July 2008 Newsletter

Case of the Month
Robert Wu, M.D.
Bay Area ENT Medical Group

A 64 year old man presented with a one to two year history of nasal obstruction on the left side. Occasional bleeding was noted and treatment had been rendered using Zithromax but with no improvement.  Upon examination, a polypoid mass in the left nasopharynx was visualized with a flexible fiberoptic scope. A MiniCAT™ CT scan was performed in the office during the same visit. It revealed a large polyp in the nasopharynx arising from the left sphenoid sinus.

There was some question of bony erosion in the skull base area on the CT, and an MRI was ordered, revealing a mass around the cavernous sinus and near the optic chiasm.  An intranasal biopsy was performed and the initial diagnosis was olfactory neuroblastoma. Due to the posterior location of the tumor, the diagnosis was then revisited and changed to an atypical pituitary adenoma.  The patient underwent an endoscopic tumor removal by a skull base
team at a University hospital.