ASOPRSFall Scientific SymposiumSyllabus
179
T25
RecurrentMalignantMeningiomaof theEthmoidSinus: CaseStudy and
LiteratureReview
LeslieNeems, ChambersChristopher. Ophthalmology, NorthwesternUniversity, Chicago, IL, UnitedStates
Introduction:
This case report is to presents a patient with recurrent malignant meningioma of the ethmoid sinus invading
the inferiormedial orbit.This patient’s course is that of a highly aggressive tumor, and poses a significant challenge to current
treatment options.
Methods:
Review of literature via PubMED andOvid. Chart review usingNorthwestern’s electronicmedical records.
Results:
55 year oldmale presented for amass adjacent to the left medial canthuswith associated tearing for threemonths.
He had a history of malignant sinonasal meningioma status post wide excision and external beam radiation four years prior.
Exam revealed a raised 1 cmmass between the left medial canthus and the bridge of the nose.MRI showed a 1.5 cmmass
involving the inferiormedial orbit. Biopsy demonstrated recurrent grade III malignant meningioma. ENT performed a radical resection
with free flap reconstruction. Oculoplastics performed a left orbitotomy, removal of themedial wall and floor with placement of
implants, and stenting of the nasolacrimal system. Pathology report showed disease freemargins.The patient is healingwell.
Conclusions:
Intracranial meningiomas are common, accounting for 30% of all intracranial tumors. Extracranial meningiomas are
rare, comprising only 1-2% of all meningiomas.This case report joins a limited body of knowledge of meningiomas of the sinonasal
tract.To date, four cases of sinonasal meningiomas presented primarily for ocular complaints.These complaints included blindness
in one case, secondary to invasion and compression of the orbit.This patient’s primary complaint was tearing from themass
compressing the nasolacrimal system.
These tumors are diagnosed and graded histologically, according to theWHO criteria.The overwhelmingmajority of tumors are grade
I, and have a benign course.This case is a grade III malignant meningioma. It has recurred and infiltrated surrounding structures.
Secondary to prior intervention, surgical planningwas complicated. Overall, the prognosis for such tumors is poor.This case
demonstrates the aggressive nature of this tumor, the complexity of treatment, and how optimal treatment is givenwith collaboration
between subspecialties.
References:
M., Petrulionis,ValevicieneN., Paulauskiene I., and Bruzaite J. “Primary Extracranial Meningioma of the Sinonasal
Tract.”Acta Radiologica 46.4 (2005): 415-18. Print.
Thompson, Lester, and Kymberly Gyure. “Extracranial Sinonasal Tract Meningiomas.”TheAmerican Journal of Surgical Pathology
24.5 (2000): 640-50. Print.
Mnejja,M., B. Hammami, and L. Bougacha. “Primary Sinonasal Meningioma.” Eur AnnOtorhinolaryngol HeadNeck Dis 129.1
(2012): 47-50. Print
Whittle, Ian R., Colin Smith, ParthibanNavoo, andDonaldCollie. “Meningiomas.”The Lancet 363 (2004): 1536-543. Print
DetailedProgram
—Thursday,October 16, 2014
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