Isolated Sphenoid Sinus Lesions: Experience with a Few Rare Pathologies

Abstract

Introduction:The sphenoid sinus is often neglected because of its difficult access. The deep position of the sphenoid sinus hinders early diagnosis of pathologies in that location. Delayed diagnosis can cause serious complications due to proximity to many important structures.Objectives:The aim of this study is to demonstrate different pathologies which can affect the sphenoid sinus and elucidate the findings.Methods:Cases of isolated sphenoid sinus lesions encountered in the neurosurgical setting which had rare pathologies are discussed. Pathologies such as Langerhans cell histiocytosis, solitary plasmacytoma, chordoma, pituitary adenoma, leiomyosarcoma, fungal infection, and mucocele which appeared primarily in sphenoid sinus are discussed along with their imaging features and pathological findings.Conclusion:Multitude of different pathologies can occur in sphenoid sinus. Detailed preoperative imaging is very helpful, but transnasal biopsy and histological study are required often for definitive diagnosis. The possible advantages of early diagnosis before spread of pathology for prognosis cannot be overemphasized.

Sphenoid sinus aspergilloma clinically mimicking as malignancy—a case report

“…However, characteristic CT and MRI findings helped to reach the diagnosis of fungal mucocele. Since the sinus was expansile and had T1 hyper intensity, other differentials were also ruled out based on imaging findings which have been tabulated in Table 1 [7][8][9].…”

Clival chordoma presenting as a parapharyngeal mass: a diagnostic challenge

“…1 For isolated sphenoidal masses rare pathologies like Langerhans cell histiocytosis, solitary plasmacytoma, chordoma, pituitary adenoma, leiomyosarcoma, fungal infection, and mucocele should be considered in the list of differential diagnosis. 9 Histopathology shows a tumour having cells in cords and nests which are dispersed in a characteristic myxoid stroma separated by fibrous bands. 5 The cells are polyhedral with eosinophilic cytoplasm and are interspersed with a variable number of classic physalipherous cells, containing abundant vacuolated bubbly cytoplasm and a bland nucleus.…”

“…Cellular atypia, mitotic figures and areas of necrosis may be present as was seen in the given case. 9 To differentiate chordoma from its mimics having chordoid morphology, positive immunohistochemistry with S100, EMA and panCK are useful. 1,10 Despite the limitations posed by the deep seated location, surgery remains the primary modality for debulking.…”

Langerhan’s cell Histiocytosis of Sphenoid Sinus causing Vision Loss: A Case Report

“…Optic neuropathy from sphenoid sinus may arise from the spread of sinus inflammation and infection, compression by an expansible lesion, neoplasm or ischemia. [1][2][3] The clinical presentation of sphenoid sinus lesions involves vague headaches and may be associated with purulent rhinorrhoea, retropharyngeal drip, nasal obstruction, abnormal vision and nerve deficit. Inflammatory conditions appear to be the major cause of sphenoid sinus lesions accounting for 65-72% of cases, followed by neoplasm (benign and malignant) accounting for 16 to 17.5%.…”