Head & Neck Case Review 2022-08

Head & Neck Case Review

August, 2022


A 36-year-old man presented with left eyelid drooping for one year along with progressively worsening headaches, blurry vision and diplopia for the prior month. A CT scan of the head showed a mass in the left maxillary sinus measuring 5.5 x 4.4 x 3.3 cm with bony destruction of the maxillary sinus walls and extension into the soft tissues of the posterior left orbit. The clinical and radiographic findings were highly suspicious for malignancy. A biopsy of the mass was subsequently performed. Representative CT scan radiographic images of the mass along with images of the surgical pathology are shown below.



1. To qualify as chronic invasive fungal rhinosinusitis (CIFR), symptoms must be present for at least:

  • A. 4 weeks
  • B. 8 weeks
  • C. 12 weeks
  • D. 26 weeks

2. Which of the following histopathologic features is seen in chronic granulomatous invasive fungal rhinosinusitis (CGIFR)?

  • A. Submucosal edema
  • B. Extensive fibrosis
  • C. Angioinvasive fungal hyphae
  • D. Well-formed granulomas with discrete rimming by mature lymphocytes
  • E. None of the above



George de Castro, BS, Medical Student
MD Program
Vanderbilt University School of Medicine

James Lewis Jr., MD
Department of Pathology, Microbiology, and Immunology
Vanderbilt University Medical Center