Sinonasal inflammatory myofibroblastic tumour: a rare entity with diagnostic challenges.

Inflammatory myofibroblastic tumour is a rare entity causing sinonasal involvement with variable behaviour. Mimicking various benign and malignant lesions, accurate diagnosis is often clinched on histopathology complemented with appropriate immunohistochemistry markers. Surgical resection is the main treatment modality with other forms of therapy reserved for unresectable lesions. We highlight a case of dual involvement of the sinonasal region and nasal bones along with the diagnostic and treatment challenges encountered. As the nasal bones were involved, surgical resection with negative margins required cosmetic reconstruction in the same sitting. A costochondral graft helped in achieving cosmetic pleasing results with no recurrence on follow-up.

Avoiding repeated surgery in patients with acute invasive fungal sinusitis.

PURPOSE: We aimed to ascertain whether using an aggressive initial surgical protocol would reduce the need for repeated sinus surgery in patients with acute invasive fungal sinusitis (AIFS). METHODS: Patients with AIFS prospectively underwent clinicoradiological assessment followed by bilateral functional endoscopic sinus surgery (FESS) and debridement of affected tissue. Antifungal therapy was also administered. Postoperative endoscopic debridement of crusts was performed weekly in the clinic. Outcomes were compared with a historical control group who underwent multiple surgeries. RESULTS: There were 42 male and 9 female patients aged 9-68 years (mean: 42.5 years). Forty (78.4%) patients were diabetic and 17.6% had hematological malignancies. The majority (60.8%) had stage 2 or 3 disease. Partial/total maxillectomy (29.4%), orbital exenteration (7.8%) and craniotomy (2%) were also performed at a single session in 20 patients. Intra-operative sampling of all sinuses was performed. Six patients who appeared to have unilateral disease based on clinicoradiological assessment were found to have bilateral disease. Only 2 patients required revision surgery. Follow-up ranged from 3 to 24 months. The survival rate was 68.2% overall and 73.5% for diabetics alone. The difference in outcomes with a single surgery versus multiple surgeries was not significant (p = 0.09) CONCLUSION: A surgical protocol involving bilateral FESS along with debridement of visibly affected areas and antifungal therapy avoids repeated surgery in patients with AIFS with no change in outcomes. The absence of clinicoradiological involvement of the paranasal sinuses does not preclude the presence of invasive fungal disease in these sinuses.