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Presented by Pedram Argani, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 4: 1 year old male with a nasal mass noted at birth.
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1. Question
Week 234: Case 4
1 year old male with a nasal mass noted at birth. After excision of this lesion, there was
no evidence of communication with the central nervous system, and no evidence of a CSF leak.images/8.9.05case41.jpg
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images/8.9.05case44.jpg
images/8.9.05case45.jpgCorrect
Answer: Nasal glioma
Histology: The lesion is composed of bland, neural appearing tissue intermixed with respiratory mucosa and collagen. In some areas, the tissue has the appearance of Schwann cells; however, in other areas, there appears to be a fibrillary background with occasional neurons. These areas label intensely for GFAP and S-100 protein.
Discussion: Encephalocele is distinguished from nasal glioma (glial heterotopia) mainly upon clinical findings. Encephaloceles are associated with cranial bone defects and resulting connection with the Central Nervous System, causing CSF leaks which can lead to meningitis. This distinction is best made on clinical and radiologic grounds. Teratoma would be composed of various tissues from ectodermal, endodermal, and mesodermal origin. Hence, there would be tissue other than glial tissue within the lesion. This lesion lacks cytologic atypism.
Incorrect
Answer: Nasal glioma
Histology: The lesion is composed of bland, neural appearing tissue intermixed with respiratory mucosa and collagen. In some areas, the tissue has the appearance of Schwann cells; however, in other areas, there appears to be a fibrillary background with occasional neurons. These areas label intensely for GFAP and S-100 protein.
Discussion: Encephalocele is distinguished from nasal glioma (glial heterotopia) mainly upon clinical findings. Encephaloceles are associated with cranial bone defects and resulting connection with the Central Nervous System, causing CSF leaks which can lead to meningitis. This distinction is best made on clinical and radiologic grounds. Teratoma would be composed of various tissues from ectodermal, endodermal, and mesodermal origin. Hence, there would be tissue other than glial tissue within the lesion. This lesion lacks cytologic atypism.
