NASAL MASSES
CONG NASAL MASSES–RARE—-PROBABLY END UP GETTING BOTH A CT AND AN MRI
DERMOID CYST (63%)
REPRESENTS TRAPPED EPITHELIAL ELEMENTS
15% OF H & N DERMOIDS—-PRIMARY SPOT IS LAT ORBIT
MOST OFTEN GLABELLAR, THEN NASAL DORSUM (OFTEN PRESENT WITH A WIDENED NASAL DORSUM) THEN TIP
OFTEN AT MIDLINE —-FUSION LINES
45% ARE DEEP TO THE NASAL BONES—1/3 OF THESE GO TO THE CRIBRIFORM
PROTRUDING HAIR, “CHEESEY”
+GFAP, +S100
HEMANGIOMA(30%)
GLIOMA (5%)
(REALLY A MISNOMER = A CHORISTOMA—NOT NEOPLASTIC)
HETEROTOPIC BRAIN TISSUE
USUALLY MIDLINE—-15% RETAIN FIBROUS ATTACHMENT TO DURA
60% EXTRANASAL, 30 %INTRANASAL, 10% BOTH
SMOTH, SOFT FIRM
ENCEPHALOCELE (2%) = ENCEPHALOMENINGOCELE
ABNL CLOSURE OF THE FONTICULUS NASOFROTALIS, FORAMEN CECUM, PRENASAL SPACE, AND GLABELLAR SKIN
FONTICULUS FRONTALIS (ANT)—-EXTRANASAL
FORAMEN CECUM (POST)—-INTRANASAL
CRANIAL DEFECT WITH HERNIATION OF BRAIN AND MENINGES
SOFT COMPRESSIBLE–PULSATILE
+ FURSTENBURG’S SIGN—-EXPANDS WITH HIGH ICP (CRYING)
RISK OF CSF LEAK AND RECURRENT MENINGITIS
GET A COMBINATION OF IMAGING STUDIES
CT—BIFIDITY OF THE CRISTA GALLI, ENLARGES FORAMEN CECUM, EROSION OF THE CRISTA GALLI, INCREASED INTRAORBITAL DISTANCE, MIXED SOFT TISSUE/FLUID DENSITY MASS, SPLAYED NASAL BONES, TELECANTHUS, WIDENED SEPTUM
MRI—CAN BETTER DEFINE THE LESION—INTRACRANIAL EXTENSION
NEUROSURG CONSULT—-ALWAYS
OLFACTORY NEUROBLASTOMA–ESTHESIONEUROBLASTOMA, ESTHESIONEUROEPTHELIOMA OLFACTIF, NEUROESTHESIOMA
ONLY -300 CASES REPORTED
IN DIFFERENTIAL FOR CONG NASAL MASS
OF NEUROECTODERMAL ORIGIN (NEUROCREST CELLS)
+ S100, +NEURON SPECIFIC ENOLASE
HISTO–PSEUDOROSETTES, SHEETS, OR CLUSTERS
PRESENT WITH SINUSITIS LIKE SYMPTOMS
VERY VARIABLY AGRESSIVE
MALE = FEMALE
BIMODAL INCIDENCE (11-20, 51-60)
BARNES (HISTO CLASSIFICATION)
40% NEUROCYTOMA–SHEETS OF CLUSTERS
40% NEUROEPITHELIOMA—TRUE ROSETTES
20% NEUROBLASTOMA–PSEUDOROSETTES
KADISH (CLINICAL CLASSIFICATION)
A–NC ONLY 100% 5 YEAR SURVIVAL
B–NC AND PARANASAL SINUSES 75% 5 YEAR SURVIVAL
C–BEYOND 10-20% 5 YEAR SURVIVAL
Rx SURGERY (CRANIOFACIAL RESECTION) AND POST OP RT +/- CHEMO
NASOLACRIMAL CYSTS
RARE—-OFTEN BILAT INF MEATAL MASSES
NAO AND EPIPHORA
Rx:INTRANASAL Bx IS OF COARSE CONTRAINDICATED—-UNLESS YOU ARE SURE THAT IT IS COMPLETELY INTRANASAL—-REMOVE ENDOSCOPICALLY
REMOVAL VIA EXTERNAL APPROACH—OFTEN WITH NEUROSURG
CAN USUALLY RESECT VIA EXT RHINOPLASY APPROACH—–EFFECTIVE AND MORE ASTHETIC