J Korean Soc Radiol.  2013 Jun;68(6):449-452. 10.3348/jksr.2013.68.6.449.

CT and Magnetic Resonance Imaging Findings of Psammomatoid Juvenile Ossifying Fibroma of the Middle Turbinate: A Case Report

• Lee SK
• Choe MS

• KMID: 2002894
• DOI: http://doi.org/10.3348/jksr.2013.68.6.449

Abstract

Ossifying fibroma of the middle turbinate is extremely rare. We report a case of psammomatoid juvenile ossifying fibroma (PsJOF) of the middle turbinate in an 18-year-old adolescent female along with its CT, MRI and pathologic features. PsJOF of the middle turbinate may present a well-demarcated, expansile, solidly enhancing mass with focal bony destruction, which may mimic various benign and malignant neoplasms of the sinonasal area. A combination of clinical, imaging and pathologic findings is prerequisite for establishing an accurate diagnosis.

MeSH Terms

Adolescent
Female
Fibroma, Ossifying
Humans
Hydrazines
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Tomography, X-Ray Computed
Turbinates
Hydrazines

Figure

• 

  Fig. 1 CT, MRI, and pathologic features of psammomatoid juvenile ossifying fibroma of the right middle turbinate in an 18-year-old adolescent female. A. Coronal enhanced CT image shows that a well-demarcated, expansile, heterogeneous mass (arrows) originating from the right middle turbinate (open arrow) involves the right nasal cavity and ethmoid sinus. Note focal bony destruction of the right lamina papyracea and right cribriform plate (arrowheads). B. Non-enhanced CT image reveals that the tumor matrix, which consists of areas of ground-glass attenuation (open arrow), hypoattenuating areas, and irregular ossifications (arrowheads), is surrounded by a thick peripheral rim of ossification (arrows). C. Enhanced CT image demonstrates moderate enhancement of the areas of ground-glass attenuation (open arrow), while the hypoattenuating areas (arrowheads) are not enhanced. D. Axial T1-weighted image shows that the mass (arrows) is heterogeneous and hypointense compared with brain. E. Axial T2-weighted image (T2WI) with fat saturation reveals heterogeneous mass (arrows) containing multiple hyperintense cystic spaces (arrowheads). Also noted is a hypointense ossification (asterisk) in the center of the mass. F. Enhanced axial T1-weighted image demonstrates moderate enhancement of the mass (arrows). Several small non-enhancing, hypointense areas (arrowheads), which are corresponded to the hyperintense cystic spaces on fast spin echo T2WI, are seen within the moderately enhancing tumor matrix. G. Low-power photomicrograph of the specimen reveals a highly cellular area (white circle), a loose or myxoid area (black circle), and scattered psammomatoid bodies (arrows) (hematoxylin & eosin staining, × 40). H. High-power photomicrograph shows characteristic psammomatoid bodies (asterisks) and intervening fibroblastic stroma (hematoxylin & eosin staining, × 200). I. High-power photomicrograph demonstrates bony trabeculae lined by osteoblastic rimming (arrowheads). J. Bone algorithm CT image obtained 13 months after endoscopic sinus surgery reveals residual disease of ground-glass attenuation at the right medial orbital wall and cribriform plate (arrows).

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