Nasal cavity paraganglioma with malignant transformation: a case report

Paraganglioma Presenting as a Nasal Septal Mass: Case Report and Literature Review

Objectives

To describe a rare case of a paraganglioma arising from the nasal septum and review the diagnosis and management of paragangliomas in the nasal cavity and paranasal sinuses.

Methods

We present a case of a 70-year-old female presenting with persistent nasal congestion and obstruction. Nasal endoscopy revealed a posterior septal mass approaching the sphenoid sinuses and partially obstructing the nasopharynx. A biopsy of the mass was taken, and histologic analysis confirmed a diagnosis of paraganglioma.

Results

The patient underwent an endoscopic resection of the tumor. There has been no evidence of disease recurrence after 3 months of follow‐up.

Conclusions

Paragangliomas arising from the nasal septum are exceedingly rare, but should be considered in the differential diagnosis in patients presenting with nasal septal masses. These tumors are typically benign, although few cases of malignant sinonasal paragangliomas have been reported. Treatment requires surgical excision with close follow-up as several cases of tumor recurrence have been reported.

Nasal Cavity Paraganglioma: Literature Review and Discussion of a Rare Case

Paragangliomas can be found from the skull base to the sacrum. Sinonasal paragangliomas are infrequent. A 16-year-old female reported spontaneous discrete bilateral epistaxis once a month beginning when she was 3 years of age. Computed tomography showed an expansive hypervascular mass occupying the right nasal cavity and nasopharynx. Sinonasal paragangliomas usually occur in middle-aged women. Radiologic investigation is essential for the diagnosis of sinonasal paragangliomas and evaluating extension of the lesion. Endoscopic and conventional approaches are effective, and preoperative embolization is paramount for reducing bleeding risk. Histopathological features cannot differentiate benign from malignant paragangliomas, and since metastasis may eventually occur, follow-up must be carried out for a long period of time.

Malignant and benign sinonasal paragangliomas

OBJECTIVES/HYPOTHESIS

To report on the clinical course and management of sinonasal paragangliomas (PGLs).

STUDY DESIGN AND METHODS

Retrospective chart review of six patients with PGLs of the nasal cavity and paranasal sinuses.

RESULTS

Three patients had tumors with malignant clinical behavior with cerebral metastases or infiltration of brain and local recurrence, despite surgery and/or radiotherapy, while three patients demonstrated a benign course.

CONCLUSION

Sinonasal paragangliomas are frequently malignant. If malignant, they are very aggressive, with rapid local spread as well as high metastatic potential despite surgical resection; and they have a poor prognosis. Malignancy cannot be diagnosed on histology, but only on the basis of clinical behavior. Intracranial metastasis is commonly expected. Long-term follow-up, with particular emphasis put on the intracranial structures, is mandatory as recurrences or metastasis may occur even after a long time interval.

Primary osteosarcoma arising from the middle turbinate in a pediatric patient

Osteosarcomas usually occur as secondary tumors after radiation therapy or chemotherapy. Without a history of irradiation to the head and neck area, primary osteosarcoma of the turbinate is extremely rare. We report here a rare case of primary turbinate osteosarcoma presenting as a relatively small, well-circumscribed, turbinate mass. Its appearance mimicked a benign nasal mass like mucocele and polyp. We also reviewed the previously reported cases of tumor arising from turbinate.