Case contribution: Dr Radhiana Hassan


  • A 55 years old lady
  • No known medical illness
  • Presented with epistaxis nasal stuffiness
  • Clinical examination shows mass lesion in the nose
MRI of paranasal sinus in axial plane T1FS pre and post contrast (upper row) and T2 and T1+Gado (lower row)
MRI of paranasal sinus in coronal plane T1FS+Gadolinium

MRI findings:

  • A large lobulated mass in the right ethmoidal sinus (yellow arrows)
  • Extension into the right orbit (white arrow) causing distortion and displacement of the right globe
  • Extension into the right maxillary sinus and inferior turbinate
  • Intracranial extension indenting the frontal lobe gyrus (red arrow)
CT scan brain in bone window

CT scan findings:

  • Right proptosis
  • Bone erosions are seen involving the right lamina papyracea
  • Right nasal bone and wall of the frontal sinus are also involved

Diagnosis: Olfactory neuroblastoma (Esthesioneuroblastoma)-Biopsy proven


  • Olfactory neuroblastoma also known as esthesioneuroblastoma
  • It is tumour arising from basal layer of the olfactory epithelium in the superior recess of nasal cavity.
  • Bimodal age distribution; 2nd decade and 5-6th decades
  • No gender predilection
  • The tumours are slow growing and begin as masses at superior olfactory recess and initially inolve the anterior and middle ethmoid air cells.
  • As it grow, it can destroy surrounding bone and can extend in any direction. It can form ‘dumbbell-shaped’ with waist as it passes through the cribriform plate. Superior invasion to anterior cranial fossal, laterally to orbits and across the midline to the contralateral nasal cavity.
  • Presence of cervical and retropharyngeal nodal metastasis is seen in 10-44% of cases at diagnosis.
  • CT scan is good in assessment of extension and bone destruction. Focal calcificaitons are occasionally present. Bony margin remodelling and resorbed are seen.
  • Variable enhancement usually moderate to intense
Author: radhianahassan