Inflammatory pseudotumor of the maxillary sinus: CT and MR findings in six cases

Plasma Cell Granuloma of the Maxillary Sinus-A Case Report and Review

Plasma cell granuloma is a rare, benign, space occupying lesions occurring after recurrent infections. It most commonly involves young adults with lungs being the most common site. They are usually rounded masses with bony expansion and destruction without any life threatening complications and surgery being the best choice of treatment. Here we reported a 33 year-old female with plasma cell granuloma of the maxillary sinus treated with surgery and no recurrence has been noted.

Solid pancreatic masses in children: A review of current evidence and clinical challenges

Pancreatic tumors in children are infrequently encountered in clinical practice. Their non-specific clinical presentation and overlapping imaging characteristics often make an accurate preoperative diagnosis difficult. Tumors are categorized as epithelial or non-epithelial, with epithelial tumors further classified as tumors of the exocrine or endocrine pancreas. Although both are tumors of the exocrine pancreas, solid pseudopapillary neoplasm is the most prevalent solid pancreatic tumor in children, while pancreatoblastoma is the most common malignant tumor. Insulinoma is the most common pediatric pancreatic tumor of the endocrine pancreas. Malignant tumors require a complete, often radical, surgical resection. However, pancreatic parenchyma-sparing surgical procedures are utilized for benign tumors and low-grade malignancy to preserve gland function. This review will discuss the epidemiology, pathophysiology, clinical and diagnostic characteristics, and management options associated with both common and rare solid pancreatic masses in children. We will also discuss current challenges encountered in their evaluation and treatment.

Inflammatory myofibroblastic tumor of the pancreatic neck: A case report and review of literature

BACKGROUND

Pancreatic inflammatory myofibroblastic tumor (IMT) is a relatively rare disease that is often confused with pancreatic cancer or pancreatic neuroendocrine tumors. The histological features of IMTs show that tissue from this type of tumor contains an intermingling of fibroblast and myofibroblast proliferation, accompanied by a varying degree of inflammatory cell infiltration.

CASE SUMMARY

The management of an IMT occurring at the neck of the pancreas is presented in this paper. A 66-year-old female patient was diagnosed with a pancreatic neck mass after a series of tests. The patient underwent enucleation of the pancreatic neck tumor after a pathological diagnosis of IMT. Previous research on the clinical features, pathological diagnosis and treatment of pancreatic IMTs was reviewed. Compared with previous reports, this is a unique case of enucleation of a pancreatic IMT.

CONCLUSION

The enucleation of pancreatic IMTs may be a safe and efficient surgical method for managing such tumors with a better prognosis. Further cases are required to explore surgical measures for pancreatic IMTs.

Fibrosing Inflammatory Pseudotumor Presenting as Cranial Neuropathy

We report two cases of biopsy-corroborated “fibrosing inflammatory pseudotumor” to illustrate that the entity, rarely described in the neurological literature, should be included in the differential diagnosis of either a cranial mononeuropathy or, certainly, in the case of progressive cranial neuropathies. A broad differential diagnosis arises in certain contexts. Early steroid treatment can be effective, and perhaps later-generation immune-modulating agents may confer further options, although there is no known definitive treatment.

Inflammatory Myofibroblastic Tumor of Nasal Septum after Septoplasty: A Case Report

Inflammatory myofibroblastic tumor is an uncommon tumor composed of myoblasts and various types of inflammatory infiltrates. Inflammatory myofibroblastic tumor is most common in the lungs but can be rarely found in the nasal cavity. Inflammatory myofibroblastic tumor is a rare entity that represents a diverse histologic pattern that can mimic malignant tumors. We report a case of inflammatory myofibroblastic tumor of the nasal septum in a 45-year-old man who presented with a tumor-like lesion of the nasal septum after two rounds of septoplasty.

Diagnosis, treatment, and rehabilitation of a patient with inflammatory pseudotumor

Inflammatory pseudotumors are a group of lesions of unknown etiology that mimic clinically and radiographically neoplasms. In the maxilla, inflammatory pseudotumors are presented with bone alterations of erosion, remodeling, and sclerosis. The diagnosis is of exclusion, where multiple biopsies are required. The present study aims to report the case of a male patient who presented with increased volume in the left maxillary region, with diagnosis after total left maxillectomy being inflammatory pseudotumor. The patient did not present recurrences with 3 years of preservation and underwent by multidisciplinary treatment with esthetic and functional rehabilitation with the preparation of a bucomaxilo prosthesis. Despite presenting some suggestive clinical features, the inflammatory pseudotumor has a difficult and of exclusion diagnosis, where multiple biopsies are required. They are lesions that simulate clinically and radiographically neoplasms. If it is surgically accessible, the treatment of choice is complete surgical resection.

The Clinical and Radiological Characteristics of Inflammatory Myofibroblastic Tumor Occurring at Unusual Sites

Inflammatory myofibroblastic tumor (IMT) can occur rarely in the soft tissue or joint of the limb. We retrospectively collected IMT cases of these rare sites and analyzed their clinical and imaging appearance. Thirteen cases of IMT were clinically diagnosed and underwent surgical procedures, pathological analyses, and postsurgical follow-up in our two hospitals. Other than one case of IMT of the bladder wall that presented with gross hematuria, none presented with local swelling, fever, or weakness. All the cases of IMT occurring at the bone showed destruction and parosteal soft tissue masses. The boundaries between the mass and normal bone were vague, without calcifications or any periosteal reaction. Five cases of IMF showed continuous enhancement on CT; seven cases demonstrated iso- or hyposignal intensity on T1WI; one case showed hypersignal intensity on T1WI, and eight cases demonstrated a hypersignal intensity signal on T2WI. All the masses located in soft tissues showed clear and sharp boundaries with different sizes of the swelling regions surrounding muscle interspaces. Three cases showed homogeneous enhancement, one case demonstrated heterogeneous enhancement, and two cases showed edge enhancement on enhanced MRI scans. On pathology, all the lesions showed an absence of a pseudocapsule, and four cases of ALK were positive. The radiological manifestations of IMT located at the soft tissue and bones were similar to benign tumors in shape; however, peritumoral edema, parosteal soft tissue, and the invasive rim of IMT are similar to the features of malignant tumors. Different radiological methods should be used to obtain an accurate diagnosis.

Plasma Cell Granuloma of the Jaw and the Infratemporal Fossa: A Clinical Case

Plasma cell granuloma or inflammatory pseudotumor (IPT) is diagnosed by a process of elimination. The precise etiology is unknown, although it can occur after a bout of periodontal infection. This report describes the various stages of progression for this ailment. A 49-year-old woman with no noteworthy medical history presented with a recurrent periodontal abscess accompanied by progressive and severe destruction of the right maxilla. There was invasion of the infratemporal fossa and very tight trismus. Histologic examination indicated a reactive plasma cell granuloma. IPT is an entity recognized by the World Health Organization. A triggering infectious or inflammatory factor is often present. In the maxilla, progression is very aggressive. Treatment relies on corticotherapy, with or without radiotherapy, and administration of cyclosporine.

Inflammatory myofibroblastic tumor of the pancreatic head - a case report of a 6 months old child and review of the literature

BACKGROUND

Inflammatory myofibroblastic tumors are rare in the pediatric population. Most common localizations were reported in the lungs. A localization in the pancreas needs differentiation from other tumors and chronic pancreatitis. Treatment is surgical resection, although there are reports of treatment with oral steroids and radiation therapy.

CASE REPORT

A 6-month-old child was treated due to a tumor in the head of the pancreas. On admission he was jaundiced with pruritus. US and MRI confirmed pancreatic tumor. Preoperative biopsy wasn't conclusive regarding the nature of the tumor. Duodenopancreatectomy was performed. Postoperative course was uneventful. Histologic examination confirmed the diagnosis of inflammatory myofibroblastic tumor. On follow up, he remained with no evidence of recurrence.

CONCLUSIONS

A literature review revealed 10 cases of pancreatic inflammatory myofibroblastic tumors in the pediatric age group. Our patient is the youngest reported. Despite major resection, there were no complications. However, management of this child might be possible with steroids, but conservative treatment might be insufficient, especially in aggressive forms of tumors.

A primary inflammatory myofibroblastic tumor of the scapula in a child: imaging findings

Inflammatory myofibroblastic tumor (IMT) is an uncommon tumor characterized by inflammatory cell infiltration and differentiated myofibroblastic spindle cells. IMT was first described in the lung and retroperitoneum. Occurrence in bone has been well described in the maxilla and occasionally in the long bones in the adult population. We present a unique case of IMT arising primarily from the scapula in an 8-year-old patient, not described previously in the pediatric or adult literature. Imaging demonstrated an ill-defined and aggressive osteolytic lesion with cortical bone destruction associated with an important soft tissue component that extended into the adjacent muscles. Histologically, the tumor was composed of spindle and polygonal cells distributed in an inflammatory background with different proportions of plasma cells, lymphocytes, eosinophils and neutrophils. The absence of cellular atypia helped to differentiate this entity from malignant spindle cell tumors, and imaging could differentiate the tumor from the nontumoral inflammatory reaction.

Maxillary sinus inflammatory myofibroblastic tumors: a review and case report

An inflammatory myofibroblastic tumor (IMT) is an immunohistochemically diverse entity demonstrating neoplastic and nonneoplastic qualities. Although IMTs can arise in any area of the body, lesions arising in certain sites, namely, the nasal cavity, paranasal sinuses, and pterygopalatine fossa, demonstrate a heightened neoplastic and invasive potential. Despite case specific complete tumor regression and disease remission in response to pharmacotherapeutics, a subset of IMTs remain resistant to all forms of therapy. We present such a case, a 34-year-old female patient, with a highly resistant, maxillary sinus IMT. Her refractory, ALK-1 negative IMT has not responded well to novel therapies reported in current literature. This case suggests the role of zonal expressivity within a single lesion as a probable mechanism for its highly resistant nature and should promote determination of each IMT's cytogenetic profile to provide more effective targeted therapy. Paper includes a literature review of all maxillary sinus IMTs from 1985 to 2014 along with their immunohistochemical staining, treatments, and outcomes.

Inflammatory myofibroblastic tumor of maxilla showing sarcomatous change in an edentulous site with a history of tooth extraction following periodontitis: A case report with discussion

Inflammatory myofibroblastic tumor (IMT) is a rare tumor of uncertain origin with variable biological behavior ranging from reactive lesions to highly aggressive malignancy. Oral IMTs are extremely rare and only 25 cases had been reported so far. A case of IMT with sarcomatous transformation in an extraction site with a history of tooth extraction following tooth mobility of an upper left molar tooth is presented here. The tooth was extracted following a complaint of gingival swelling and mobility of tooth. Though malignant transformation in IMTs had been documented in the extra oral sites, wide search of associated literature suggests, this is the first case of oral IMT showing malignant change associated with gingiva. The case report attempts to highlight the variant possibilities of tooth mobility other than periodontitis and the importance of assessing the primary cause of such conditions.

Inflammatory myofibroblastic tumors of the nasal cavity and paranasal sinus: a clinicopathologic study of 25 cases and review of the literature

Inflammatory myofibroblastic tumor (IMT) is rare in nasal cavity and paranasal sinus. The aim of this study was to describe the clinicopathological features of sinonasal IMT and analyze the relationship between the clinicopathological features and the prognosis. A retrospective study of 25 IMT patients between 2001 and 2012 was performed. Data on clinical features, treatment, and follow-up were recorded. The histological characters were observed. Overall survival (OS) and event-free survival (EFS) were estimated using the Kaplan-Meier method. Clinically, the most common symptoms were nasal obstruction, facial pain, and toothache. Twenty patients received follow-ups 6-120 months after initial diagnosis. Fifteen (75 %) developed recurrence 1 or more times. One patient had left cervical lymph node metastasis (5 %). Five patients died of the tumor (25 %). Histologically, the IMTs composed of bland spindle cells admixed with a prominent infiltrate of plasma cells and lymphocytes and showed obvious atypia in recurrent cases. Histology with necrosis, mitosis (≥1/10 HPF), ganglion-like cells, histological pattern I or II and relapse (≥4 times) was significantly associated with poor OS and EFS. IMT of the nasal cavity and paranasal sinuses exhibits relatively bland histologic appearances, but can shows strongly aggressive behavior and relatively poor outcomes. Multiple relapse, necrosis, frequent mitosis, the presence of ganglion-like cells, and histological pattern might be associated with poor clinical outcomes.

Idiopathic inflammation of the orbit and contiguous structures

Idiopathic orbital inflammation is a common cause of acute orbital signs and symptoms. It is typically confined to the bony orbit; however, it can rarely involve contiguous structures with or without lytic change raising clinical suspicion for malignancy. Three cases of idiopathic inflammation of the orbit that affected adjacent structures are reported here; 2 cases had maxillary sinus involvement, while a third had extension in the temporal fossa.

Inflammatory myofibroblastic tumour of the maxillary sinus: CT and MRI findings

AIM

To characterize the computed tomography (CT) and magnetic resonance imaging (MRI) findings of inflammatory myofibroblastic tumours (IMTs) of the maxillary sinus.

MATERIALS AND METHODS

The imaging findings of eight patients with IMTs of the maxillary sinus were reviewed retrospectively. Of the eight patients, four patients underwent unenhanced and contrast-enhanced CT, and one patient underwent unenhanced CT only; three patients underwent unenhanced and contrast-enhanced MRI.

RESULTS

Five cases of IMTs occurred in the left maxillary sinus, while three cases were right-sided. Four cases occupied the entire sinus, and the other four cases only partially occupied the sinus. Unenhanced CT images showed heterogeneous masses in four cases and a homogeneous mass in one case. One of the tumours showed some areas of calcification. T1-weighted MRI images showed isointense lesions. T2-weighted images showed mixed isointense and mild hyperintense lesions. All cases showed bone destruction and had infiltrated into the nasal fossa, orbit, infratemporal fossa, and other adjacent tissues. Seven cases showed mild to moderate heterogeneous enhancement on contrast-enhanced CT or T1-weighted MRI images.

CONCLUSION

IMTs of the maxillary sinus can be characterized as a soft-tissue mass with bony destruction and infiltration of the adjacent tissues, with mild to moderate enhancement after the injection of contrast medium. CT and MRI can help to diagnose IMTs, determine the extent of the lesion and its relationship with adjacent tissues, and thus facilitate the prediction of surgical resectability.

Transcatheter arterial embolisation for paediatric inflammatory pseudotumour of the maxillary sinus

BACKGROUND

Inflammatory pseudotumours are mostly seen in the lung, and occasionally in the head and neck region including the sinonasal area. Reported treatment modalities comprise corticosteroid treatment, surgical excision and radiotherapy. The latter option is required because wide surgical resection may be difficult for head and neck lesions, especially in children. However, clinicians should be aware of the risk of late-onset side effects of radiotherapy in children.

CASE REPORT

We present a two-year-old girl with a massive inflammatory pseudotumour of the maxillary sinus. Transcatheter arterial embolisation was performed, and the lesion was successfully managed without additional therapy. There was no evidence of recurrence over the next five years.

CONCLUSION

This is the first report presenting the utility of arterial embolisation for inflammatory pseudotumour.

Spontaneous hearing improvement in a patient with an inflammatory myofibroblastic tumor of the temporal bone

Inflammatory myofibroblastic tumor (IMT) is a rare lesion of unknown etiology and difficult diagnosis. The treatment of IMT is controversial. We report a case of IMT of the temporal bone in a young man presenting with a progressive hearing loss. Three years after diagnosis, partial hearing improvement has been documented.

Inflammatory myofibroblastic tumor of the head and neck

Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm. The aim of this study was to enhance the understanding of head and neck IMT and to improve its diagnosis and management. Clinical features and related treatment of 10 IMT cases were retrospectively analyzed and the literature was reviewed. Tumor sites identified included four in the maxillary space, two in the buccal space, two in the parotid gland, one in the post aurem, and one in the neck. Nine of ten patients received local resection, and one of ten patients received a total maxillectomy. One patient had a local recurrence and died, while the other nine patients had no distant metastases and survived. A computed tomography (CT) exam performed on nine of the ten patients showed that six of these nine cases were heterogeneous in density, while the other three cases were homogeneous. Four cases showed marked heterogeneous enhancement, two cases showed mild heterogeneous enhancement, and three cases showed moderate homogeneous enhancement on contrast-enhanced CT images. The incidence of IMT in the head and neck is low, and local resection is currently the best treatment. A prolonged postoperative follow-up period is necessary for patients with IMT.

IgG4-related inflammatory pseudotumor of the trigeminal nerve: another component of IgG4-related sclerosing disease?

IgG4-related IPTs have been reported in various sites and may form part of the spectrum of systemic IgG4-related sclerosing disease. Some pseudotumors are clinically and radiologically indistinguishable from malignant tumors. We present the first case of an IgG4-related IPT of the trigeminal nerve diagnosed histopathologically without involvement of any of the common sites. The trigeminal nerve pseudotumor may represent a component of IgG4-related sclerosing disease.

Differential diagnosis of proptosis: report of 2 cases

We rarely encounter patients with proptosis, however, it is known that inflammation and extension of paranasal sinus tumors may cause this condition. We should consider the diseases that may cause proptosis to facilitate the diagnosis. Recently, we treated proptosis in 2 cases, one with inflammatory myofibroblastic tumor (IMT) and the other with malignant lymphoma. As these 2 diseases show various clinical features and these features frequently overlap, it is difficult to differentiate between IMT and malignant lymphoma without pathological examinations. In this study, we review the relevant literature reports and discuss the difficulties in establishing a clinicopathological diagnosis and present a slight distinction in magnetic resonance imaging.

Imaging of nasopharyngeal inflammatory pseudotumours: differential from nasopharyngeal carcinoma

The purpose of this study was to describe the MRI findings of inflammatory pseudotumours (IPTs) involving the nasopharynx and to differentiate IPTs from nasopharyngeal carcinoma (NPC). The medical records and imaging studies of 7 patients (6 men, 1 woman; age range, 32-71 years; mean age, 52.4+/-18 years) with IPT involving the nasopharynx were reviewed retrospectively. The MRI findings were compared with those of seven patients with advanced NPC with skull base invasion. All patients with IPT involving the nasopharynx presented with single or multiple cranial neuropathies; six reported pain; and four patients had a recent history of otitis media. Three were initially misdiagnosed as having NPC according to MRI findings, and all underwent nasopharyngeal biopsy to exclude malignancy. 7/7 (100%) patients received systemic corticosteroid treatment; 7/7 (100%) showed initial rapid resolution of clinical symptoms or radiographical findings; 3/7 (42.9%) had resolution of all signs and symptoms; 3/7 (42.9%) still have limited residual symptoms; and 1/7 (14.3%) suffered recurrence 3 years after remission. The characteristic MR findings of IPT include an infiltrative growth pattern, minimal to mild mass effect, hypointensity on T(2) weighted images, and moderate homogeneous enhancement after contrast administration. Intact nasopharyngeal mucosa, internal carotid artery encasement and narrowing, extensive pachymeningeal thickening and a relative paucity of associated neck lymphadenopathy are additional MR findings that favour the diagnosis of IPT rather than NPC. In conclusion, IPT involving the nasopharynx has characteristic MR findings which, together with clinical and laboratory presentations, are helpful in differentiating IPT from malignant tumours, especially NPC.

Is radical surgery necessary to head and neck inflammatory myofibroblastic tumor (IMT) in children?

PURPOSE

We report a case of head and neck inflammatory myofibroblastic tumor (IMT) in an infant. Reviewing the literature, we discuss the etiology, diagnosis, treatment, and prognosis of the head and neck IMT in children.

MATERIALS AND METHODS

A 52-day-old infant was admitted with an enlarging lesion in the right head and neck region. Following total excision, the lesion recurred and progressed to terminal stage. We performed a review of the literature on head and neck IMTs in children up to the age of 18 years and assessed the treatments and related prognosis of IMT in the head and neck region.

RESULTS AND CONCLUSIONS

The children's prognosis of head and neck IMT is diverse with different treatments. Combined treatment of surgical and corticosteroid is recommended for younger children, especially infants.

The development and pathologic processes that influence maxillary sinus pneumatization

The maxillary sinus is universally described as a pyramidal-shaped cavity in the maxilla. Hypoplasia, which can occur unilaterally or bilaterally, is graded by the authors by the degree of failure of descent below the nasal floor in achieving its position adjacent to the posterior dentition in the adult. Unlike early studies using plain X-rays, which considered pneumatization into the zygomatic recess and dental alveolus as criteria, the authors have adopted the above-cited parameters based on computed tomography (CT) imaging, which reveals that even when smaller the sinus retains a pyramidal configuration, although truncated. Rarely, the sinus is excessively pneumatized in the nonpathologic state. Review of the literature failed to reveal a comprehensive study of the conditions that alter maxillary sinus volume and configuration. Based on a retrospective review of 6,000 high resolution CT scans of the paranasal sinuses, the types and relative incidences of these conditions have been determined, and a classification system proposed. The mixed-sex sample group (= 2,540) was comprised of nonpediatric (adolescent and adult) and was of a polyethnic composition. Results showed that enlargement of the sinus is uncommonly encountered, and is produced by air (pneumocele) and mucus (mucocele) entrapment, or by benign tumors which have arisen in the sinus or adjacent maxilla and have grown intracavitarily, with the sinus walls expanding and remodeling to accommodate them. Reduction in size and volume is more frequent. Heredo-familial syndromic conditions reduce sinus size by impaired facial growth centers, or obliteration by dense osteosclerosis. Irradiation for neoplastic disease in the pediatric population similarly, directly effect growth centers, or impairs pituitary function. Another iatrogenic cause, direct surgical intervention (Caldwell-Luc procedure) almost universally alters sinus volume and shape by osteoneogenesis. Midfacial fractures involving the sinus also produce distortion by sclerosis as well as by malpositioning of bone fragments. The principal systemic disorders, sickle cell anemia and osteopetrosis, which diffusely effect medullary bone, do so either through compensatory marrow proliferation or sclerotic new bone formation, thus serving to produce maxillary enlargement and sinus obliteration. The greatest source of maxillary sinus distortion and destruction are neoplasms. Malignant sinonasal and oral cavity tumors produce bony erosion of the sinus walls, whereas benign odontogenic cysts remain external to the sinuses and compress it as they enlarge. Most odontogenic tumors produce external compression and remodeling. Fibro-osseous disorders similarly produce size and shape distortions by external impingement. Although diverse developmental and pathological conditions influence maxillary sinus morphology, there is a limited range of biologic response.

An inflammatory myofibroblastic tumor of the nasal dorsum

Inflammatory myofibroblastic tumor of the nose is an uncommon benign proliferative lesion that clinically mimics a neoplastic process. Our case arose in a 4-year-old girl presenting with a mass in the nasal dorsum. The mass was completely excised without any difficulty under general anesthesia. This tumor is a localized and completely benign lesion. Surgical resection is proper management for this condition.

Fibrosing inflammatory pseudotumor of the nasopharynx: MR features and histopathologic correlation

PURPOSE

To describe the magnetic resonance (MR) imaging features of six cases of pathologically proven fibrosing inflammatory pseudotumor involving the nasopharynx, and to compare the MR signal intensities of the lesions with histopathologic findings.

METHODS

We reviewed the MR finding of six patients with pathologically proved fibrosing inflammatory pseudotumor at the nasopharyngeal wall with respect to the following points: extent, margins, signal intensity and enhancement degree of the lesion; cervical lymphadenopathy and response to steroid therapy. MR findings were correlated with histopathologic findings.

RESULTS

All lesions showed ill-defined margins and looked less-likely contour bulging features. The signal intensity of the lesions was hypointense or slightly heterogeneous relative to brain cortex on both T1- and T2-weighted images, and enhancement was weakly homogeneous in all cases. There was no demonstrable cervical lymphadenopathy in all cases. After steroid therapy, the lesions showed decreased extent and weaker enhancement in three patients. Histopathologic findings showed high degree of polymorphous inflammatory cellular infiltration with underlying significant reactive fibrosis.

CONCLUSION

Fibrotic inflammatory pseudotumors involving nasopharynx are very rare, and can mimic malignancy. MR imaging showed ill-defined margins, hypointensity or slightly heterogenous signal intensity on T2-weighted image and weak enhancement. There was no significant cervical lymphadenopathy.

Inflammatory pseudotumors of the paranasal sinuses

Inflammatory pseudotumors may be defined as lesions that clinically and radiologically simulate neoplasms. These tumor are not a single clinical-pathological entity, but rather a generic term applied to any nonspecific, chronic, inflammatory expanding lesion. There are few reports of inflammatory pseudotumors in the nasal cavity and paranasal sinuses.

CASE REPORT

We report three cases of inflammatory pseudotumors of the nose and paranasal sinuses seen at the Division of Otolaryngology of the Medical School University Hospital, Sao Paulo University.

DISCUSSION

Inflammatory pseudotumors of the paranasal sinuses present a variety of symptoms according to the site.

Sphenoid wing inflammatory pseudotumor mimicking a clinoidal meningioma: case report and review of the literature

BACKGROUND

Inflammatory pseudotumor is a nonneoplastic process of unknown etiology most frequently involving the lungs and orbits. Primary intracranial inflammatory pseudotumors are exceptionally rare. The authors report a rare case of clinoidal inflammatory pseudotumor mimicking a medial sphenoid wing meningioma.

CASE DESCRIPTION

A 24-year-old woman presented with visual diminution and proptosis in the left eye for one and a half years. Imaging revealed a medial sphenoid wing mass, which was surgically decompressed. Histopathology confirmed the diagnosis of inflammatory pseudotumor after which she was treated with steroids. The patient is doing well at 3 months' follow-up with resolution of proptosis and no further diminution of vision.

CONCLUSION

Inflammatory pseudotumors can mimic a malignant tumor both radiologically and clinically. The treatment options consist of surgery, high-dose steroids, irradiation, and chemotherapeutic agents with variable therapeutic response. Intracranial involvement due to inflammatory pseudotumor is exceptionally rare. The importance of recognizing and appropriately diagnosing this rare intracranial pathology lies in prognostication and avoidance of overzealous treatment.

Inflammatory pseudotumor of the sinonasal tract

Inflammatory pseudotumors (IPTs) are a clinically and histologically diverse group of lesions characterized by a tumor mass of acute and chronic inflammatory cells with a variable fibrous response. IPTs most commonly involve the lung and orbit, but rarely the sinonasal tract. We report a 68-year-old male with an IPT of the sinonasal tract presenting as nasal obstruction and postnasal dripping for several years. A gray-white soft mass was noted in the right nasal cavity. Computed tomography revealed a solid mass filling the right nasal cavity and maxillary sinus. Caldwell-Luc operation with ethmoidectomy (right) was conducted to resect the mass en bloc. Pathology revealed admixture of plasma cells, lymphocytes and eosinophils, confirming the diagnosis of IPT. The patient remained symptom-free over 4 years of follow-up. Awareness of the clinical presentations, histopathologic features and treatment of choice of this rare disease entity is necessary to distinguish it from malignancy and avoid unnecessary management.

Inflammatory pseudotumour of the paranasal sinuses--a case report

Inflammatory pseudotumour represents benign non-specific granulation, and is uncommon in the head-and-neck region, particularly in the paranasal sinuses. We present herein the case of a 63-year-old woman with inflammatory pseudotumour of the paranasal sinuses. Physical examination and computed tomography revealed a mass in the bilateral nasal cavity and paranasal sinuses with extension to bilateral orbits. Multiple intranasal biopsies revealed marked lymphoplasmatic infiltration and myofibroblastic proliferation with hyalinisation. Systemic steroid therapy was selected and was very effective. The lesion has shown no evidence of enlargement for more than 1 year. The difficulties in establishing the clinico-pathological diagnosis and treatment are discussed.

Immune reconstitution inflammatory syndrome presenting as sinusitis with inflammatory pseudotumor in an HIV-infected patient: a case report and review of the literature

Immune reconstitution inflammatory syndrome (IRIS) encompasses a variety of conditions that occur among HIV-infected patients in a temporal relationship with increases in CD4 cell count as a result of highly active antiretroviral therapy (HAART). Most conditions associated with IRIS are infectious. Malignancies, such as Kaposi's sarcoma, have also been reported. We report a case of sinusitis with presumptive inflammatory pseudotumor as a manifestation of IRIS that occurred 20 weeks after the initiation of HAART.

Inflammatory pseudotumor of the nasal cavity

Inflammatory pseudotumor is usually found in the orbits and lungs, but rarely in the sinonasal area. We present a 59-year-old woman with a right nasal mass. This lesion caused nasal bleeding and blockage. Image study showed that the solid mass eroded the bony structure and pushed the nasal septum toward the left side. Wide excision was done via lateral rhinotomy. Although its clinical picture mimicked a malignant tumor, histological examination showed an inflammatory process composed of a mixture of lymphoplasmacytic infiltrate, histiocytic cells, and spindled fibroblastic/myofibroblastic cells. Both culture and pathology identified no microorganism. No evidence of recurrence was found after follow-up for more than 2.5 years. The clinical behavior of inflammatory pseudotumor was confusing and tended to be mistaken as malignancy. Its diagnosis and management could be a great challenge for clinicians.

Three cases of organized hematoma of the maxillary sinus

Organized hematoma of the maxillary sinus is a rare clinical disease. To our knowledge, only a few cases of organized hematoma of the maxillary sinus have previously been published, most coming without bleeding history and disorders. We report three cases of organized hematoma of the maxillary sinus presenting with an enlarging maxillary sinus mass. In the evaluation of a patient with recurrent nasal bleeding, nasal obstruction, and an enlarging maxillary mass, organized hematoma of the maxillary sinus should be included in the differential diagnosis.

Plasma cell granuloma of the maxillary sinus: a case report and literature review

BACKGROUND

Plasma cell granulomas are rare and heterogeneous tumor-like lesions of mixed inflammatory cell infiltrates of unknown etiology. Although they have the potential to occur in sites throughout the body, their occurrence in the paranasal sinuses and nasal cavity is uncommon and often associated with unique clinical characteristics and natural history.

METHODS

We present a case of an aggressive plasma cell granuloma of the maxillary sinus and a review of the literature (28 cases).

RESULTS

The patient was treated with definitive radiotherapy (45 Gy in 25 fractions) and experienced a local recurrence 2 years later. The lesion initially responded to corticosteroids and then progressed. Resection was performed and was followed by another recurrence. The patient was treated with radiosurgery and is disease free 8 years after initial treatment.

CONCLUSIONS

Review of the literature indicates that the optimal first line of treatment is high-dose corticosteroids. Surgery is indicated if the lesion fails to respond. Radiotherapy is indicated if complete resection is not feasible.

Inflammatory pseudotumor of the cavernous sinus and skull base

Inflammatory pseudotumor is a non-neoplastic process of unknown etiology characterized by a proliferation of connective tissue with an inflammatory infiltrate. Intracranial inflammatory pseudotumors classically involve the cavernous sinus but can also occur in the supratentorial or infratentorial compartments and spinal canal. Symptoms are dependent on location, and, when present in the cavernous sinus, typically include cranial nerve palsies of those nerves in the cavernous sinus. These lesions are rapidly responsive to steroid therapy. Surgery is typically indicated for biopsy only, but complete resection may be justified for lesions outside the cavernous sinus.

Inflammatory pseudotumour of the maxillary sinus presenting as a sino-nasal malignancy

Inflammatory pseudotumours are a rare group of benign neoplasms of unknown aetiology. They are uncommon in head and neck sites, particularly the paranasal sinuses. Surgical excision, radiotherapy and steroids have all been used as treatment modalities. A report is made of a 27-year-old female who presented with a rapid-onset proptosis that clinically and radiologically mimicked an aggressive sino-nasal malignancy. Histology eventually confirmed an inflammatory pseudotumour of the maxillary sinus. The patient was treated successfully with a combination of surgery and steroid therapy.

Sclerosing inflammation in the orbit and in the pterygopalatine and infratemporal fossae

PURPOSE

To describe two cases with sclerosing inflammation in the orbit and in the pterygopalatine and infratemporal fossae and to review the literature of head and neck idiopathic inflammation.

METHODS

Interventional case series. Two clinical case reports of sclerosing inflammation in the orbits and in the pterygopalatine and infratemporal fossae are presented. A review of the literature and discussion was performed.

RESULTS

Both patients had histologic findings typical of chronic orbital sclerosing inflammation, including mature lymphocytes associated with dense collagen deposition and occasional lymphoid follicles. Bone erosion was present in one patient.

CONCLUSIONS

The clinical findings of this case series concur with the literature that idiopathic inflammation can be found simultaneously in the orbit and in the infratemporal and pterygopalatine fossae. These cases of idiopathic inflammation are often clinically indistinguishable from malignant neoplasms.

Radiological appearances of sinonasal abnormalities

The aim of this pictorial review is to present a variety of abnormalities of the sinonasal cavities to emphasize the diversity of lesions occurring in this region. These include congenital, neoplastic and granulomatous disorders and some allergic and inflammatory lesions with uncommon radiological appearances, as well as expanding lesions of the facial bones or of dental origin with secondary involvement of the related sinus(es).

[Inflammatory pseudotumor of paranasal sinuses]

Inflammatory pseudotumor is a rare benign lesion of unknown etiology which was first described in the lung. In head and neck the areas most commonly involved are the orbit and paranasal sinuses, but they have been also described in the larynx, pterygomaxilar space, tonsils, ears, gingiva and other periodontal tissues. We present a case of a 64 years old male who presented a three months history of right nasal obstruction. Physical examination showed a big nasal tumor arising from the nostril. CT scan shows nasal fossa mass with a normal paranasal sinuses. Histology made the diagnosis of an inflammatory pseudotumor. The lesion was surgically removed trough a midface degloving approach. The patient has no signs of recurrence two years after surgery. Data about diagnosis, treatment and outcome of inflammatory pseudotumors is revised also in this paper.