Brain Pathology Case of the Month - May 2006

Contributed by Antje Bornemann1, MD, and Assen Koitschev2, MD
1Institut of Brain Research and 2Department of Otorhinolaryngology, Eberhard-Karls University, Tübingen, Germany
Published on line in May 2006


The 57-year-old female patient presented to a neurologist with chronic cephalgia since three years. She had had no previous rhinologic history. A contrast enhanced computer tomography was performed and revealed an isolated unilateral opacification within the left ethmoid sinus (Fig. 1). There were no signs of chronic sinusitis but thinning of the bone surrounding the tumor (arrow). Under the suspicion of a mucocele functional endoscopic sinus surgery was performed. Reddish tumor mass was found instead of mucus within the bulla ethmoidalis and anterior ethmoid sinus. After complete tumor removal the endoscopic view revealed destruction of the lamina papiracea induced by volume pressure of the tumor without invasive growth into the bone of the skull base or soft tissue of the orbita.


The respiratory mucosa was invaded by a tumor consisting of uniform round cells (Fig. 2). Cell-rich islands characteristically intermingled with nucleus-free areas of neuropil (Fig. 2). The fibrillary processes consistently expressed synaptophysin (Fig. 3). The tumor cells were negative for glial fibrillary acidic protein (not shown). Less than 1% of the cells were proliferating as seen with MIB1 labeling (not shown).


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