Case Report: Neurofibroma of the ethmoid and sphenoid sinus - a rare differential diagnosis of unilateral nasal obstruction

Introduction Neurofibroma is a benign tumor, which arises from the connective tissue of peripheral nerves. The most frequent locations are the extremities and the head and neck area. In only about 4 % of the cases the tumor presents in the nasal cavity and paranasal sinuses. The tumor is often seen in patients with neurofibromatosis (NF1).

Case report A 34-year-old woman presented with right nasal obstruction of 6 months evolution. Nasal endoscopy showed a polypoid mass filling the right nasal cavity. CT and MRI scans showed an extended, tumor-like, homogeneous enhanced mass, filling the right nasal cavity, ethmoid cells and sphenoid sinus. The wall of the right maxillary sinus was displaced laterally. The intraoperativ finding showed that the polypoid mass was necrotic on the inside. A biopsy was taken for pathological study which proved a neurofibroma. Genetic testing showed no neurofribromatosis mutations. The tumor was completely resected with endoscopic surgery and the patient s ability of smell was fully preserved. The MRI scan three months after the operation showed no signs of recurrence or residual tumor. The next follow up examination is planned in 6 months.

Discussion Neurofibroma of the parananasal sinuses is a very rare cause of unilateral nasal obstruction and shows clinical features similar to nasal polyps. The histological examination confirms the diagnosis. The first line treatment is the tumor resection. Every patient should undergo genetic testing of neurofibromatosis mutations. Recurrencies are very rare but follow up examinations are recommended.

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Publication History

Article published online:
10 June 2020