Diagnostic challenges of sinonasal extracranial meningiomas: A case report

Albarosa De Pascale; Madaro Ferruccio; Porro Giuseppe; Arra  Gabriele; Antonio Palumbo; Eleonora M.C. Trecca

doi:10.23750/abm.v96i1.16109

Diagnostic challenges of sinonasal extracranial meningiomas: A case report

Authors

Albarosa De Pascale Department of Otolaryngology- Head and Neck Surgery, University A. Moro, Bari , Italy https://orcid.org/0009-0007-1139-8164
Madaro Ferruccio Department of Otolaryngology- Head and Neck Surgery, Vito Fazzi Hospital, Lecce, Italy
Porro Giuseppe Department of Otolaryngology- Head and Neck Surgery, Vito Fazzi Hospital, Lecce, Italy
Arra Gabriele Department of Otolaryngology- Head and Neck Surgery, Vito Fazzi Hospital, Lecce, Italy
Antonio Palumbo Department of Otolaryngology- Head and Neck Surgery, Vito Fazzi Hospital, Lecce, Italy
Eleonora M.C. Trecca IRCCS Research Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy https://orcid.org/0000-0001-6490-1746

Keywords:

sinonasal meningiomas, differential diagnosis, diagnostic pitfalls, skull base tumors, meningioma misdiagnosis, extracranial neoplasms, sinonasal tract tumors, ct/mri sinonasal meningiomas, histopathology sinonasal meningiomas

Abstract

Background and aim: Meningiomas, the most prevalent non-glial intracranial neoplasms, exhibit different biological features and are typically identified with a characteristic dural tail sign on MRI. However, a subset, approximately 7-16% can manifest extracranially. This case report presents a 70-year-old-woman with nasal dyspnea and intermittent epistaxis due to an ectopic meningioma originating from the nasal cavity, a rare extracranial location. Additionally, a thorough review of the relevant literature was conducted.

Methods: Radiological imaging, including maxillofacial CT and MRI, revealed a solid tissue occupying the left nasal cavity, having its origin in middle turbinate. The patient underwent endoscopic sinus surgery (ESS), leading to the histological diagnosis of a WHO grade I meningothelial meningioma with psammomatous bodies. Follow- up at 3-6-12 months showed no recurrence.

Results: Extracranial meningiomas constituting less than 1% of non-epithelial tumors, often mimic other sinonasal masses, posing diagnostic challenges. Comprehensive radiological investigation, complete surgical removal, and thorough histopathological examination are crucial for accurate diagnosis and effective treatment planning.

Conclusions: This report and literature review emphasizes the importance of preoperative diagnostic-instrumental paths and highlight specific radiological patterns for differential diagnosis, contributing to the understanding and the management of this rare presentation of meningiomas

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