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Αλέξανδρος Γ. Σφακιανάκης

Tuesday, June 29, 2021

An unusual nasal polyp

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https://www.sciencedirect.com/sdfe/pdf/download/eid/1-s2.0-S1879729621001393/first-page-pdf
,A 76-year-old patient was referred for isolated, permanent,
complete left nasal obstruction, refractory to local treatments and
gradually deteriorating over a period of ten years. Ophthalmological and neurological examination was normal. Nasal endoscopy
(Fig. 1) demonstrated a pink, homogeneous, non-pulsatile,
∗ Corresponding author at: Hôpital d'Instruction des Armées Sainte-Anne, BCRM
Toulon, 2, boulevard Sainte-Anne BP 600, Toulon cedex 9 83800, France.
E-mail address: jbmorvan@hotmail.com (J.-B. Morvan).
obstructive polypoid lesion medial to the left middle turbinate and
extending inferiorly as far as the posterior aspect of the inferior
turbinate. The lesion was soft and resilient on palpation. The middle
meatus was not involved.
Head CT scan showed a solid, polypoid lesion centred on the
sella turcica (Fig. 2), measuring 60 mm by 43 mm by 37 mm with
suprasellar extension between the frontal hemispheres and invading the cavernous sinuses laterally, the sphenoid sinuses and the
posterior part of the left nasal cavity with osteolysis of the walls of
the sella turcica. Intense and homogeneous contrast enhancement
was observed. Magnetic resonance imaging (Fig. 3) visualised this
homogeneous, champagne cork-shaped lesion penetrating through
the diaphragma sellae with a discrete T2 hypersignal with no
calcification, displacing withoutinvading the optic chiasm,the cavernous segment ofthe internal carotidarteries andthe frontallobes. 18F-FDG PET-CT (Fig. 4) showed isolated intense increased uptake
with a SUVmax of 32.6. A hormonal work-up did not reveal hyperprolactinaemia or hypopituitarism. Transnasal endoscopic biopsy
for histological examination was performed under general anaesthesia.
Histological examination (Fig. 5) revealed a lesion with a sheetlike architecture, richly vascularized by fine capillaries, composed
of monomorphic round cells, with scant, non-vacuolized cytoplasm, rare mitotic figures and no necrosis. Tumour cells expressed
chromogranin and synaptophysin neuroendocrine markers, with
low expression of LH. The Ki-67 proliferative index was estimated
at 2%.

Eur Ann Otorhinolaryngol Head Neck Dis. 2021 Jun 24:S1879-7296(21)00139-3. doi: 10.1016/j.anorl.2021.06.005. Online ahead of print.

NO ABSTRACT

PMID:34176776 | DOI:10.1016/j.anorl.2021.06.005

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