Sinonasal and ventral skull base Inflammatory pseudotumor: A systematic review

Abstract

Objectives/Hypothesis Inflammatory pseudotumor is a benign idiopathic inflammatory process often misdiagnosed as an infection or neoplasm. This review analyzes all reported cases of sinonasal and ventral skull base inflammatory pseudotumor to date, and provides a framework for evaluation and management of this uncommon condition. Data Sources MEDLINE/PubMed database. Review Methods A search for articles related to sinonasal and ventral skull base inflammatory pseudotumor, along with bibliographies of those articles, was performed. Demographics, presentation, radiographic findings, treatment, follow‐up, and outcome were analyzed. Results Thirty‐three articles were reviewed, including a total of 87 patients. The most common presenting symptom was vision change (58.6%). Sinonasal and ventral skull base inflammatory pseudotumor was found in the cavernous sinus in 46.0% of cases. The lesion appeared isointense (66.7% of cases) and homogeneously enhancing on T1‐weighted magnetic resonance imaging (MRI), whereas it appeared hypointense on T2‐weighted MRI in 90.7% of cases. Inflammatory pseudotumor appeared hyperdense on computed tomography in 78.9% of cases. Histopathological analysis of biopsied specimens revealed presence of inflammatory cells (94.4%) and fibrosis (80.3%). Corticosteroids alone were the most common treatment modality (55.2%), resulting in disease‐free patients in 22.9% of cases over a median follow‐up period of 17.6 months. Surgical management alone was uncommon (8.0%), but showed high success rate (57.1%). Conclusion This review is the most comprehensive analysis of sinonasal and ventral skull base inflammatory pseudotumor to date. Radiologic findings and histopathological analysis are essential for diagnosis. Corticosteroids are the most common treatment modality. Surgery, although uncommon, appears to be an efficacious treatment modality. Level of Evidence N/A Laryngoscope, 125:813–821, 2015

Inflammatory myofibroblastic tumor of carotid artery resulting in recurrent syncope: A case report

“…It also occurs in different extrapulmonary locations, such as the abdomen, retroperitoneum, pelvis, heart, head and neck, upper respiratory tract, trunk, bladder, and extremities . The locations of IMT in the head and neck include skull base, nose, paranasal sinus, larynx, hypopharynx, orbit, brain, temporal bone, parapharyngeal space, middle or inner ear, thyroid gland, and carotid artery, among which paranasal sinus is the most common site, followed by the larynx . The meaning of medical imaging technology in the diagnosis of IMT is controversial in some literature, and the infiltrative margin of the lesion is often interpreted as malignancies .…”

“…If there is any recurrence, corticosteroids can be administered again. Radiotherapy is regarded as the most controversial modality that can be used when en bloc resection cannot be achieved and/or corticosteroids do not work . For those patients with immunoglobulin G4–related IMT, corticosteroids may be a good choice, but how long corticosteroids should be taken, life‐long or short‐term, remains a question .…”

Lateral skull base Inflammatory pseudotumor: A systematic review

“…A recent systematic review on sinonasal and ventral skull base IPT also found that similar to orbital IPT, corticosteroids treatment alone was the most common (55.2%) therapeutic modality used for these lesions, and resulted in disease‐free patients in 22.9% of the cases . That systematic review also showed that corticosteroids and radiotherapy was the second most common treatment modality for sinonasal and ventral skull base IPT . Surgery alone was the third most common treatment modality for this condition and resulted in high success rate …”

“…For a subset of patients with recalcitrant disease and relentless progression, orbital exenteration may be required . A recent systematic review on sinonasal and ventral skull base IPT also found that similar to orbital IPT, corticosteroids treatment alone was the most common (55.2%) therapeutic modality used for these lesions, and resulted in disease‐free patients in 22.9% of the cases . That systematic review also showed that corticosteroids and radiotherapy was the second most common treatment modality for sinonasal and ventral skull base IPT .…”

Treatment-refractory ALK-positive inflammatory myofibroblastic tumour of the oral cavity

“…Yet consensus on the optimal treatment for IMT is still lacking. In a review of 87 patients with sinonasal and base of skull IMT, Desai et al found surgical resection to be the most successful approach, with corticosteroids also showing significant benefit in disease management 14. Only when radiotherapy was combined with surgery did it seem to show a treatment benefit.…”