Glioma nasal: relato de três casos e revisão de literatura

Abstract

Gl ioma Nasal é uma malformação congênita rara, benigna e diagnosticada habitualmente logo após o nascimento, que requer tratamento precoce para evitar deformidades faciais. São relatados três casos de pacientes com diagnósti-co de Glioma Nasal em acompanhamento no Departamento de Otorrinolaringologia do Hospital das Clínicas da Faculdade de Medicina da USP, com descrição, para cada caso, dos exames subsidiários, do tratamento empregado e de sua evolução. O primeiro caso é do sexo feminino, que apresentava uma massa sólida que se exteriorizava pela fossa nasal esquerda. O segundo paciente era do sexo masculino e apresentava uma fenda palatina por onde se exteriorizava uma massa ocupando a cavidade oral. O terceiro paciente era do sexo masculino e apresentava uma tumoração em dorso nasal. Após a ressecção cirúrgica, todas as peças mostravam glioma nasal. Massas congênitas de Linha Média Nasal podem representar uma lesão de difícil diagnóstico antes do estudo histopatológico, porém não se deve poupar esforços para fazer o diagnóstico correto, proporcionando assim um prognóstico acurado e uma programação cirúrgi-ca apropriada.

Intranasal Glioma with Post-Endoscopic Resection in 1 Year Old Infant: Case Report and Literature Review*

“…The latter are the ones with the most intracranial connection, which occurs in 35% of cases. 2,5,7,10,[15][16][17] Also called glial nasal heterotopy, due to the non-neoplastic nature of the lesion, gliomas are not considered hereditary. Some authors believe there is a predilection for the tumor in males, in a ratio of 3:2.…”

“…Depending on the patency of this diverticulum and its content, the resulting lesion may be a dermoid cyst, a glioma or an encephalocele, which are the nasal masses with the potential to link with the central nervous system. 1,5,[7][8][9]14,15,17 Encephalocele has the same embryological origin as nasal glioma and is an important differential diagnosis between nasal masses. 2 Encephaloceles have an incidence of one in 3.000 live births and are caused by herniation of neural tissue through defects in the skull, which may contain brain tissue and meninges or just meninges.…”

“…Gliomas are considered encephaloceles that have lost their connection with the meninges of the intracranial space sarcomas. 9,12,13,[15][16][17][18] Dermoid cysts are also a relevant differential diagnosis. They are connected to intracranial content in 26 to 30% of cases, with an incidence of one in 6.000 live births.…”

“…Other differential diagnoses include sebaceous cysts, epidermoid cysts, papillomas, inflammatory nasal polyps -extremely rare in children -, carcinomas, lipomas, fibromas, meningiomas, lymphomas and sarcomas. 6,8,9,[13][14][15][16][17][18] Gliomas are more commonly identified at birth, but their diagnosis can also be made during a later stage of childhood or even in adulthood. 2,16 This type of congenital nasal mass is not associated with other anomalies, in most cases, but it can develop with cleft lip and palate, choanal atresia, hydrocephalus, urethral duplication and supernumerary finger.…”

“…13 Heterotopy has an approximate incidence of one case for every 20.000 to 40.000 live births and is considered benign but can cause deformities due to its slow growth. 3,7,9,11,14,15 Some authors report that there is no gender predominance, while others believe that the anomaly is more common in boys (3:2). There is no family predisposition.…”