Imaging EvaluationPara nasal

SinusesBy: Ali Hekmatnia, MD

Hossain Ahrar, MD

Sinonasal Overview

Sinonasal Overview

OSTIOMEATAL UNIT (OMU)

Sinonasal Overview

Sinonasal Overview

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%

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

Inverted papilloma

Inverted papilloma

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)

Osteoma

Osteoma

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

Fibrous dysplasia

Fibrous dysplasia

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

Nerve sheet tumor

Nerve sheet tumor

Nerve sheet tumor

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

Juvenile Angiofibroma

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

SCC

Lymphoma

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Minor Salivary Glands Tumors

10% of PNS Tumors Adenoid Cystic Carcinoma Mucoepidermoid Carcinoma

Perineural spreado Adenoid Cystic Carcinoma

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

Adenocarcinoma

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

Melanoma

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

Esthesioneuroblastoma

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

Chondrosarcoma

Chondrosarcoma

Osteosarcoma

Rabdomyosarcoma

Fungal Sinositis

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

Lymphoma

Lymphoma

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Metastatic Tumors Breast and lung carcinoma most common

primaries Widespread skeletal metastases present

Metastasis

Thanks for your attention