Isolated sinonasal sarcoidosis with intracranial extension: case report

Abstract

The case is presented of a 20-year-old female who was incidentally diagnosed with isolated sarcoidosis in the form of a nasal mass involving the ethmoid sinuses with destruction of the cribriform plate and intracranial extension. The patient complained of cacosmia and nasal obstruction. Histopathologic examination of biopsies from the nasal mass led to a diagnosis of non-caseating granuloma, highly suggestive of sarcoidosis. No systemic manifestations were detected, and the patient was started on a regimen of systemic steroids. Over the 3 months following biopsy and commencement of systemic steroids, the patient showed improvement in symptoms, and computed tomography of the paranasal sinuses revealed complete resolution of the sinonasal mass. Follow-up for one year revealed no recurrence.

Fig. 1

CT PNS showing left lacrimal gland enlargement, free ethmoid sinuses and nasal roof. NB enlarged inferior turbinates.

Fig. 2

CT PNS showing sinonasal mass occupying roof of nose and both ethmoidal sinuses. NB destruction of cribriform plate, more on right side.

Fig. 3

MRI PNS showing sinonasal mass exhibiting marked enhancement on T1 weighted images with gadolinium contrast. Evident breach of cribriform plate with involvement of lower part of right frontal lobe of brain can be seen.

Fig. 4

Sheets of inflammatory cells comprising lymphocytes and plasma cells widely separated by non-caseating granulomas composed of central epithelioid cells with multinucleated giant cells. Respiratory nasal epithelium can be seen on lower left (H&E x40).

Fig. 5

CT PNS showing complete involution of sinonasal mass