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Previous Volume 356:2721-2730 June 28, 2007 Number 26 Next

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Presentation of Case

Dr. Margo McKenna Benoit (Otolaryngology): An 11-year-old boy was referred to a pediatric otolaryngologist at the Massachusetts Eye and Ear Infirmary because of headaches and a right nasal mass. Bifrontal headaches had started approximately 5 years earlier; in recent months, the pain had been predominantly in the right supraorbital area. The patient had chronic nasal congestion with occasional rhinorrhea. Approximately 2 years earlier, a neurologist had made a diagnosis of migraine headache. Magnetic resonance imaging (MRI) of the head at that time showed no intracranial abnormalities, but the findings were interpreted as being consistent with sinusitis.

Two months before presentation, . . . [Full Text of this Article]

Differential Diagnosis

Congenital and Inflammatory Nasal Masses

Neoplasms in the Nasal Cavity

            Juvenile Nasal Angiofibroma

            Soft-Tissue Sarcomas and Lymphomas

Fibro-Osseous Lesions

            Fibrous Dysplasia

            Ossifying Fibroma

            Juvenile Ossifying Fibroma

            Osteosarcoma and Chondrosarcoma

Olfactory Neuroblastoma

Summary

Dr. Michael J. Cunningham's Diagnosis

Pathological Discussion

Discussion of Management

Staging of Olfactory Neuroblastoma

Surgical Management

            Anterior Craniofacial Resection

Radiation Therapy

Anatomical Diagnosis

Source Information

From the Departments of Otolaryngology (M.J.C., D.T.L.) and Radiology (H.D.C.), Massachusetts Eye and Ear Infirmary; the Departments of Neurosurgery (W.T.C.), Pediatrics (D.H.E.), Radiation Oncology (T.I.Y.), and Pathology (W.C.F.), Massachusetts General Hospital; and the Departments of Otology and Laryngology (M.J.C., D.T.L.), Surgery (W.T.C.), Pediatrics (D.H.E.), Radiation Oncology (T.I.Y.), Radiology (H.D.C.), and Pathology (W.C.F.), Harvard Medical School — all in Boston.

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