental factor. Additional studies are needed to evaluate these possible associations.

Paleopathological evidence of paranasal lesions: Two cases of frontal sinus osteomata from Imperial Rome

The archaeological excavations carried out in 1999 in the Collatina necropolis of the Roman Imperial Age (1st-3rd centuries AD) (Rome, Italy) discovered the skeletal remains of two adult males with evidence of paranasal lesions. Both individuals showed postmortem damage in the frontal bone, through which it was possible to macroscopically detect an oblong new bone formation. In both specimens, radiological examination of the defects' morphology showed new pediculated-based bone formations. Radiology also confirmed the presence of benign osseous masses arising from the right frontal sinus and interpreted as osteomata. Their dimensions did not exceed 10 mm, so that mechanical complications and compression of the adjacent structures could be ruled out. The osteomata of paranasal sinuses are rarely reported in paleopathology, since they can be discovered only incidental to bone breakage or radiography. Hence, the evaluation of their occurrence in past populations represents an important challenge. The two cases presented here show direct and rare evidence of frontal sinus osteomata dating back to the Roman Imperial Age.

Large Frontoorbital Osteoma Causing Ptosis

Osteomas are the most frequent benign tumor of the paranasal sinuses. The commonest site is the frontal sinus but intraorbital extension of frontal osteoma is rare. Here, the authors report a 15-year-old adolescent boy who presented with left superior orbital rim swelling and ptosis. Waters radiography and computed tomographic scan revealed a bone density mass in the left frontal sinus with upper orbital wall extension. The tumor was removed via open eyebrow incision. The histopathologic evaluation was consistent with osteoma.

Characteristics of sinonasal fibrous dysplasia: experience from a single department

OBJECTIVES

We summarized the characteristics of fibrous dysplasia patients in our department to obtain clinical data on this disease.

METHODS

We retrospectively reviewed 28 patients who were diagnosed with sinonasal fibrous dysplasia based on pathological examination results from March 2012 to February 2017 in our department.

RESULTS

The 28 patients included 16 females and 12 males, and the median age was 31.5 (range, 7-69) years. The three most common symptoms were nasal obstruction (25%), impaired vision (21%) and headache (18%). Most of the tumors were located in the sphenoid sinus (50%), nasal cavity (39%) or ethmoid sinus (36%). The surgical strategy included an exclusive endoscopic approach (25 cases) and an endoscopic approach combined with sublabial incision (three cases). The median follow-up period was 29 months (range, 3-62 months), and three patients were lost to follow-up. Two of the remaining 25 patients developed recurrence. However, since the second surgery, there has been no recurrence to date.

CONCLUSIONS

Our study indicates that the treatment of fibrous dysplasia patients should be tailored according to patient and disease characteristics. The main surgical procedure is the endoscopic approach, and the effect is good. Although the recurrence rate is low, follow-up is necessary.

A review of nasal, paranasal, and skull base tumors invading the orbit

Tumors that invade the orbit are uncommon. The majority are meningiomas arising from the sphenoid ridge (66%). Others are bone and cartilage tumors arising from the surrounding bones of the orbit, pituitary adenomas, and epithelial tumors arising from the paranasal sinuses and nasal cavity. Meningiomas occur more often in women, whereas epithelial tumors have a predilection for men. Meningiomas and epithelial tumors typically present in the sixth decade of life, whereas bone tumors tend to affect individuals in their third decade of life. Patients often present with a combination of ophthalmological and otorhinolaryngological symptoms, including proptosis, pain, decreased visual acuity, restrictions in motility of the eye, epistaxis, and nasal obstruction. Sarcomas and benign bone and cartilage tumors arise from surrounding structures, whereas carcinomas usually arise from the paranasal sinuses. Surgery is the mainstay of treatment. Depending on the aggressiveness and histology of the tumor, surgery may be combined with radiation and chemotherapy. The prognosis is generally poor, but varies depending on histology and cell origin, size of the tumor, and degree of invasion. Meningiomas and benign bone tumors have the best prognoses. Sinonasal undifferentiated carcinomas, small-cell neuroendocrine carcinomas, osteosarcomas, and rhabdomyosarcomas have poorer prognoses.

Primary intraosseous meningioma: an osteosclerotic bone tumour mimicking malignancy

BACKGROUND

Sclerotic tumours of the calvarial bones are rare and may be due to primary and secondary bone tumours as well as extradural tumours of meningeal origin.

CASE PRESENTATION

We report a case of primary intraosseous meningioma (PIM) which arose in the frontal bone of a 63 year old woman who complained of progressive pain and thickening of the right skull. Radiology showed a large osteosclerotic lesion in the right frontal bone. Histology showed an intraosseous lesion containing dense fibrous tissue in which there were scattered cells that expressed epithelial membrane antigen and progesterone receptor. The tumour was partially resected and 3 years after operation has not recurred.

CONCLUSIONS

PIM is a rare tumour which needs to be distinguished from primary/secondary osteosclerotic calvarial bone tumours.