A Rare Occurrence of an Extensive Sino-Nasal Solitary Fibrous Tumour

Solitary fibrous tumours are uncommon in head and neck region, especially in the nasal cavities and paranasal sinuses, with most cases reported in the thoracic region in the pleura. It is often considered a borderline or low-grade malignant soft tissue tumour. Complete surgical resection is currently the treatment of choice, though intracranial and orbital extension of these lesions must be carefully evaluated and navigated to ensure a safe outcome.

A 36 years-old lady presented with a long one-year history of left-sided nasal obstruction with facial pain, headaches and mild visual disturbances. She had been treated for sinusitis for a prolonged period. Clinically, there was a left nasal mass obliterating the ostiomeatal complexes and the roof of the nasal cavity. MRI showed heterogeneously enhancing mass occupying the left ethmoid sinuses extending laterally eroding the left lamina papyracea to the orbit, medially towards the right nasal cavity eroding the nasal septum, and superiorly to extend intracranially. After inconclusive biopsies were performed, the mass was excised with a combined endoscopic and open lateral rhinotomy approach with left medial maxillectomy and reconstruction of the skull base defect. The tumour was eventually reported as a solitary fibrous tumour.

Solitary fibrous tumour is a rare differential of tumours in the sino-nasal region, diagnosed via histopathology. Although generally slow-growing, these lesions may extend the adjacent structures namely the orbit and skull base. Definitive treatment via surgical resection may be performed safely after careful radiological assessment and multidisciplinary consideration.