Benign Spindle Cell Lesion of the Nasal Cavity: A Rare Presentation of Solitary Fibrous Tumor

Abstract

Solitary fibrous tumors (SFTs) are rare neoplasms primarily found in the pleural region but have been documented in diverse extrapleural sites, including the nasal cavity and paranasal sinuses, albeit infrequently. Here, we present a case of a 48-year-old female who presented with a right-sided nasal mass and associated ophthalmologic symptoms, ultimately diagnosed with a benign spindle cell lesion localized to the nasal cavity. The patient underwent a comprehensive evaluation involving clinical examination, radiological imaging, and histopathological analysis, leading to the identification of a benign solitary fibrous tumor. Notably, diagnosing SFTs in the nasal cavity presents challenges due to their nonspecific clinical and imaging features, necessitating a multidisciplinary approach for accurate diagnosis and optimal management. Surgical excision, preferably via endoscopic techniques, remains the cornerstone of treatment based on tumor characteristics and extent. This case underscores the importance of recognizing uncommon presentations of sinonasal lesions, navigating diagnostic complexities, and emphasizing the critical role of multidisciplinary collaboration in achieving favorable treatment outcomes for patients with such nasal cavity tumors.

Keywords: carcinoma; diagnostic nasal endoscopy; excision; lesion; nasal cavity; spindle cell.

Figure 1. Right eye proptosis - forwards and outwards

Figure 2. CT scan of the paranasal sinus

(A) CT of the paranasal sinuses-axial section showing a soft tissue density that is hypodense with that of the brain and a contrast CT of the same section showing mild fairly uniform contrast enhancement. (B) Contrast CT of Paranasal sinuses-coronal view showing a soft tissue density occupying the Right ethmoid sinus and extending into the right sphenoid sinus, the nasal septum, and possibly intracranially.

Figure 3. Intra-operative findings

A) A posterior septal bulge caused by the mass seen in the left nasal cavity (B) Firm friable mass arising from the right posterior ethmoid and right sphenoid sinus pushing the left nasal cavity and eroding the posterior end of the nasal septum. Yellowish purulent material was noted arising from the right sphenoid sinus.

Figure 4. Histopathological findings

(A) The section studied showed benign tumor cells composed of ovoid to spindle-shaped cells arranged in interlacing sweeping fascicles and focal vague storiform patterns. (B) Immunohistochemistry for CD34 was positive (a tumor marker for solitary fibrous tumor).

Figure 5. Postoperative CT of the Paranasal sinuses after 10 days

(A) Coronal section reveals the absence of mass in the previously occupied right posterior ethmoid and right sphenoid sinuses. (B) Axial view showing a mid-nasal septal defect post septoplasty, sphenoidotomy, and nasal mass excision.