A Sinonasal Mass with Epistaxis: A Rare Subtype of Common Pathology

Abstract

A 32-year-old woman presented to the ear, nose, and throat clinic with a two-month history of nasal bleeding and discharge from the left nostril. Her past medical history was unremarkable, and she was not taking any regular medications. On examination, she was afebrile and maintained normal saturation in room air, with heart rate and blood pressure within normal limits. There was no evidence of diplopia or facial tenderness. Nasal endoscopic examinations showed a large polypoidal, rubbery-looking lesion filling the left nasal cavity and bulging from the left maxillary sinus through the ostiomeatal complex and extending posteriorly to the posterior choanae, with mild septum deviation. The rest of the nasal examination was unremarkable. Computed tomography (CT) of the paranasal sinuses showed a hyperdense lesion in the left maxillary sinus extending to the left nasal cavity. The lesion was associated with bone remodeling with expansion and bone thinning but without aggressive bone changes. Magnetic resonance imaging (MRI) showed the lesion as lobular in shape with a T2-hypointense rim. The lesion was T1 hypointense with mild internal hyperintensity and showed intense centrilobular enhancement.

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