An Unusual Mass Filling Within the Middle Meatus Mustafa Sagit, MD,* SabrN Guler, MD,* Mehmet Yasar, MD,* SeckN n Cetinkaya, MD,* Ferhat Korkmaz, MD,* Arzu Tasdemir, MD,Þ Mehmet AkN f Somdas, MD* Abstract: Schwannoma is a benign tumor that originates from sheath of myelinated peripheral nerves, rarely seen at the nasal cavity and paranasal sinuses. Symptoms of this tumor are nonspecific, and di- agnosis is often made only after histological examination. Schwan- noma is radioresistant, and chemotherapy is not effective, so surgical resection is the only curative treatment for this tumor. Endoscopic sinus surgery was the first choice for this case because of its definite origin and being easy to remove for complete excision. We present a patient with schwannoma who underwent an endonasal endoscopic approach for complete resection. Key Words: Schwannoma, nasal mass, endoscopic surgical approach S chwannoma is a benign tumor that originates from the sheath of myelinated peripheral nerves. The eighth nerve is the most common site of origin and next commonly developed from the fifth to ninth cranial nerves. 1 In the nerves where it reaches, schwannoma can occur. Although these tumors usually occur in the head and neck region, they are rarely seen at the nasal cavity and paranasal sinuses. 2 Symptoms of this tumor are nonspecific, which cannot be distin- guished from any other neoplasms in the nasal tract. The signs and symptoms are the same as those of the other mass of the sinonasal tract, which include epistaxis, nasal obstruction, serous or muco- purulent rhinorrhea, hyposmia, facial swelling, proptosis, and pain. Surgical resection is the only curative treatment for sinonasal schwannoma. 2 We describe a patient with schwannoma who underwent an endonasal endoscopic approach for complete resection. CLINICAL REPORT A 57-year-old man presented left-sided nasal obstruction and headache that had a slow progress over 3 years. A rigid endoscopy revealed a smooth-surfaced red-gray mass that filled the left nasal cavity. The nasal septum was central, and the right nasal cavity was clear. The rest of the patient’s otolaryngologic and physical exami- nation was normal. Enhanced computed tomography (CT) showed a homogeneously enhancing mass that filled the left nasal cavity (Fig. 1). The mass was obstructing the left osteomeatal complex. Magnetic resonance imaging showed a nasal tumor in the left nasal cavity with hypoin- tense signals on T1-weighted images and moderately hyperintense signals on T2-weighted images (Fig. 2). Biopsy of the tumor was performed, and preoperative histopathologic examination revealed schwannoma. Functional endoscopic sinus surgery was performed under gen- eral anesthesia. The tumor, which originated from the lateral nasal wall near the posterior of maxillary sinus ostium, was excised completely with middle and partial superior turbinate. The tumor was thus successfully removed in 1 piece with surgical margin free of disease. Histopathologic examination revealed a spindle cell neoplasm, with hypercellular areas corresponding to Antoni A and edematous hypocellular areas of Antoni B type. Palisading nuclei consistent with Verocay bodies were noted (Fig. 3). Immunohistochemically, the tumor cells were immunoreactive for S-100 protein (Fig. 4). The patient’s postoperative course was unremarkable. Follow-up at 1 year revealed no evidence of disease, and the patient was also symptom-free. DISCUSSION Schwannoma is most commonly benign, painless, slow-growing neurogenic tumor that originates from the sheath of myelinated nerve fiber. This tumor usually consists of the head and neck region; however, finding the tumor in the nasal cavity and parana- sal sinuses was reported in about 4% of cases. 2 Symptoms of this tumor are nonspecific, which cannot be distinguished from any other neoplasms in the nasal tract. The specific symptom of a nasal schwannoma is hypesthesia or paresthesia due to the compression of the involved nerve by tumor. Imaging is very helpful in the diagnosis of the sinonasal mass. Endoscopic nasal examination, paranasal sinus CT, and magne- tic resonance imaging are usually preferred for these masses. T1-weighted images of schwannoma show isointense (Antoni A and mixture type) or hypointense (Antoni B type) signal intensity; From the Departments of *ENT and †Pathology, Kayseri Training and Re- search Hospital, Kayseri, Turkey. Received March 28, 2012. Accepted for publication April 28, 2012. Address correspondence and reprint requests to SabrN Guler, MD, Kayseri E?itim ve AraztNrma Hastanesi KBB Klini?i, Sanayi Mah. Atatu ¨rk BulvarN Hastane Cad. No: 78, 38010, Kayseri, Turkey; E-mail: drsabriguler@gmail.com This study was presented at the 33rd Turkish National Otorhinolaryngology and Head and Neck Surgery Congress, Antalya, Turkey, October 26Y30, 2011. The authors report no conflicts of interest. Copyright * 2012 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0b013e31825d0bb6 FIGURE 1. Coronal paranasal sinus CT demonstrates a homogeneously enhancing mass that filled the left nasal cavity (arrow). FIGURE 2. Magnetic resonance imaging demonstrates a nasal tumor in the left nasal cavity with hypointense signals on T1-weighted images (A) and moderately hyperintense signals on T2-weighted images (B). The Journal of Craniofacial Surgery & Volume 23, Number 6, November 2012 Brief Clinical Studies * 2012 Mutaz B. Habal, MD e567 Copyright © 2012 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.