Download ectopic secondary paranasal sinus meningioma with orbital

ECTOPIC SECONDARY PARANASAL SINUS MENINGIOMA WITH ORBITAL
EXTENSION
TATIANA ROSCA MD, PHD1, NIKOLAOS MARAGKOS MD2, TEODORA VLADESCU MD,
PHD1, GHERGHESCU GH. MD, PHD1
1Neuro-Surgery
Department, Clinical Emergency Sf. Pantelimon Hospital, Bucharest, Romania
Department, “Agios Panteleimonas” General Hospital, Pireas Greece
The author responsible for manuscript preparation: Tatiana Rosca, 59 Gala Galaction Street, 011305
Bucharest, Romania, tel/fax: +40-21-6663751, E-mail: [email protected]
2Anaesthesiology
Background. Description of a meningioma arising from the paranasal sinuses (bilateral frontal and ethmoidal sinus origin).
Material and method. A 54-year-old patient with meningioma originating in bilateral frontal and ethmoidal sinus and invading the
right orbit. Results. The management of the case is presented. Conclusion. Meningiomas originating in the paranasal sinuses
are very rare. They are ectopic and there are only a few cases reported in literature.
Keywords: ectopic meningioma, proptosis, paranasal sinusis
INTRODUCTION
Meningiomas account for 3 to 9% of all orbital
tumors and are certainly not considered rare. [1]
Primary orbital meningiomas represent between 0.4 to
2% of all intracranial meningiomas [1]. Secondary
orbital meningiomas are considerably more common
than their primary counterparts. The ectopic orbital
meningiomas were first mentioned in the 80’s. [8,10].
BACKGROUND
A 54-year-old man presented with an 11-month
history of progressive protrusion and infradisplacement
of the right eye and a 3-month history of horizontal
diplopia (Fig. 1).
MATERIAL AND METHOD
On examination, the patient’s visual acuity was
20/20 OU, with normal visual fields and normal ocular
fundi. Extraocular movements were full, but the patient
had 5 mm of right proptosis and infradisplacement of
the right globe.
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CT scan revealed opacification of the right anterior
ethmoid sinuses and both frontal sinuses (Figs. 2a-c).
There was no evidence of any intracranial mass (2a-d).
MRI revealed that the frontal sinus mass had
destroyed the roof of the right orbit and was extending
into the orbit, pushing the right eye downward (Fig. 3)
The patient underwent a right superior anterior
orbitotomy with resection of the mass from both the
orbit and the sinuses. (Fig. 4).
On histopathologic examination, the mass was
found to be a meningioma that appeared to be arising
from the paranasal sinus mucosa (Figs. 5a-c).
RESULTS
Postoperatively, the patient’s proptosis and diplopia
resolved (Fig. 6), and CT scanning showed no
significant residual tumor in either the orbit or paranasal
sinuses. (Fig. 7)
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ECTOPIC SECONDARY PARANASAL SINUS MENINGIOMA WITH ORBITAL EXTENSION
FIG. 4 Surgery piece
FIG. 1 Patient before surgery
FIG. 2A
FIG. 2B
FIG. 2C
FIG. 2D
FIG. 5A
FIG. 5B
FIG. 5C
FIG. 2A CT scan revealed opacification of the right
anterior ethmoid sinus
FIG. 2B CT-scan revealed opacification of both frontal sinuses
FIG. 2C CT-scan revealed opacification of orbital region
FIG. 2D CT-scan revealed no evidence of any intracranial mass
FIG. 5a Paranasal sinus tumor infiltration (Obx10 H&E)
FIG. 5b Spindle-shaped cells disposed in a whirlpool pattern
(Obx10 H&E)
FIG. 5c HE ob x 20 Celule meningoteliale in tesutul conjunctv
al mucoasei sinusale
FIG. 3 MRI revealed that the frontal sinus mass had destroyed
the roof of the right orbit and was extending into the orbit
FIG 6. Patient after surgery
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TATIANA ROŞCA
of Pathology. The location of these lesions included the
nasal cavity (n = 14), the nasopharynx (n = 3), the
frontal sinus (n = 2), the sphenoid sinus (n = 2), or a
combination of the nasal cavity and ethmoid, frontal,
sphenoid, and/or maxillary sinuses (n = 9). All these
cases had been reported and treated by
otolaryngologists [4-10].
REFERENCES
FIG. 7 CT-scan showed no significant residual tumor in either
the orbit or paranasal sinuses
CONCLUSION
Our case affected both the ethmoid and frontal
sinus with orbital involvement, requiring a combined
approach by an opththalmologist and neurosurgeon.
DISCUSSION
A meningioma outside the central nervous system
(CNS) is considered to be ectopic [1]. Ectopic
meningiomas are differentiated by their connection to
the CNS (primary) or without a CNS connection
(secondary) [2]. Meningiomas are benign tumors
arising from the arachnoid cells that form the arachnoid
villi and are generally seen in association with the dural
sinuses. [3]
Meningiomas originating in the paranasal sinuses
are very rare. These tumors are thought to arise from
embryonal arachnoid nests that were pinched off and
left behind during embryonic development. Only a few
such cases have ever been described. In 2000,
Thompson and Gyure published 30 cases of sinonasal
tract meningiomas diagnosed between 1970 and 1992
that had been retrieved from the files of the
Otorhinolaryngic Registry of the Armed Forces Institute
34
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Mandell, M.D., Ph.D., and John A. Jane, Sr., M.D., Ph.D.,
Meningiomas of the Orbit: Contemporary Considerations
Neurosurg Focus 10(5), 2001
2. Kleihues P, Cavenee WK. WHO classification tumours of the
central nervous system. Lyons, France: IACR, 2000: 176-184
3. Lang FF, Macdonald OK, Fuller GN, DeMonte F. Primary
extradural meningiomas: a report on nine cases and review of
literature from the era of computerized tomography scanning. J
Neurosurg 2000;93:940-950.
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nose and paranasal sinuses (report of a case). J Laryngol Otol
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5. De SK, Chatterjee AK, Misra AK: An unusual presentation of
meningioma of the frontal sinus. J Laryngol Otol 100:711-714,
1986
6. Fagerlund M, Stenling R, Söderberg O: A subfrontal
meningioma with primary origin from the nasal cavity. Acta
Otolaryngol 95:365-370, 1983
7. Godel V, Samuel Y, Shanon E: Maxillary meningioma
appearing as exophthalmos. Arch Otolaryngol 107:626-628, 1981
8. Ho KL: Primary meningioma of the nasal cavity and paranasal
sinuses. Cancer 46:1442-1447, 1980
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paranasal sinuses. Childs Nerv Syst 9:483-484, 1993
10.Thompson LD, Gyure KA, Extracranial sinonasal tract
meningiomas: a clinico- pathologic study of 30 cases with a
review of the literature. Am J Surg Pathol. 2000 May; 24(5):64050.
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