Tawagi Karine, Akaraz-Avedissian Rita, Burman-Solovyeva Irina
Internal Medicine, Saint Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan, USA.
BMJ Case Rep. 2018 Feb 16;2018:bcr-2017-219832. doi: 10.1136/bcr-2017-219832.
A 48-year-old man presented to urgent care with recurrent epistaxis over 6 months. Initially, nosebleeds were controlled with packing or cautery. Ultimately, he was referred to ear, nose and throat department and underwent nasal endoscopy which revealed polypoid tissue. A biopsy of the polyp showed non-specific inflammation with no evidence of malignancy. Follow-up maxillofacial CT revealed a large mass lesion in the right maxillary sinus, right nasal fossa, much of the ethmoids and right sphenoid, with destruction of adjacent bony structures. MRI revealed a mass in the right nasal cavity with extension into the ethmoid and anterior sphenoid sinus, anterior cranial fossa and medial orbits. Staging CT discovered metastatic disease in the adrenal glands and lymphadenopathy in the neck. The patient underwent endoscopic sinus surgery with debulking and tissue diagnosis of malignant melanoma. He completed radiation therapy to sinus and was subsequently enrolled in a clinical trial. Most recent imaging revealed complete metabolic response on positron emission tomography.
一名48岁男性因反复鼻出血6个月前来急诊。起初，鼻出血通过填塞或烧灼得以控制。最终，他被转诊至耳鼻喉科，接受了鼻内镜检查，发现有息肉样组织。息肉活检显示为非特异性炎症，无恶性证据。后续的颌面CT显示右侧上颌窦、右侧鼻腔、大部分筛窦和右侧蝶窦有一个大的肿块病变，相邻骨质结构被破坏。MRI显示右侧鼻腔有一个肿块，延伸至筛窦和前蝶窦、前颅窝和内侧眼眶。分期CT发现肾上腺有转移性疾病，颈部有淋巴结病。该患者接受了内镜鼻窦手术，进行了肿瘤减容并组织诊断为恶性黑色素瘤。他完成了鼻窦放疗，随后参加了一项临床试验。最近的影像学检查显示正电子发射断层扫描有完全代谢反应。
