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Midline Destructive Lesions of the Sinonasal Tract: Simplified Terminology Based onHistopathologic Criteria

Alexandra BorgesGo,a, James Finka, Pablo Villablancaa, Roy Eversolea and Robert Lufkina

a From the Departments of Radiological Sciences (A.B., J.F., P.V., R.L.) and Oral Pathology (R.E.), University of California, Los Angeles.



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  		FIG 1. Patient 5. Initial diagnosis: nonhealing midline granuloma (Stewart's syndrome); final diagnosis: non-Hodgkin's T-cell lymphoma.

A, CT scan of the paranasal sinuses shows soft-tissue opacification of the anterior ethmoidal air cells bilaterally, soft-tissue density in the region of the right ostiomeatal unit, and mild mucosal thickening in the inferior aspect of the right maxillary sinus. The left maxillary sinus is hypoplastic and the remainder of the sinus cavity is filled with soft tissue. Bony destructive changes are noted with a nasoseptal perforation and destruction of the inferomedial wall of the right orbit. However, the abnormal soft tissue does not appear to infiltrate the extraconal space. The bony defect in the inferior aspect of the left maxillary sinus is postsurgical in nature, due to a prior Caldwell-Luc antrostomy for chronic sinus disease. Some soft-tissue thickening is noted in the left premaxillary region.

B, Histologic slide of a sinonasal biopsy specimen shows lymphocytic invasion of a blood vessel reflecting the angioinvasive nature of the disease. Also noted is a heterogeneous and polymorphic inflammatory infiltrate (hematoxylin-eosin, original magnification x400).

C, Histologic slide of a sinonasal biopsy specimen shows invasion of trabecular bone in the right upper corner of the image (hematoxylin-eosin, original magnification x100).

D, Histologic slide of a sinonasal biopsy specimen shows positive staining with CD45RO T-cell marker (original magnification x200).

E, Histologic slide of a sinonasal biopsy specimen shows negative staining with CD20, a B-cell marker (original magnification x200).



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  		FIG 2. Patient 4. Initial diagnosis: malignant midline granuloma; final diagnosis: Wegener's granulomatosis.

A and B, Axial (A) and coronal (B) CT scans of the paranasal sinuses (bone window) show complete soft-tissue filling of the nasal cavity and nasal vault extending posteriorly to the choana and high nasopharynx. The anterior aspect of the bony nasal septum has been destroyed. The left maxillary sinus is totally opacified and slightly expanded with mild bowing of the medial wall of the sinus. The bony walls of the left maxillary sinus are intact. No abnormal soft tissue is seen in the retroantral fat or pterygopalatine fossa.

C, Histologic slide of a sinonasal biopsy specimen shows an inflammatory infiltrate composed mainly of histiocytes and eosinophils. Note also an area of fibrinoid necrosis in the center of the slide (hematoxylin-eosin, original magnification x200).

D, Histologic slide of a sinonasal biopsy specimen shows typical multinucleated giant cells. A final diagnosis of Wegener's granulomatosis was based on the histologic findings and on necrotizing vasculitis (hematoxylin-eosin, original magnification x400).





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X