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Leiomyoma

Leiomyoma is a benign myogenic neoplasm which may sporadically occur in the sinonasal area (Zijlker and Visser 1989; Nall et al. 1997). From the histological standpoint, it is classified into the following subtypes: vascular, nonvascular, and epi-thelioid, also known as leiomyoblastoma (Batsakis 1978). In the former type, the lesion seems to arise from vessel walls. In the second type, neoplastic cells are generally spindle-shaped and associated with lengthened blunt-ended nuclei and eosinophilic cytoplasm. In the epithelioid form, the cells are round or polygonal, with clear or eosinophilic cytoplasm (Shanmugaratnam 1991).

Sinonasal Schwannoma

Fig. 8.47a-c. Benign schwannoma. Plain CT (a), SE T2 (b), Gd-DTPA SE T1(c), coronal plane. A soft tissue mass occupies the left nasal fossa. Mild displacement of the nasal septum is observed, in the absence of bone destruction. Bright contrast enhancement might reflect the relative prevalence of Antoni A component in the histology of the lesion

Sinonasal Schwannoma

Fig. 8.47a-c. Benign schwannoma. Plain CT (a), SE T2 (b), Gd-DTPA SE T1(c), coronal plane. A soft tissue mass occupies the left nasal fossa. Mild displacement of the nasal septum is observed, in the absence of bone destruction. Bright contrast enhancement might reflect the relative prevalence of Antoni A component in the histology of the lesion

Hachisuga et al. (1984), in a large series of 562 patients affected by leiomyoma, observed only five cases of sinonasal involvement. Nicolai et al. (1996), in a review of the literature, identified about 30 instances of well-documented sinonasal leiomyomas. The neoplasm usually affects subjects between the fifth and sixth decade of life, with a slight predominance for females.

The rarity of such a lesion in the sinonasal tract may be explained by the paucity of vascular smooth muscle fibers, which are considered the elements of origin (Batsakis 1978; Mccaffrey et al. 1978; ). According to other theories, the lesion could stem from aberrant undifferentiated mesenchymal cells or from piloerector or sweat gland muscles (Batsakis 1978; Barr et al. 1990).

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