Case ReportThe Unusual Presentation of a Myxoma Within the Sphenoid Sinus: Case Report and Review of the Literature
Introduction
Myxomas are benign neoplasms that histologically resemble the mucinous appearance of the umbilical cord.1 In 1948, Stout2 characterized myxomas as tumors that are derived from primitive mesenchyme that do not metastasize. Myxomas most frequently are found in the atria but can also present in bone, skin, skeletal muscle, and subcutaneous tissue. Head and neck myxomas are rare and are more likely to be present in the mandible, maxilla, and soft tissue of the face.3 There are even rarer reports of myxomas occurring in the nasal cavity, paranasal sinuses, and nasopharynx.4, 5, 6, 7 To diagnose a myxoma, other neoplasms with myxoid elements such as schwannomas, liposarcomas, rhabdomyosarcomas, meningiomas, chordomas, and chondroblastic and fibroblastic tumors must be excluded.8 Sato et al.8 and Moore et al.9 described cases of myxoma arising in the sphenoid sinus that were resected via an endoscopic endonasal approach and a transfacial approach, respectively. We now describe in detail another rare case of a sphenoid sinus myxoma that was resected successfully via the endoscopic endonasal skull base approach and review the literature regarding these rare skull base tumors.
Section snippets
History and Presentation
A 72-year-old woman presented with proptosis, left periorbital fullness, and diplopia. She underwent magnetic resonance imaging (MRI), which demonstrated a sphenoid wing meningioma as well as a sphenoid sinus tumor. The lobulated 4.5 × 3.0 × 4.4 cm mass in the sphenoid sinus was heterogeneously hyperintense on T2 sequences and enhanced avidly and heterogeneously on T1 sequences with gadolinium. There was central hypointensity on T1-enhanced sequences. The lesions appeared discontiguous and
Discussion
Myxomas of the head and neck are very rare benign neoplasms derived from primitive mesenchyme.2 In the head and neck, these tumors most likely are present in the mandible and maxilla.3 Myxomas of the paranasal sinus constitute an even smaller minority of cases within the head and neck.8, 9, 12, 13, 14 Paranasal sinus myxomas are usually soft, painless masses15 and are very difficult to diagnose and treat. Most paranasal sinus myxomas develop in the maxillary sinus. These neoplasms have a
Conclusions
Myxoma of the sphenoid sinus is a rare tumor of the paranasal sinuses and skull base. The literature regarding paranasal sinus myxomas is reviewed. We describe a (rare) case of a sphenoid sinus myxoma. Myxomas are benign tumors that are treated by complete surgical resection. We describe and demonstrate the feasibility of a gross total resection of a skull base myxoma via a minimally invasive endoscopic endonasal approach that is performed with the aid of an endoscopic endonasal specific
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.