Frontal Sinus Osteoma with Osteoblastoma-like Histology and Associated Intracranial Pneumatocele

Abstract

Osteomas of the cranial sinuses are rare, benign bony tumors that can be complicated by the formation of an intracranial pneumatocele. If not treated promptly, a pneumatocele can lead to abscess formation, meningitis, or ventriculitis. In the present case, an intracerebral pneumatocele was formed when an 18 cm 3 osteoma breached the posterior wall of the frontal sinus creating a one-way valve through which air could enter the intracranial cavity. The patient presented after forceful sneezing with nonspecific symptoms of headache, nausea, and vomiting. CT demonstrated a frontal collection of loculated air with mass effect within the left cerebral hemisphere. A partly mineralized mass occupied the left superior nasal ethmoid sinus and left frontal sinus. Of interest pathologically in this case, the tumor had a substantial osteoblastoma-like component. Surgical repair involved frontal craniotomy to remove the osteoma and debride frontal sinus mucosa, plugging the frontal nasal ducts and sinus with fat and bone wax, and dural restoration using an underwater closed drainage system to vent intracranial air and stabilize the patient.

Benign osteoblastoma of ethmoid and sphenoid sinus: a rare presentation

“…[10] In the current case, the patient had suffered from headaches, retro-orbital pain and nasal obstruction for a year. Paranasal CT findings showed the osteoblastoma, so endoscopic sinus surgery was applied to the patient.…”

“…[8] Osteoblastomas are usually wellcircumscribed masses. [9,10] The tumor usually shows radiolucent deficits with varying degrees of calcification.…”

Sino-Orbital Osteoma With Osteoblastoma-Like Features

“…Very rarely, sinonasal osteomas arise as a component of Gardner syndrome and in the current case the patient was otherwise healthy and did not manifest any features of the syndrome [4,5]. Clinically sino-orbital osteomas can present with a broad spectrum of signs and symptoms that may include pain, headache, facial distortion, proptosis, polyps, rhinorrhea, epistaxis, periorbital edema and visual changes; true mucoceles and infections may result when frontal sinus osteomas cause nasofrontal duct obstruction, whereas pneumatocele, cerebrospinal fluid leakage, meningitis and cerebral abscess can occur from tumors that erode the supraorbital plate and dura mater [4,6,7]. These symptoms are due to mass effect and it has been suggested that osteomas remain asymptomatic until they reach a certain size [8].…”

“…Microscopically, ossifying fibromas and fibrous dysplasia, are readily separated based on the usual presence of abundant collagenous fibroblastic tissue. The presence of mild cytologic atypia in the large osteoblasts rimming thin trabeculae of osteoid may result in consideration of an osteoblastic osteosarcoma, however evidence of maturation and an absence of atypical stromal cells precludes a diagnosis of osteosarcoma [7]. Ultimately, distinguishing osteoma with osteoblastoma-like features from these entities requires correlating both morphologic and radiographic findings.…”

Observation of a patient with simultaneous finding in the frontal sinus of osteoma and mucocele

“…As a result of the operation, almost all intraocular complications were successfully eliminated. Histological examination of the material removed from the sinus confirmed the presence of a compact osteoma and chronically inflamed FROM PRACTICE Это доброкачественное костное образование неизменно вызывает интерес у практических оториноларингологов, ему посвящено большое количество публикаций, охватывающих различные стороны этой патологии [3][4][5][6][7][8].…”