Article
Differentiation diagnosis of a rapid growing paranasal tumor
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Authors
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Simona Cantemir
- HNO-Klinik Hagen, Hagen, Germany
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Armin Laubert
- HNO-Klinik Hagen, Hagen, Germany
| Published: | September 7, 2016 |
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Outline
Text
Paranasal tumors can grow slowly or fast, they may have a soft or a hard consistency and the entities vary between children and grown-ups.
Children with paranasal tumors often have a harmless dermoid cyst, an atheroma, or a nasal cyst. Generally it is advisable to initiate a MRI scan in order to detect the extremly rare case of a glioma or an encephalomeningocele.
Considering benign tumors in adults one has to differentiate between soft consistency (atheroma or mucocele), hard constistency (ostema, neurofibroma, fibrous histiocytoma), thrombosis of vena angularis or the manifestation of a systemic disease.
Malignant paranasal tumors in adults are often metastasis (mamma, bronchi, prostata or hypernephroma); carcinoma; malignant lymphoma or plasmocytoma.
We present a case of a 37-year-old female with a rapid growing, indolent paranasal tumor. There was no trauma and no signs of inflammation in blood tests.
The CT scan showed a smooth tumor of the paranasal soft parts without infiltration of the nasal bone or the orbital cavity. The MRI scan detected no signs of infiltration concerning the cartilage. Further investigations showed a bihilar lymphadenopathy without pulmonal infiltration. At this point the patient reported about nodules of the hands for the first time.
Representative biopsy of the nasal dorsum gained by a closed rhinoplasty was sent to histological examination specifying it as granulomatous tissue containing giant cells without atypicals.
Considering all facts of our investigation it led to the diagnosis of Sacoidosis. The patient was treated with 60 mg Prednisolone in descending dosis showing a rapid regression and is now free of symptoms for over three years. The incidence of the Sarcoidosis in Germany is 12/100,000 inhabitants in which the cutaneous form takes 20% as a late manifestation of the disease.
The Löfgren’s-Syndrome as an acute manifestation of Sarcoidosis with fever, arthritis, hepatosplenomegalie and rash (erythema nodosum) should be considered in the differential diagnosis, having an excellent prognosis which doesn’t need any treatment.
