A 12-year-old male child had headache for 2 months and diplopia for 15 days. Child had right 6th nerve paresis. CT showed a well-defined homogenously enhancing sphenoid sinus lesion. Extending superiorly and on both sides. MRI showed T1-hypo-isointemse, T2-hyper-isointense, and heterogeneously enhancing mass in sphenoid sinus. Patient underwent endoscopic transnasal decompression of lesion. Lesion was grayish white granular with moderate vascularity. Histopathology showed polymorphous cellular lesion with multiple conglomerate confluent histiocytic cells, with giant cells and mixed inflammatory cells. Hemorrhage and necrosis were noted. Histiocytes had a moderate amount of cytoplasm with oval nucleus and central constriction and groves. Immunohistochemistry (IHC) showed CD1a positive with MIB-1 labeling index of 10%-12% [Figure 1]. Diagnosis of Langerhans cell histiocytosis (LCH) was made. Patient was conservatively managed, and the child is asymptomatic at 18 months follow-up
A 43-year-old male had headache for 1 year, double vision for 8 months, and diminution of vision in both eyes for 1 month. He was on antiretroviral therapy for human immunodeficiency virus (HIV) infection since 3 years. CD4 count was 320 cells/mm3. He was previously treated for pulmonary tuberculosis 1 year back. The visual acuity was 6/18 bilaterally with left lateral rectus palsy. CT scan showed a sphenoid-sellar lesion. MRI showed well-defined lobulated homogeneous lesion involving the sphenoid sinus, sella, and clivus. The lesion was homogeneously isointense to gray matter on T2-weighted image (T2WI) and hyperintense on T2-weighted image (T1WI) without any diffusion restriction. There was no evidence of blooming on gradient images. Strong homogeneous postcontrast enhancement was noted. The lesion was seen invading bilateral cavernous sinuses. Patient underwent endoscopic transnasal decompression of the lesion. Histopathology showed cellular lesion with monomorphic small to medium cells in sheets, infiltrating bone which was strongly positive for lambda light chain and few cells for kappa chain, negative for cytokeratin, chromogranin, and pituitary hormones [Figure 2]. Features were suggestive of plasmacytoma. Systemic workup for myeloma was negative. Patient underwent radiotherapy, and MRI performed 1 year later showed no recurrence
A 41-year-old male had headache and blurring of vision for 1 year, which increased in last 10 days. There was no perception of light in the left eye, and vision in the right eye was 6/9. CT showed well-defined sphenoid sinus lesion with sellar and suprasellar extension. MRI showed an expansile mass lesion arising from the sphenoid sinus expanding the sinus uniformly. Pituitary was seen separately and displaced superiorly. Lesion showed hypointense signal on T1WI, hyperintense on T2WI with scattered areas of microbleeds within. Diffusion-weighted imaging showed predominantly facilitated diffusion. On postcontrast study, variegated pattern of enhancement was seen within the lesion. Optic nerves appeared to be compressed at the optic canal level with superior displacement of the optic chiasm. Bilateral ICA was splayed by the mass lesion without any luminal narrowing. Patient underwent endoscopic transnasal transsphenoidal decompression of soft suckable vascular lesion inside sphenoid sinus. Histopathology showed a cellular neoplasm with prominent myxoid stroma, small epithelial-like dispersed cells with eosinophilic cytoplasm arranged in sheets, and trabeculae, interspersed with characteristic vacuolated physaliphorous cells [Figure 3]. Impression was chordoma. MRI at 3 months after surgery showed small residue for which radiotherapy was given
A 52-year-old male had headache for 5 years, and nasal bleeding for 1 month. He is a known case of Parkinson's disease on treatment. Although his visual acuity was normal, he had right temporal field defect. MRI was suggestive of primary sphenoid sinus lesion, with sellar extension. Patient underwent transnasal decompression of soft suckable vascular lesion. There was no bony defect seen in the sellar floor [Figure 4]. Histopathology was suggestive of ectopic pituitary adenoma. He underwent radiotherapy for residual tumor. MRI performed at 7 months after surgery showed very small residual lesion, which was managed conservatively
A 53-year-old male had headache for 8 months, decreased vision in the right eye, and numbness of face for 1 month. Visual acuity was limited to perception of light. MRI showed a sphenoid sinus lesion T1-isointense, T2-hypointense, and well enhancing on contrast. CT scan showed lesion extending till posterior nasal cavity with bone erosion. Patient underwent endoscopic transnasal decompression of lesion which was seen growing predominantly posterior and inferior, occluding choana superiorly till cranial base and nasal cavity. Lesion was firm, moderately vascular with cartilaginous feel. Dura was not involved. Histopathology of lesion showed variably cellular lesion composed of fragments of interlacing and whorled fascicles of spindle cells having oval flat ended nuclei and moderate eosinophilic cytoplasm. There were significant anisonucleosis and scattered mitosis (2-3/10 hpf) and evidence of bone invasion. IHC showed tumor cells to be strongly positive for vimentin and smooth muscle actin, negative for desmin and S-100. MIB-1 labeling was 8%-10% [Figure 5]. Features were suggestive of leiomyosarcoma (LMS). Patient was referred to oncologist for adjuvant therapy and is not available for follow-up
A 48-year-old diabetic female had double vision for 2 days. She had isolated left 6th nerve paresis. MRI showed a T1-hyperintense, T2-hypointense right-sided sphenoid sinus lesion, which was showing peripheral contrast enhancement. Patient underwent transsphenoidal biopsy. Histopathological examination revealed fungal ball with admixture of broad aseptate fungi with thin septate acute angled hyphae with chains of spores and conidia indicative of Aspergillus. Some hyphae were pigmented. There were no eosinophilic infiltrate or Charcot-Leyden crystals [Figure 6]. Final impression was combined zygomycosis and Aspergillus infection without any host response. Patient was put on voriconazole and was asymptomatic at 13 months follow-up
A 61-year-old male presented with progressive visual deterioration in the left eye, and ptosis for 1 month. He was previously operated for a mucocele about 5 years back. Patient underwent transnasal resection of lesion [Figure 7]. Diagnosis was sphenoid sinus mucocele.