Fibrous Dysplasia of Paranasal Sinuses – An atypical case

Dr AC Srivastava and colleagues at Dr R.M.L. Hospital, Lucknow have reported a rare case of Fibrous Dysplasia of Paranasal Sinuses. The case has appeared in the Journal of Physicians of India.

Fibrous dysplasia is a fibro-osseous lesion where normal bone and marrow is replaced with fibrous tissue, resulting in the formation of bone that is weak and prone to expansion. It represents 2% of the osseous tumours. The involvement of the craniofacial skeleton is not uncommon but rarely involves the paranasal sinus.

A 61- year old male patient came with chief complaints of frontal headache for 3 months duration and pain and redness in the right eye for 1 week. He denied a deficit of visual accuracy, watering and discharge from eyes, neither any complaints of otalgia, nasal obstruction, nasal discharge, and toothache. The patient was a known case of diabetes and had been taking medications for that and his blood sugar level was controlled. There was mild proptosis of the right eye. There was no facial asymmetry, the glasses are worn by the patient was according to his visual accuracy, the intraocular pressure was within normal limits. No other abnormality was detected on ophthalmoscopy.

Systemic examination was clinically normal, and routine blood examinations were within normal limits. He was managed on an OPD basis for iritis of the right eye and for identifying the aetiology behind mild proptosis of the right eye, CECT paranasal sinuses were done. It showed ground-glass opacity predominantly involving the right side, bilateral maxillary sinus, and obliterated right fronto-ethmoidal and bilateral spheno-ethmoidal recess (Figure 1). He underwent nasal endoscopy and biopsy.

Histopathology of excised tissue showed a benign fibro-osseous lesion formed by a hypercellular fibroblastic stroma consisting of spindle cells arranged in whorls with storiform pattern and also in loose sheets with intervening collagen interspersed amongst these was immature woven bone with Chinese letter configuration. These features were consistent with fibrous dysplasia. But since fibrous dysplasia is a benign bone disease and the patient's age was 61 years, there was no surgical treatment required. He was continued with the treatment of iritis. Progress after treatment was on expected lines and recovery was complete by the time of discharge.