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 By: Ali Hekmatnia, MD Hossain Ahrar, MD.

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1  By: Ali Hekmatnia, MD Hossain Ahrar, MD

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8  Very rare 3%  Predominately of older males  Delay in diagnosis due to similarity to benign conditions  Maxillary sinus: 70%  Ethmoid sinus: 20%  Sphenoid: 3%  Frontal: 1% 8

9  Papillomas  Osteomas  Fibrous Dysplasia  Neurogenic tumors  Juvenile Angiofibroma 9

10  Fungiform: 50%, nasal septum  Cylindrical: 3%, lateral wall/sinuses  Inverted: 47%, lateral wall Unilateral Malignant degeneration in 2-13% 10

11  CT: Lobular mass on lateral nasal wall ± maxillary/ethmoid extension or intralesional Ca++  MR: "Convoluted," "cerebriform“ architecture on T2 & post-gadolinium images; necrosis = coexistent carcinoma

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18  Benign slow growing tumors of mature bone  Location: o Frontal, ethmoids, maxillary sinuses  When obstructing mucosal flow can lead to mucocele formation  CT: Density varies from dense (compact  type) to less ossified (fibrous type) 18

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25  Medullary bone replaced by woven bone  Monostotic vs Polyostotic  Facial bone involvement greater in polyostotic form  CT/MR: Appearance varies with amount of fibrous tissue (classic "ground-glass“ appearance)  Malignant transformation to rhabdomyosarcoma has been seen with radiation 25

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32  4% are found within the paranasal sinuses  Schwannomas  Neurofibromas  When associated with Von Recklinghausen’s syndrome: more aggressive (30% 5yr survival).  Imaging: Well-circumscribed mass with bone remodeling (CT)  MR: Intermediate T1 signal T2 varies with cellularity; large lesions ± cystic degeneration 32

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39  Adolescent male patient with nasal obstruction and epistaxis  Centered at sphenopalatine foramen with spread into pterygopalatine fossa, nasal cavity, and nasopharynx  Vascular mass with flow voids and avid enhancement

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44  Squamous cell carcinoma  Adenoid cystic carcinoma  Mucoepidermoid carcinoma  Adenocarcinoma  Hemangiopericytoma  Melanoma  Olfactory neuroblastoma  Osteogenic sarcoma, fibrosarcoma, chondrosarcoma, rhabdomyosarcoma  Lymphoma  Metastatic tumors  Sinonasal undifferentiated carcinoma 44

45  Patient demographics: Adult patient (95%> 40 years); M > F  Location: o Maxillary sinus (70%) o Nasal cavity (20%)  Poorly defined with aggressive bone  destruction; heterogeneous enhancement 45

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50  10% of PNS Tumors  Adenoid Cystic Carcinoma  Mucoepidermoid Carcinoma  Perineural spread o Adenoid Cystic Carcinoma 50

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53  2 nd most common malignant tumor in ethmoidal air cells  Strong association with occupational exposures like hardwood workers  Adult (40-60 year old) male patient  Nonspecific imaging features, but may be more well defined than squamous cell carcinoma and esthesioneuroblastoma 53

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58  % of melanoma  Malignancy from mucosal melanocytes; nasal cavity> sinuses  Imaging: Soft tissue mass with bone remodeling ± destruction  MR: high T1 & low T2 signal in melanotic form; enhance ± foci of hemorrhage 58

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63  Originate from stem cells of neural crest origin that differentiate into olfactory sensory cells.  Adolescent or middle-aged patient with unilateral nasal obstruction and mild epistaxis  Morphology: "Dumbbell-shaped" mass centered at cribriform plate  CT: Intralesional Ca++  MR: Avid enhancement; foci of hemorrhage; intracranial cyst formation 63

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68  Osteogenic Sarcoma o Most common primary malignancy of bone. o Mandible > Maxilla o Sunray radiographic appearance  Fibrosarcoma  Chondrosarcoma  Rabdomyosarcoma: in children 68

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81  Most common tumor of PNS  Non-Hodgkin type  nasal cavity> sinuses  CT: Homogeneous and may be hyperdense relative to other soft tissue  MR: Homogeneous signal and enhancement; decreased T2 signal due to high nuclear :cytoplasmic ratio of cells 81

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86  Breast and lung carcinoma most common primaries  Widespread skeletal metastases present 86

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