Presentation
2-day history of progressively worsening left periorbital swelling and pain associated with extra ocular movement.
Patient Data
Contrast enhanced maxillofacial CT demonstrates a mildly peripherally enhancing hypodense expansile lesion in the left nasal cavity with mass effect into the left orbit with thinning of the left lamina paprycea. Mild to moderate mucosal thickening of the maxillary sinuses was also noted.
MRI of the face demonstrated a well-circumscribed expansile mass centered around the left nasal passage with heterogenous serpiginous internal enhancement. The mass was hypointense on T1-weighted images (T1WI) and hyperintense on T2-weighted images (T2WI) with linear internal hypodensities that demonstrated loss of signal on fat-saturated images. It did not restrict diffusion. Contrast enhanced images demonstrated a heterogeneously enhancing mass with internal separations and areas of low signal intensity. It exerted mass effect on the surrounding structures with mild deviation on the left medial rectus muscle and rightward deviation of the nasal septum
Otolaryngology performed a nasopharyngoscopy/laryngoscopy (NPL) which showed a large polypoid mass originating from the middle meatus with mass effect on the nasal septum with resultant rightward bowing. There were no obvious signs of mucosal changes, bleeding, or purulent discharge. The NPL scope could be minimally passed between the nasal septum and the mass.
The patient was scheduled for functional endoscopic sinus surgery (FESS) with orbital decompression. Frozen biopsy and subsequent histopathology showed hypocellular chondroid neoplasm with myxoid features composed of fibroadipose tissue and underlying benign sinonasal mucosa. The tumor demonstrated a lobular growth pattern with conspicuous atypia of the chondrocytes, including multinucleation, nuclear enlargement and membrane irregularities with increased mitotic activity, consistent with a Grade 1 (low grade) chondrosarcoma.
Case Discussion
This case demonstrates a young patient who presented with nasal stuffiness and progressive periorbital swelling associated with eye movement, later determined to be secondary to a chondrosarcoma of the nasal septum. The patient had FESS with orbital decompression, with histopathologic analysis revealing low grade chondrosarcoma (Grade 1). There was complete resection of the mass and the patient has been disease free with no recurrence of symptoms.
CO-AUTHOR: Leen Alkukhun MD
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