Clinical-radiological aspects of primary extracranial meningioma of the ethmoid sinus in a child

Abstract

Meningiomas are tumors of benign histological nature which represent 13 to 26% of all primary intracranial neoplasia 1 . Approximately 20% of intracranial meningiomas present extracranial dissemination at sites such as the orbit, middle ear, nasal cavity, nasopharynx and paranasal sinuses 2 . Primary extracranial meningiomas are histologically identical to intracranial meningiomas. They usually occur in 40 to 60-year-old patients and are rare in the pediatric age group. Primary extracranial meningiomas represent 1 to 2% of all meningiomas [1][2][3][4][5] . We to report the case of a 13-year-old girl with a primary extracranial meningioma of the ethmoid sinus, including the main findings of the imaging examination and a brief review of the literature. CaseA 13-year-old girl was referred to our service with a 30-day history of constant and strong frontal headache, nasal obstruction, and progressive proptosis of the left eye without signs of phlogiston or alterations in visual acuity.At rhinoscopy, a lesion of the soft tissues was observed occupying the left superior meatus of the nasal cavity with a smooth pink surface.In light of these findings, a CT of the skull and face sinuses was performed showing an extensive hypodense non-calcified lesion measuring 2.0x2.0 cm located in the left ethmoid sinus. The lesion presented heterogeneous iodinated contrast enhancement and demonstrated remodeling of the adjacent bone structures (Fig 1).MRI of the facial sinuses was requested to evaluate the involvement of the soft structures as well as the invasion of the adjacent structures and resection planes. The lesion in the left ethmoid sinus was hypointense in T1 and T2-weighted sequences, with heterogeneous paramagnetic contrast enhancement, determining a mass effect on the adjacent structures, lateral divergence of the medial rectus muscle of the left orbit, but with- out invasion (Fig 2). Additionally, maxillary and sphenoidal sinus disease was observed.The patient was submitted to excision of the lesion by external and endoscopic ethmoidectomy with a complete cure of the exophthalmus in the postoperative period. Diagnosis of atypical meningioma was attained by histopathological examination. disCussionThe present study shows the clinical and imaging aspects of primary extracranial meningioma of the ethmoid sinuses in a child. Primary extracranial meningioma of the nasal cavity or paranasal sinuses is rare, especially in children. The paranasal sinuses most commonly affected are the frontal, maxillary, ethmoid and sphenoid sinuses 2,3,5 .