case_images: PMC10586917_01
case_images: Axial view CT facial bone. (a) Noncontrast image demonstrating soft tissue density opacification of the left nasal cavity and left maxillary sinus with normal aeration of the right nasal cavity and maxillary sinus. (b) Postcontrast image revealing a heterogeneously enhancing mass within the middle left nasal cavity (solid arrow) with homogeneous enhancement of the inferior nasal turbinate (dashed arrow) which is displaced inferiorly and laterally. Mucosal enhancement of the left maxillary sinus with no enhancement of the contents of the left maxillary sinus (curved arrow) indicating retained secretions. (c) Bone reconstruction images showing bowing of the bony nasal septum and medial wall of the left maxillary sinus (solid arrows) which are reduced in density indicating chronicity with no features of bony destruction.
case_images: CRIOT2023-5561092.001.jpg
case_images: PMC10586917_01_CRIOT2023-5561092.001.jpg
case_images: fig1
case_images: A contrast-enhanced computed tomography scan and magnetic resonance imaging of the patient's paranasal sinuses revealed a heterogeneously enhancing soft tissue mass extending from the superior nasopharynx to the middle third of the inferior turbinate with no bony erosion (Figures 1-3).
case_images: Sagittal views: postcontrast images of (a) CT facial bones and (b) MRI facial bone T1-weighted sequence which reveal the craniocaudal extent of a left nasal cavity heterogeneously enhancing mass with mild protrusion of the posterior border into the sphenoid sinus and superior nasopharynx (solid arrows). The pituitary gland (curved arrows) can also be seen with a similar enhancement pattern to that of the left nasal cavity mass.
case_images: CRIOT2023-5561092.002.jpg
case_images: PMC10586917_01_CRIOT2023-5561092.002.jpg
case_images: fig2
case_images: A contrast-enhanced computed tomography scan and magnetic resonance imaging of the patient's paranasal sinuses revealed a heterogeneously enhancing soft tissue mass extending from the superior nasopharynx to the middle third of the inferior turbinate with no bony erosion (Figures 1-3).
case_images: MRI facial bones coronal views: (a, b) postcontrast TI-weighted images and (c) T2-weighted images. The localization of the heterogeneously enhancing mass to the left nasal cavity can be seen (cross arrow). The sphenoid sinus contents (solid arrows) demonstrate a decreased signal intensity relative to the lateral ventricles on T2-weighted images while exhibiting an increased signal intensity on T1-weighted images. These findings align with the presence of retained secretions resulting from the obstruction of the drainage pathway caused by the mass within the left nasal cavity.
case_images: CRIOT2023-5561092.003.jpg
case_images: PMC10586917_01_CRIOT2023-5561092.003.jpg
case_images: fig3
case_images: A contrast-enhanced computed tomography scan and magnetic resonance imaging of the patient's paranasal sinuses revealed a heterogeneously enhancing soft tissue mass extending from the superior nasopharynx to the middle third of the inferior turbinate with no bony erosion (Figures 1-3).
case_images: Histology showed sheets of small to medium sized round cells (a) that were positive for keratin (AE1/3) (b) and synaptophysin (c) and negative for calretinin (d).
case_images: CRIOT2023-5561092.004.jpg
case_images: PMC10586917_01_CRIOT2023-5561092.004.jpg
case_images: fig4
case_images: Histological analysis of the biopsy specimen showed sheets of small to medium sized round cells with a mitotic index of 3/10 per high power field, positive for keratin (A1/3) and synaptophysin and negative for calretinin supportive of a pituitary adenoma (Figure 4).
case_images: Immunohistochemical stains for subtyping were negative for TSH (a), prolactin (b), LH (c), GH (d), FSH (e), and ACTH (f), respectively.
case_images: CRIOT2023-5561092.005.jpg
case_images: PMC10586917_01_CRIOT2023-5561092.005.jpg
case_images: fig5
case_images: Further immunohistochemical stains for growth hormone (GH), prolactin, adrenocorticotrophic hormone (ACTH), thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), and luteinizing hormone (LH) were all negative (Figure 5).