Eosinophilic angiocentric fibrosis of the sinonasal tract

Abstract

Eosinophilic angiocentric fibrosis (EAF) is an exceedingly rare and potentially disfiguring and obstructing benign lesion involving the upper airways. We report two cases of EAF originating from the nasal cavity in a 31-year-old female and a 58-year-old male exhibiting nasal obstructive symptoms, with imaging features and histopathology characteristic of EAF. Surgical excision was performed on one patient with a disfiguring nasal mass at a tertiary referral rhinology practice within a university centre. Summarized are the relevant clinical issues to increase awareness of this disease. The slow progression and rarity of the disease has previously resulted in diagnostic difficulty. We review the limited current literature surrounding the clinical features and treatment options for this progressive and potentially morbid condition. These cases reinforce that, while rare, inflammatory and fibrosing lesions in general should still be considered as part of the differential diagnosis in patients presenting with obstructive lesions in the sinonasal tract.

Figure 1.

Patient 1. Nasal mass biopsy. Thick collagen bundles with perivascular fibrosis in an “onion-skin” type whorling pattern. Eosinophil-rich inflammatory infiltrate is also present (haematoxylin and eosin).

Figure 2.

MRI of patient 1. (a) Coronal T ₂ (b) sagittal T ₁ and (c) coronal T ₁ weighted images showing a central soft tissue mass bilaterally infiltrating the nasolabial folds, inferior and middle turbinates, and nasal septum, with soft tissue thickening extending to the nasal bridge. There is mild narrowing of both nasal vestibules.

Figure 3.

Patient 2. Nasal biopsy demonstrating prominent perivascular fibrosis with numerous eosinophils (haematoxylin and eosin).

Figure 4.

Patient 2. Coronal CT scan showing a nasal mass measuring 2.6 × 3.1 × 2.9 cm predominantly to the left of the nasal septum and extending across the midline to the right. The lesion also extends into the premaxillary space. The erosion through the left hard palate is significant.