Unusual cause of maxillary sinus mass with proptosis

Abstract

We report a case of a 21-year-old Indian man with an 8-month history of left-sided headache, maxillary sinus mass, proptosis and swelling of the left temple, whose contrast-enhanced CT scans of the paranasal sinuses showed an enhancing, destructive soft tissue mass involving the left maxillary sinus, orbit, infratemporal fossa and anterior cranial fossa, suggestive of a malignancy or chronic granulomatous disease. Histopathological examination of the sinus mass, which was debulked and partially excised via an endoscopic approach, suggested a diagnosis of immunoglobulin G4-related sclerosing disease of the maxillary sinus. Subsequent immunohistochemical staining and biochemical tests confirmed the diagnosis. We highlight the importance of considering this increasingly recognised but rare entity that can mimic a malignant lesion with its clinical and radiological features but which, unlike the latter, has a very good prognosis with appropriate treatment.

Immunoglobulin G4-related disease of the paranasal sinuses

“…A similar presentation of proptosis and facial fullness was found by Kurien et al in a patient with IgG4-RD of the maxillary sinus. Their patient also did not complain of nasal obstruction 4. Additionally, Vandjelovic et al demonstrated that cases relating to the paranasal sinuses are often expansive and locally destructive.…”

Foreign body mimicking malignancy in acquired dacryocystocele

“…No mention was found in the literature about specific radiological features for foreign body‐induced granulation tissue or whether it could take on a malignancy‐like appearance causing dacryocystocele. One case of immunoglobulin G4‐related sclerosing disease, an inflammatory syndrome, was, however, found in the English medical literature and that mimics malignancy on initial CT findings . On the other hand, malignant tumors causing dacryocystocele have quite distinct features; more importantly contrast enhancement on CT acquisition, which reduces their likelihood to be mistaken with benign causes .…”

“…On the other hand, malignant tumors causing dacryocystocele have quite distinct features; more importantly contrast enhancement on CT acquisition, which reduces their likelihood to be mistaken with benign causes . In the previously mentioned case of immunoglobulin G4‐related sclerosing disease, images were enhanced in a similar way to malignant lesions . MRI is used as a complementary investigation for paranasal masses , as aggressive bony malignant findings are generally well identified on CT .…”

IgG4-assoziierte Orbitopathie als wichtige Differenzialdiagnose eines fortgeschrittenen Silent-Sinus-Syndroms

“…Es handelt sich um einen gleichzeitigen Befall der paranasalen Sinus und der Orbita. Es existieren wenige Fallberichte, die eine ähnliche, jedoch nicht identische Befundkonstellation beschreiben [14,15].…”

“…Es handelt sich um einen gleichzeitigen Befall der paranasalen Sinus und der Orbita. Es existieren wenige Fallberichte, die eine ähnliche, jedoch nicht identische Befundkonstellation beschreiben [ 14 , 15 ]. Inwieweit ältere Fallberichte zur eosinophilen angiozentrischen Fibrose den IgG4-assoziierten Erkrankungen der Nase und der Orbita zugeordnet werden müssten, ist im einzelnen Fall unklar.…”