Challenges in distinguishing amongst large maxillary sinus lesions with calcified matrix: a differential diagnostic exhibit

Abstract

Clinical Presentation

Case 1: A 64-year-old man with history of metastatic pancreatic cancer underwent a computed tomography (CT) scan for suspected recurrence, which revealed an incidental large, destructive mass with internal calcified matrix in the left maxillary sinus with associated bone destruction. The tumor extended into the left sinonasal cavity, oral cavity, and retroantral soft tissue, with resultant obstructive sinusitis.

Case 2: A 19-year-old man presented with intermittent epistaxis of the right nostril. Examination revealed a polyp-like mass in the right nasal cavity. The CT scan demonstrated a large, expansile mass with extensive internal calcifications centered in the right nasal vault, completely involving the right maxillary sinus, right ethmoid air cells, and the posterior bony orbit.

Case 3: A 15-year-old female patient with history of swelling and a slow-growing lesion underwent CT imaging, which revealed a well-defined, expansile lesion with calcified matrix in the left maxilla protruding into the left maxillary antrum. There was destruction of the posterior wall of the left maxillary sinus, and the lesion displaced #15 laterally and #16 superiorly into the maxillary sinus.

Differential Diagnosis

Case 1 and 2: The extensive and destructive findings are concerning for malignancy, particularly chondrosarcoma and osteosarcoma. An alternative diagnosis for case 1 includes metastasis, given the history of cancer.

Case 3: Differential diagnoses include chondrosarcoma, ossifying fibroma, and venous malformation of bone.

Diagnosis and Management

Histologic examination revealed glomangiopericytoma for case 1, mesenchymal chondrosarcoma for case 2, and unusual ossifying fibroma for case 3. All tumors were surgically removed. Case 3 displayed recurrence upon follow-up imaging 11 months later.

Conclusions

A wide range of expansile sinus masses with calcified matrix exists, comprising both benign and malignant entities. Radiographic features help distinguish between benign and malignant categories; however, differentiating between malignancies is challenging due to overlapping radiologic characteristics. Thus, histopathologic examination is crucial for definitive diagnosis.