Patient 5. Patient 5. Initial diagnosis: nonhealing midline granuloma (Stewart's syndrome); final diagnosis: non-Hodgkin's T-cell lymphoma. A, CT scan.

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Presentation transcript:

Patient 5. Patient 5. Initial diagnosis: nonhealing midline granuloma (Stewart's syndrome); final diagnosis: non-Hodgkin's T-cell lymphoma. A, CT scan of the paranasal sinuses shows soft-tissue opacification of the anterior ethmoidal air cells bilaterally, soft-tissue density in the region of the right ostiomeatal unit, and mild mucosal thickening in the inferior aspect of the right maxillary sinus. The left maxillary sinus is hypoplastic and the remainder of the sinus cavity is filled with soft tissue. Bony destructive changes are noted with a nasoseptal perforation and destruction of the inferomedial wall of the right orbit. However, the abnormal soft tissue does not appear to infiltrate the extraconal space. The bony defect in the inferior aspect of the left maxillary sinus is postsurgical in nature, due to a prior Caldwell-Luc antrostomy for chronic sinus disease. Some soft-tissue thickening is noted in the left premaxillary region.B, Histologic slide of a sinonasal biopsy specimen shows lymphocytic invasion of a blood vessel reflecting the angioinvasive nature of the disease. Also noted is a heterogeneous and polymorphic inflammatory infiltrate (hematoxylin-eosin, original magnification ×400).C, Histologic slide of a sinonasal biopsy specimen shows invasion of trabecular bone in the right upper corner of the image (hematoxylin-eosin, original magnification ×100).D, Histologic slide of a sinonasal biopsy specimen shows positive staining with CD45RO T-cell marker (original magnification ×200).E, Histologic slide of a sinonasal biopsy specimen shows negative staining with CD20, a B-cell marker (original magnification ×200). Alexandra Borges et al. AJNR Am J Neuroradiol 2000;21:331-336 ©2000 by American Society of Neuroradiology