by: ali hekmatnia, md hossain ahrar, md
TRANSCRIPT
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Imaging EvaluationPara nasal
SinusesBy: Ali Hekmatnia, MD
Hossain Ahrar, MD
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Sinonasal Overview
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Sinonasal Overview
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OSTIOMEATAL UNIT (OMU)
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Sinonasal Overview
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Sinonasal Overview
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Sinonasal Overview
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Neoplasms of PNS
Very rare 3% Predominately of older males Delay in diagnosis due to similarity to benign
conditions Maxillary sinus: 70% Ethmoid sinus: 20% Sphenoid: 3% Frontal: 1%
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Benign Lesions Papillomas Osteomas Fibrous Dysplasia Neurogenic tumors Juvenile Angiofibroma
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Papilloma Fungiform: 50%, nasal septum Cylindrical: 3%, lateral wall/sinuses Inverted: 47%, lateral wall
Unilateral
Malignant degeneration in 2-13%
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Inverted Papilloma CT: Lobular mass on lateral nasal wall ±
maxillary/ethmoid extension or intralesional Ca++
• MR: "Convoluted," "cerebriform“ architecture on T2 & post-gadolinium images; necrosis = coexistent carcinoma
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Inverted papilloma
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Inverted papilloma
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Inverted papilloma
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Osteomas Benign slow growing tumors of mature bone Location:
o Frontal, ethmoids, maxillary sinuses When obstructing mucosal flow can lead to
mucocele formation CT: Density varies from dense (compact type) to less ossified (fibrous type)
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Osteoma
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Osteoma
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Mycetoma
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Fibrous dysplasia Medullary bone replaced by woven bone Monostotic vs Polyostotic Facial bone involvement greater in polyostotic
form CT/MR: Appearance varies with amount of fibrous
tissue (classic "ground-glass“ appearance) Malignant transformation to rhabdomyosarcoma
has been seen with radiation
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Fibrous dysplasia
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Fibrous dysplasia
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Ossifying fibroma
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Neurogenic tumors 4% are found within the paranasal sinuses Schwannomas Neurofibromas When associated with Von Recklinghausen’s
syndrome: more aggressive (30% 5yr survival). Imaging: Well-circumscribed mass with bone
remodeling (CT) MR: Intermediate T1 signal T2 varies with cellularity; large lesions ± cystic degeneration
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Nerve sheet tumor
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Nerve sheet tumor
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Nerve sheet tumor
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Juvenile Angiofibroma Adolescent male patient with nasal obstruction
and epistaxis Centered at sphenopalatine foramen with spread
into pterygopalatine fossa, nasal cavity, and nasopharynx
Vascular mass with flow voids and avid enhancement
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Juvenile Angiofibroma
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Juvenile Angiofibroma
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Malignant lesions Squamous cell carcinoma Adenoid cystic carcinoma Mucoepidermoid carcinoma Adenocarcinoma Hemangiopericytoma Melanoma Olfactory neuroblastoma Osteogenic sarcoma, fibrosarcoma,
chondrosarcoma, rhabdomyosarcoma Lymphoma Metastatic tumors Sinonasal undifferentiated carcinoma
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Squamous cell carcinoma
Patient demographics: Adult patient (95%> 40 years); M > F
Location:o Maxillary sinus (70%)o Nasal cavity (20%)
Poorly defined with aggressive bone destruction; heterogeneous enhancement
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SCC
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Lymphoma
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Minor Salivary Glands Tumors
10% of PNS Tumors Adenoid Cystic Carcinoma Mucoepidermoid Carcinoma
Perineural spreado Adenoid Cystic Carcinoma
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Adenoid Cystic Carcinoma
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Adenocarcinoma 2nd most common malignant tumor in ethmoidal
air cells Strong association with occupational exposures
like hardwood workers Adult (40-60 year old) male patient Nonspecific imaging features, but may be more
well defined than squamous cell carcinoma and esthesioneuroblastoma
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Adenocarcinoma
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Adenocarcinoma
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Melanoma 0.5- 1.5% of melanoma Malignancy from mucosal melanocytes; nasal
cavity> sinuses Imaging: Soft tissue mass with bone remodeling
± destruction MR: high T1 & low T2 signal in melanotic form;
enhance ± foci of hemorrhage
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Melanoma
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Melanoma
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Olfactory NeuroblastomaEsthesioneuroblastoma
Originate from stem cells of neural crest origin that differentiate into olfactory sensory cells.
Adolescent or middle-aged patient with unilateral nasal obstruction and mild epistaxis
Morphology: "Dumbbell-shaped" mass centered at cribriform plate
CT: Intralesional Ca++ MR: Avid enhancement; foci of hemorrhage;
intracranial cyst formation
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Esthesioneuroblastoma
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Esthesioneuroblastoma
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Sarcomas Osteogenic Sarcoma
o Most common primary malignancy of bone.o Mandible > Maxillao Sunray radiographic appearance
Fibrosarcoma Chondrosarcoma Rabdomyosarcoma: in children
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Chondrosarcoma
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Chondrosarcoma
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Osteosarcoma
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Rabdomyosarcoma
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Fungal Sinositis
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Fungal Infection, Invasive
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Lymphoma Most common tumor of PNS Non-Hodgkin type nasal cavity> sinuses CT: Homogeneous and may be hyperdense
relative to other soft tissue MR: Homogeneous signal and enhancement;
decreased T2 signal due to high nuclear :cytoplasmic ratio of cells
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Lymphoma
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Lymphoma
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Metastatic Tumors Breast and lung carcinoma most common
primaries Widespread skeletal metastases present
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Metastasis
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Thanks for your attention