Sphenoid Masses in Children: Radiologic Differential Diagnosis with Pathologic Correlation

Abstract

SUMMARY:Childhood central skull base masses are rare, often difficult to diagnose, and have overlapping imaging findings. In this review, we provide an overview of the epidemiology, clinical findings, and management of pediatric sphenoid bone and sphenoid sinus masses with an emphasis on imaging findings that may help to differentiate lesions. Radiologic-pathologic correlation is provided. Finally, an imaging-based algorithm is presented as a guide to help radiologists narrow their differential diagnoses. Some of the entities discussed are virtually unique to the pediatric population; others occur rarely in this age group but should be considered in the appropriate clinical setting. Entities included in the discussion are grouped into 2 categories: those that cause nonaggressive osseous remodeling and those that are more commonly associated with aggressive bone changes. Mucocele, aneurysmal bone cyst, giant cell lesions, meningioma, and fibrous dysplasia tend to remodel bone, while entities such as chordoma, craniopharyngioma, rhabdomyosarcoma, sinonasal carcinoma, and neuroblastoma may cause more aggressive local bone changes.ABBREVIATIONS: FLAIR ϭ fluid-attenuated inversion recovery: HE ϭ hematoxylin-eosin; NF 1 ϭ neurofibromatosis type 1; NF 2 ϭ neurofibromatosis type 2; T1WI ϭ T1 weighted imaging; T2WI ϭ T2 weighted imaging

Clinical and Radiological Findings Suggesting Disorders Other Than Tolosa–Hunt Syndrome Among Ophthalmoplegic Patients: A Retrospective Analysis

“…Although extra‐CS invasion may occur in patients with THS, this finding only accounts for a minority of cases. On the other hand, the paranasal sinus and cranial base are common sites for malignant processes . Taken together, our findings suggest that the diagnosis of THS in patients with sphenoid sinus and cranial base lesions should be made with caution.…”

“…On the other hand, the paranasal sinus and cranial base are common sites for malignant processes. 21,[23][24][25] Taken together, our findings suggest that the diagnosis of THS in patients with sphenoid sinus and cranial base lesions should be made with caution.…”

“…Moreover, distant metastases from renal, gastric, thyroid, lung, and breast cancers may have parenchymal lesions and exhibit dural enhancement on MR images . Finally, it should be noted that cranial bone erosion is mainly evocative of malignancies …”

“…Lesions that are rarely presented in THS and suggest alternative diagnoses to THS were defined as atypical image findings . Atypical imaging features are illustrated in Figure A, and include: (1) lesions extending medially into the sellar fossa; (2) lesions extending laterally into the middle cranial fossa or downward into the infratemporal fossa; (3) lesions located posteriorly to the prepontine cistern; (4) lesions invading the sphenoid sinus, ethmoid sinus, and/or frontal sinus; (5) lesions invading the adjacent parenchyma of brain; (6) lesions invading skull and/or causing bone erosion; or (7) an enhanced and dilated superior orbital vein . Representative image findings are presented in Figure B‐O.…”

Ophthalmoplegia secondary to left sphenoid sinus mucocele

“…They expand towards the neighborhood structures by thinning the bone tissues surrounding the sinuses. Mucopyoceles or neoplasms should be considered if there is no thinning in the bone tissue and there is a nodular enlargement [6]. Especially, MRI is indicative of the differential diagnosis of other sinus pathologies.…”