A Clinical and Radiological Approach to the Management of Benign Mesenchymal Sinonasal Tumors

Abstract

Keywords Sinonasal mass · Benign mesenchymal sinonasal neoplasms · Osteoma · Fibrous dysplasia · Computed tomography · Magnetic resonance imaging AbstractPurpose: Benign mesenchymal sinonasal neoplasms (BMSN) are rare and histologically heterogeneous. Differential diagnosis, appropriate management, and outcome are still a matter of debate. The aim of this study is to provide evidence for further refinement of assessment and treatment in the future. Procedures: We retrospectively reviewed data on 93 patients with neuroradiologically verified BMSN treated at our university reference center during the past 22 years. Results: The most frequent BMSN recorded in our cohort was osteoma of the frontal sinus. Only one-third of the patients affected were symptomatic at initial presentation. The 2 other common fibro-osseous tumor entities, fibrous dysplasia and ossifying fibroma, were confirmed in 12 and 6 patients, respectively. Patients with soft tissue tumor entities such as hemangioma, glomangiopericytoma, angiofibroma, and hamartoma were all symptomatic and underwent surgical resection. Conclusion: Understanding and recognizing the spectrum of appearances of benign mesenchymal sinonasal tumors will improve patient assessment and clinical management. The pathognomonic neuroradiological signs of a particular tumor entity should be actively sought as the neuroradiological features may be the diagnostic clues. Computed tomography and magnetic resonance imaging play complementary roles in identifying the morphological details and locoregional staging of benign mesenchymal sinonasal tumors.

ACR Appropriateness Criteria® Sinonasal Disease: 2021 Update

“…CT best depicts osseous changes, although it is limited in determining soft-tissue and intracranial extent. Although MRI is useful for evaluating intracranial extension of a sinonasal mass, contrast-enhanced CT can also be useful for evaluating the soft-tissue and intracranial extent of the mass [51]. CT maxillofacial is useful as the first-line CT examination for suspected sinonasal mass, but contrastenhanced CT head may be added if increased coverage of the intracranial component of a mass and its associated mass effect of the intracranial structures is required.…”

“…CT Maxillofacial. CT best depicts osseous changes and can help distinguish bony remodeling that is more typical of slow growing or benign masses from lytic destruction seen with more aggressive malignancies [7,51]. CT can demonstrate lesion mineralization, including the osseous matrix of osteomas, the chondroid matrix of cartilaginous tumors, and the ground glass density of fibro-osseous lesions.…”

“…If an MRI is also planned or performed, the CT can be performed without IV contrast because the main purpose of the CT is to evaluate osseous involvement. Although MRI is superior for evaluating the soft tissues, contrast-enhanced CT can also be useful for evaluating the soft-tissue and intracranial extent of the mass [51].…”

“…Radiography Paranasal Sinuses. Radiography is not considered to be part of the imaging workup of sinonasal neoplasms [51].…”