Vol.95 No.11 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 95 No. 11 November 2002
A Case of Inflammatory Pseudotumor in the
Maxillary Sinus Mimicking Malignancy
Takashi Nakagawa, Kenji Hattori, Nobuko Iwata,
Takahide Hoshino and Tomo Sasaki
(Sumitomo Hospital)
Inflammatory pseudotumor is a benign chronic non-specific granulation consisting of fibroblasts, histiocytes, plasma cells and inflammatory cells. It forms a space-occupying, rounded mass, appearing in various locations, but its occurrence in the paranasal sinus is rare. We report a 63-yeas old man with inflammatory pseudotumor in the maxillary sinus. Histopathological diagnosis of inflammatory pseudotumor is difficult, and differential diagnosis from malignant tumor is often a concern for otolaryngologists and pathologists. Indeed our case also resembled malignant tumor, especially nasal NK/T cell lymphoma. In this report, we discussed the clinicopathological features of inflammatory pseudotumor and reviewed the pertinent literature.
The patient presented a left lacrimation and exophthalmos at the initial medical examination. The findings of computer tomography (CT) and magnetic resonance image (MRI) strongly suggested malignant tumor of the maxillary sinus. To establish a histopathological diagnosis, biopsy was performed by nasal endoscopy. Surprisingly, there were no tumor cells seen in the biopsy specimen, and the diagnosis was inflammatory pseudotumor. Seven days later, radical surgery was performed, and the mass was resected completely. Three months after the initial surgery, recurrence in the maxillary sinus was confirmed. The second procedure was carried out, but total removal of the mass could not be achieved. After surgery, local corticoid steroid injections were repeated by administered over a one-week period. However, one year after the last surgery, the mass started to re-grow. A third procedure was performed for volume reduction with a KTP laser. Five months have passed since the third surgery and there has been no change observed in the size of the mass.
Key words : inflammatory pseudotumor, paranasal sinus, histopathological diagnosis, operation, local corticoid steroid injections