Recurrent pleomorphic adenoma: unusual cause of isolated sphenoid sinus lesion

Abstract

Pleomorphic adenoma is the most common benign salivary gland tumour of the head and neck region, most commonly seen in parotid glands. These may arise also from minor salivary glands of the upper aerodigestive tract comprises the upper lip, cheek, floor of the mouth and rarely from mucoserous glands in the nasal cavity and paranasal sinuses. A middle-aged man, who had undergone surgery for a nasal mass 14 years ago, presented with headache and visual complaints from a recurrent mass originating from the sphenoid sinus. Isolated sphenoid sinus space-occupying lesions have always been a diagnostic challenge. The mass was biopsied and diagnosed as pleomorphic adenoma on histopathology, and then excised endoscopically. Early and accurate diagnosis on a biopsy may result in complete excision of the tumour and prevent recurrence. The endoscopic route is preferred for surgical excision and the patient should be followed up clinically and radiologically to detect early recurrence.

Keywords: Ear, nose and throat/otolaryngology; Otolaryngology / ENT.

Figure 1

Preoperative CT scans (coronal section) of paranasal sinuses showing hypodense mass in the left sphenoid sinus.

Figure 2

Preoperative contrast-enhanced MRI (coronal section) of paranasal sinuses showing large multilobulated heterogeneously enhancing soft tissue mass in sphenoid sinus with the expansion of the sinus, and causing indentation and mass effect on the posterior part of the optic nerve and optic chiasm and closely abutting left internal carotid artery (ICA).

Figure 3

Histopathological examination showing features of a pleomorphic adenoma (A; H&E, x200), immunopositive for S-100 (B; immunohistochemistry, x200).

Figure 4

Postoperative contrast-enhanced CT of nose and paranasal sinuses without any evidence of tumour recurrence.