Primary nasosinus meningioma, an etiology masks another: Case report

INTRODUCTION AND IMPORTANCE: Extracranial meningiomas of the sinonasal tract are rare tumors. The diagnosis is not generally evident. We report, through an observation, the clinical particularities, the diagnostic difficulties and the therapeutic approach of primary sinonasal meningiomas. CASE PRESENTATION: We report the case of a 54-year-old woman who presented with complaints of right nasal obstruction with the notion of recurrent epistaxis evolving for one year. At the examination, nasal endoscopy found a voluminous purplish-gray mass filling both the middle meatus and the olfactory cleft. The CT examination showed an ethmoïdonasal tumoral process extending to orbital cavity and infratemporal fossa without endocranial extension. A transnasal approach was performed, histopathological examination demonstrates a méningothélial meningioma rank1. The clinical, endoscopic and CT controls did not show tumor residue or a local recurrence. CLINICAL DISCUSSION: Meningioma is a common non-glial intracranial neoplasm. Primary or secondary extracranial meningioma (depending on whether they are isolated or associated with an intracranial tumor) location is uncommon, clinical presentation is nonspecific. Diagnostic confirmation is anatomopathological with immunohistochemically study. Imaging confirms the primary nature of these tumors. The prognosis is favorable after complete surgical excision without further adjuvant treatment. CONCLUSION: Primary nasosinus meningiomas are rare, with non-specific symtomatology and common with other local pathologies. Imaging confirms the primary character of these tumors, anatomopathological examination completed by immunohistochemical study confirms the diagnosis. Surgery with complete exeresis remains the best option with a good prognosis.