PRIMARY SINONASAL MENINGIOMA MIMICKING BENIGN NASAL LESIONS - A CASE REPORT AND LITERATURE REVIEW
Journal
Academic Medical Journal
Date Issued
2025
Author(s)
H. Sulejmani
Jovcheva, A
Ivanova, M
Abstract
Introduction: Primary extracranial meningiomas are rare neoplasms, accounting for less than
2% of all meningiomas. The sinonasal tract represents an uncommon site of origin and
frequently presents diagnostic challenges due to nonspecific clinical and radiological features.
Case Presentation: A 79-year-old male presented with a unilateral nasal cavity mass. Computed
tomography revealed diffuse polypoid mucosal thickening with near-complete opacification of
paranasal sinuses and obliteration of aeration. Histopathology showed a circumscribed
neoplastic proliferation arranged in lobular and whorled patterns beneath intact respiratory
epithelium. Tumor cells displayed uniform morphology with oval nuclei, eosinophilic
cytoplasm, and inconspicuous nucleoli. Psammoma bodies and delicate vascular channels were
present. Necrosis, nuclear atypia, and mitotic activity were absent. Immunohistochemistry
showed strong positivity for epithelial membrane antigen (EMA), vimentin, p63, and
progesterone receptor, while cytokeratin AE1/AE3, CD34, smooth muscle actin (SMA), S100,
SOX10, desmin, and synaptophysin were negative. The proliferative index (Ki-67) was <5%.
Discussion: Extracranial meningiomas are rare neoplasms with poorly understood histogenesis,
presumably arising from displaced meningothelial cells during embryonic development.
Sinonasal meningiomas may mimic other nasal masses including nasal polyps, inverted
papilloma, olfactory neuroblastoma, or carcinoma. In this case, the morphological features
combined with the supportive immunohistochemical profile confirmed the diagnosis of WHO
Grade I meningothelial meningioma with angiomatous features.
Conclusion: Primary sinonasal meningioma should be included in the differential diagnosis of
sinonasal masses. Accurate recognition through comprehensive histopathological and
immunohistochemical analysis is essential for proper diagnosis and management.
2% of all meningiomas. The sinonasal tract represents an uncommon site of origin and
frequently presents diagnostic challenges due to nonspecific clinical and radiological features.
Case Presentation: A 79-year-old male presented with a unilateral nasal cavity mass. Computed
tomography revealed diffuse polypoid mucosal thickening with near-complete opacification of
paranasal sinuses and obliteration of aeration. Histopathology showed a circumscribed
neoplastic proliferation arranged in lobular and whorled patterns beneath intact respiratory
epithelium. Tumor cells displayed uniform morphology with oval nuclei, eosinophilic
cytoplasm, and inconspicuous nucleoli. Psammoma bodies and delicate vascular channels were
present. Necrosis, nuclear atypia, and mitotic activity were absent. Immunohistochemistry
showed strong positivity for epithelial membrane antigen (EMA), vimentin, p63, and
progesterone receptor, while cytokeratin AE1/AE3, CD34, smooth muscle actin (SMA), S100,
SOX10, desmin, and synaptophysin were negative. The proliferative index (Ki-67) was <5%.
Discussion: Extracranial meningiomas are rare neoplasms with poorly understood histogenesis,
presumably arising from displaced meningothelial cells during embryonic development.
Sinonasal meningiomas may mimic other nasal masses including nasal polyps, inverted
papilloma, olfactory neuroblastoma, or carcinoma. In this case, the morphological features
combined with the supportive immunohistochemical profile confirmed the diagnosis of WHO
Grade I meningothelial meningioma with angiomatous features.
Conclusion: Primary sinonasal meningioma should be included in the differential diagnosis of
sinonasal masses. Accurate recognition through comprehensive histopathological and
immunohistochemical analysis is essential for proper diagnosis and management.
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