A rare cause of nasal obstruction: a solitary neurofibroma

A Rare Case of a Large Sinonasal Neurofibroma

A neurofibroma is a benign peripheral nerve sheath tumor. Its appearance in the nose and paranasal sinuses is extremely rare. We present the case of a 61-year-old female with a large sinonasal neurofibroma. The patient was referred to our department due to the findings of a large invasive lesion originating from the left sinus with extension to the adjacent structures on computed tomography. A thorough examination revealed a mass within the left nasal cavity and exophthalmos. The initial symptoms of the disease probably appeared three years ago when she reported that she developed facial swelling following dental work. In the following period and due to reported blurred vision, she consulted with several medical specialists without receiving a diagnosis, while later she visited an otorhinolaryngologist, complaining of ear fullness, and local treatment was prescribed. Due to persistent symptoms, the patient was finally referred for computed tomography. Upon arrival at our department, she underwent a biopsy, which revealed the existence of a neurofibroma. The patient underwent endoscopic resection of the tumor and remains under close follow-up with no signs of recurrence. Sinonasal neurofibroma is a rare condition that presents with non-specific symptoms and may take years to reach a diagnosis. Open or endoscopic surgical resection seems to offer satisfactory results; however, similar cases reported in the literature are scarce.

Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base

Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.

The effect of vibrissae on subjective and objective measures of nasal obstruction

BACKGROUND

Nasal congestion and/or obstruction represents a prevalent and extensively studied problem. No published research exists that describes the impact of nasal hair (vibrissae) on nasal obstruction.

OBJECTIVE

To assess the impact of nasal vibrissae on subjective and objective measurements of nasal obstruction.

METHODS

In this prospective study, 30 healthy participants without nasal symptoms were assessed for baseline vibrissae density and were treated with a topical decongestant. The subjects were then asked to subjectively assess nasal breathing by using four questions from the Nasal Obstruction Symptom Evaluation instrument before undergoing rhinomanometry. Nasal vibrissae were then trimmed, and the participants repeated the subjective and objective assessments. Pre- and postintervention outcomes, including symptom scores, nasal airflow, and resistance, were compared by using statistical analysis.

RESULTS

Statistically significant improvement was noted in subjects' nasal airway specific symptom scores and in objective measurements of their nasal airway. Patients with moderate or many vibrissae at baseline were noted to have greater likelihood of improvement in subjective and objective obstruction assessments than patients rated with few.

CONCLUSION

In these 30 subjects, statistically significant improvement occurred in both subjective and objective assessments of nasal obstruction, particularly in patients with greater density of vibrissae. These findings support further study of the potential benefit of the reduction of vibrissae density in some patients with nasal obstruction.

Sinonasal Tract Neurofibroma: A Clinicopathologic Series of 12 Cases with a Review of the Literature

Neurofibroma (NF), a benign peripheral nerve sheath tumor, is very uncommon in the sinonasal tract, with only a few reported cases in the English literature. Cases within the files of the authors' institutions confined to the sinonasal tract were compared to cases reported in the English literature (Medline 1966-2014). The 12 patients included 6 females and 6 males, aged 26-75 years (mean 46.2 years). The patients usually presented clinically with a mass lesion (n = 11), obstruction (n = 4) or pain (n = 3), with an average symptom duration of 42.9 months. Two patients had neurofibromatosis (NF1). Tumors involved the nasal cavity alone (n = 8), maxillary sinus alone (n = 2), or mixed sites (n = 2), with a range of 0.4-4.1 cm (mean 2.2 cm). The tumors were circumscribed, composed of spindled to wavy cells with curvilinear nuclei set in a background of collagenized stroma and mast cells. Nuclear palisading and perivascular hyalinization were not seen. Mitoses were scant. Pleomorphism, necrosis and increased cellularity were absent. By immunohistochemistry, the lesional cells were S100 protein, SOX10 and NFP positive, while CD34 highlighted the perineurium. INI1 was intact, with strong nuclear expression in all cases. All patients had surgical excision without recurrence (mean follow-up 8.6 years). The principle differential diagnoses include schwannoma, perineurioma, fibromatosis, and solitary fibrous tumor. NF of the sinonasal tract occurs in middle-aged patients without a gender predilection, usually with non-specific symptoms present for a long duration. Tumors are relatively large (mean 2.2), and usually affect one site only. Surgery is curative, with only 16.7 % NF1 associated. S100 protein, SOX10 and NFP highlight the Schwann cells, with CD34 highlighting the perineural fibroblasts.

Endoscopic Excision of Solitary Neurofibroma Arising from Posterior Nasal Septum

Neurogenic tumors form a very small percentage of all neoplastic lesions of the head and neck region. However, the head and neck region is by far the most common location for benign peripheral neural tumors. Several cases involving the nasal cavity and paranasal sinuses have been sporadically documented throughout the medical literature. We present a rare case of a solitary neurofibroma arising from the posterior nasal septum of a 37-year-old woman. En bloc surgical resection of the mass was achieved by endoscopic approach. This case highlights the importance of considering this clinical entity in the differential diagnosis when encountering a unilateral soft tissue mass in the nasal cavity and use of endoscopic technique in the management of such tumors.

Abbreviations

Contrast enhanced computed tomography (CECT), Magnetic resonance imaging (MRI).

[A case of nasal septum schwannoma: endoscopic resection]

OBJECTIVES

To define clinical and radiological characteristics of nasal septal schwannoma, and to propose endoscopic surgery.

PATIENT AND METHODS

We report a case of an isolated schwannoma of the anterior part of the nasal septum, without involvement of any local structure. The only preoperative symptom was nasal obstruction. Imaging study included a CT scan and an MRI study.

RESULTS

Schwannoma is a sheath tumor originating from Schwann cells of peripheral nerves. It rarely occurs in nasal and paranasal sinuses and its development on the nasal septum is extremely rare. Complete removal of the tumor was performed by endoscopic sinus surgery technique. Limits of the excision were free of tumor and the histological type was Antoni type A Schwannoma. After a year of follow up, the patient is free of recurrence.

CONCLUSION

The Schwannoma of the nasal septum is a rare tumour whose clinical and radiological diagnosis by CT scan and IRM is relatively easy. Its treatment is surgical and the endoscopic surgery can be proposed in the forms slightly extensive.

Solitary neurofibroma of the inferior nasal turbinate

We present a case of neurofibroma of the nasal inferior turbinate operated under endoscopic control. A 29 year-old female reported progressive left-side nasal obstruction over the past year. Endoscopic examination revealed a mass arising from the left inferior turbinate. Evaluation of multiple sections of the mass by hematoxylin and eosin, S-100 protein and neuron specific enolasa stains showed the tumor to be a neurofibroma.