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Clinical Problem Solving: Pathology |

Pathology Quiz Case 2

R. Peter Manes, MD; Yuri Lemeshev, MD, PhD; Pete S. Batra, MD
Arch Otolaryngol Head Neck Surg. 2011;137(2):198-202. doi:10.1001/archoto.2010.248-a.
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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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