Clin Exp Otorhinolaryngol.  2021 Nov;14(4):374-381. 10.21053/ceo.2020.01522.

Long-Term Clinical Course of Benign Fibro-Osseous Lesions in the Paranasal Sinuses

• Lee JJ
• Ryu G
• Lee KE
• Hong SD
• Jung YG
• Kim HY
• Dhong HJ
• Chung SK

• KMID: 2522428
• DOI: http://doi.org/10.21053/ceo.2020.01522

Abstract

Objectives
. Fibro-osseous lesions of the paranasal sinuses can present various clinical manifestations. This study aimed to report the long-term clinical course of benign fibro-osseous lesions (BFOLs) in the paranasal sinuses, including clinical and radiologic features.
Methods
. Radiologically confirmed BFOLs between 1994 and 2016, with the exclusion of osteoma cases, were retrospectively reviewed. We compared demographic characteristics between the surgery and observation groups. The reasons for the imaging study, radiographic features, histopathology, and clinical course based on serial image scans were analyzed.
Results
. In total, 183 subjects were selected from a thorough review of head and neck radiologic tests (n=606,068) at a tertiary referral hospital over 22 years. Patients’ mean age was 28.6±18.1 years, and 56.3% were males. A diagnostic imaging workup was performed in 55.7% of patients due to facial asymmetry, headache, skull mass, or other symptoms related to BFOLs. In other patients (37.7%), BFOLs were found incidentally on computed tomography or magnetic resonance imaging. The most common diagnosis was fibrous dysplasia, followed by ossifying fibroma, based on both radiologic exams and histopathologic results. In total, 42.6% of the patients underwent surgery because of subjective symptoms or esthetic concerns. The patients who underwent surgery were younger (P<0.001) and had a longer follow-up duration (P<0.001) than those who underwent observation. Patients who experienced lesion growth (11.5%) were younger (P<0.001) and had more lesion sites (P=0.018) than those who did not, regardless of surgical treatment. Five patients underwent optic nerve decompression, and one patient experienced malignant transformation.
Conclusion
. BFOL in the paranasal sinuses is a rare disease, and most cases were observed without specific treatment. Surgical treatment should be considered in symptomatic patients with aggressive clinical features. Regular observation and management are needed, particularly in younger patients in their teens.

Keyword

Fibro-Osseous Lesion; Paranasal Sinus; Fibrous Dysplasia; Ossifying Fibroma

Figure

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  Fig. 1 Radiologic findings of pathologically confirmed benign fibro-osseous lesions of the paranasal sinuses. Computed tomography scans of three different patients with fibrous dysplasia (FD) and ossifying fibroma (OF). (A) FD involving the right maxilla and zygoma. (B) FD confined to the right ethmoid bone. (C) FD of the sphenoid bone. (D, E) OF in the left maxillary sinus. (F) OF in the right ethmoid sinus.

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  Fig. 2 Cases with tumor regrowth after multiple operations. (A) An 8-year-old female patient with fibrous dysplasia who underwent four operations. (B) A 12-year-old female patient experienced a malignant transformation of ossifying fibroma to osteosarcoma.

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  Fig. 3 The reasons for surgery in patients with benign fibro-osseous lesions.

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  Fig. 4 Adult cases with lesion growth after surgery. (A) A 23-year-old male patient with ossifying fibroma in the right ethmoid sinus underwent surgery twice due to tumor regrowth after partial resection. Computed tomography (CT) images of initial, first postoperative, recurrent, second postoperative (with packing material), and final status. (B) A 53-year-old female patient with fibrous dysplasia exhibited lesion growth in the sphenoid sinus after surgery, as shown on two preoperative and two postoperative CT images.

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  Fig. 5 Histologic findings (H&E) of a 12-year-old patient with malignant transformation. (A) Ossifying fibroma at the first surgery. Mineralized matrix with stromal fibroblastic cells with innumerable psammomatoid calcifications. (B) Osteosarcoma at the third surgery. Pleomorphic atypical cells of various sizes with large nuclei. Osteoids with a dense and amorphous extracellular matrix.

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