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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).
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