Xanthoma of the Sphenoid Sinus: A Rare Presentation

Abstract

Objectives:

1) Present what is to the best of our knowledge the first reported case of a patient with a sphenoid sinus xanthoma. 2) Discuss the details of the clinical presentation, histopathological and radiological findings, and management of this patient.

Methods:

Medical charts and the scientific literature were reviewed.

Results:

A 36-year-old female patient with family history of hyperlipidemia presented with a 1-year history of sporadic epistaxis and an episode of severe headache 2 months prior to evaluation. The rest of her medical history and physical examination were unremarkable. Computed tomography (CT) scan and magnetic resonance images revealed a soft tissue lesion occupying and infiltrating the posterolateral aspect of an expanded sphenoid sinus on the left side. Patient underwent endoscopic sinus surgery in December 2011 with intraoperative findings of a yellow-tan, friable soft tissue filling the left sphenoid sinus. Biopsy was taken for which histologic and immunohistochemical analysis revealed proliferating foamy histiocytes consistent with xanthoma cells. As of her last follow-up examination (9 months post-op), the patient has remained asymptomatic without evidence of disease progression on nasal endoscopy or CT scan.

Conclusions:

Very few cases of xanthomas arising in the paranasal sinuses have been described in the literature. Those that have been described have only occurred in the maxillary sinus. We present the case of a 36-year-old woman with family history of herlipidemia with a left sphenoid sinus xanthoma. This is to our knowledge the first case of such a lesion reported in the English literature.