Meningiomas of the Paranasal Sinuses

Abstract

Extracranial meningiomas are rare tumors, comprising approximately 2% of all meningiomas. Previously reported sites include the orbit, parapharyngeal space, and rarely, the paranasal sinuses. A retrospective chart review of patients with meningiomas was performed over the last 25 years, and three patients were identified with meningiomas involving the paranasal sinuses. The locations included the frontal sinus, the ethmoid sinus, and the sphenoid sinus. Presenting symptoms included facial pain and nasal obstruction; two patients noted facial swelling. Diagnosis was established via endoscopic transnasal biopsy in two patients. Computed tomographic (CT) guided biopsy was utilized to confirm the diagnosis in the third patient. Surgical extirpation was successfully performed with tumors arising from the ethmoid and frontal sinuses. The patient with neoplasm in the sphenoid sinus underwent radiation therapy. Extracranial meningiomas of the paranasal sinuses are rare tumors that may present a diagnostic and therapeutic challenge. We present three cases and discuss the clinical presentation, radiographic findings, diagnostic evaluation, and treatment options.

Trabecular and Psammomatoid Juvenile Ossifying Fibroma of the Skull Base Mimicking Psammomatoid Meningioma

“…Primary extracranial meningiomas are rare and constitute 2% of all meningiomas. PM has been reported in the nasal cavity, paranasal sinuses and nasopharynx [2][3][4], arising from heterotopic rests of arachnoid cells (meningiocytes, meningothelial cells) [11]. Histopathologically, JPOF and PM may be difficult to distinguish at the time of intraoperative consultation (frozen sections), or even after obtaining routine H&E sections.…”

“…JPOF usually occurs in the orbital bones, paranasal sinuses, mandible, and has been reported in the skull. Although rare, primary extracranial meningiomas have been reported occurring in the nasal cavity, paranasal sinuses and nasopharynx [2][3][4]. Furthermore, the distinction between JPOF and psammomatoid meningiomas (PM) arising in the craniofacial bones can be challenging.…”

Primary Extracranial Meningioma: The Royal Pearl Experience

“…Meningiomas involving the sinonasal tract may mimic sinusitis with patients presenting with nasal obstruction, anosmia, facial pain, nasal discharge and epistaxis. Nasal endoscopy usually shows a firm reddish pink to grey mass in the nasal cavity which could be globular or lobulated, but well-circumscribed with displacement and without infiltration into the surrounding tissues [6].…”

“…No intracranial component was demonstrable in either of the 2 cases. Surgery is reported to be the only curative modality for these tumours [5,6]. Complete extirpation of theses masses may be accomplished by endoscpic, open or a combination of both approaches [5,10].…”

Cranial juvenile psammomatoid ossifying fibroma: case report

“…Primary extracranial psammomatoid meningioma is an uncommon pathology, just 2% of all meningiomas. They may arise from heterotopic rests of arachnoid cells in locations such as the nasal cavity, paranasal sinuses, and nasopharynx 24 and show an irregular bone surface. Histopathologically in psammomatoid meningioma there is a random distribution of psammoma bodies, which are rimmed by a group of osteoclasts and osteoblasts.…”