Sphenoid sinus myxoma: case report and literature review

Abstract

Objectives: We present the first known case in the English-language literature of a myxoma arising in the sphenoid sinus. By describing the patient's clinical course and the salient features of this rare neoplasm, we seek to increase the awareness of the presentation, histological features, and treatment considerations for myxomas of the head and neck. In the process, we intend to describe the work-up of isolated sphenoid sinus lesions and focus on the varying and evolving techniques for surgical access to the sphenoid sinus.

Study design and methods: Case report and literature review.

Results: We describe the clinical course of a patient with a myxoma of the sphenoid sinus. The patient underwent an external sphenoethmoidectomy through a lateral rhinotomy approach with medial maxillectomy under MRI-guidance. He remains without evidence of recurrent disease after 8 months.

Conclusions: Myxomas of the head and neck are rare neoplasms. Their infiltrative nature and tendency to recur demand an aggressive surgical approach that may be accomplished with minimal morbidity using currently available image-guided techniques.

Keywords: Myxoma; neoplasms; sphenoid sinus.

Figure 1. Contrasted axial CT scan demonstrating soft tissue mass filling the sphenoid sinus, with extension into the left middle cranial fossa, pterygopalatine fossa, and posterior ethmoid sinus. Note the anterior bowing of the posterior wall of the left maxillary sinus, as well as the destruction of the pterygoid plates.

Figure 2. Gadolinium-enhanced T1 weighted MRI images of the sphenoid sinus mass. It appears to encase both carotid arteries and closely approximate the pituitary gland, with anterior extension along the planum sphenoidale.

Figure 3. Coronal view of contrasted MRI. The mass spills anteriorly and laterally from the sphenoid sinus, extending throughout the pterygomaxillary space in the region of the vidian canal and foramen rotundum.

Figure 4. Photomicrograph of tumor specimen at 10× magnification with hematoxylin and eosin stain.