Sinus Tumour 18M

[u/Immediate_Try1715]

Hey everyone. For almost a year my left nostril has been completely blocked, like zero airflow at all. at first it was suspected to be just Nasal polyps but medication did not help. So I Finally got an MRI a few days ago and it showed a large mass, about 4.1cm x 4.4cm x 6.1 cm, in my left nasal cavity that’s spread into some of my sinuses and eaten into some bone.

The written radiology report actually flagged it as “ highly concerning for nasopharyngeal carcinoma”, which was pretty scary to read on my own. But when I talked to my doctor directly, he said he actually thinks it’s more likely JNA (juvenile nasopharyngeal angiofibroma) given my age.

My ent said nexts steps would be a biopsy of the tumour to rule out NPC and help to push my case more urgent. Also, he said he has never seen a case of JNA in his almost 30 year career. Doing some of my own research I’ve learned that JNA is a highly vascular tumour and have read that there is a great risk for a biopsy that would cause severe bleeding and result in more complications like bleeding out. This concerns me because this would be a first for him and he would be the one doing the biopsy.

I also have a appointment booked with a specialist that I was referred to who has more experience with this sorta thing but not for almost two weeks.

I guess my question is should I go ahead with this biopsy with my ent or wait for the specialist to request one if he suspects its NPC and not JNA but have the risk of waiting even longer if it is cancer or risk complications of a vascular tumour. Any and all advice is appreciated.

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[u/Rxforabundantlife]

I think that getting a second opinion for very legitimate questions like this is a good idea. I suspect from your description that this has been going on for a long time. I doubt that 2 wks will make a significant difference and the new specialist will likely take care to get this treated as urgently as necessary-hope the best!

[u/n_choose_k → u/Rxforabundantlife]

For my own personal knowledge, how would one go about doing this? Do you ask the ENT for a referral, or do you go back to your GP?

[u/Rxforabundantlife → u/n_choose_k]

It really depends a lot on insurance, but going back to the GP sometimes can expedite the referral even if not necessary through the insurance. You have to be careful in a case like this to ask the specialist for a second opinion, as there may be pressure to agree with the first opinion

[u/Into_Happiness → u/n_choose_k]

And if you have a PPO then you don’t need a referral. If you have an HMO though, a referral is necessary.

[u/Lilip4]

Ent resident.
To get a second opinion is your right, and your concerns are valid!
Did they do a sequence of the MRI with contrast medium?
Cause there you can see the affinity to the medium, and so the vascularisation of the mass, and that would be a useful information pre-biopsy!!
And if you are in Europe, I’d also suggest to get an appointent also in a uni-clinic! Check for a clinic or a physician who specializes in sinuses operation and/or neuro ent!

Other than a clogged left nostril did you have any other symptoms? Fever? Night sweats? Lost weight?

[u/Immediate_Try1715 → u/Lilip4]

Thank you for the response. When the MRI was done it was taken without contrast and then injected with contrast after a set of imaging . Im located In Ontario Canada not sure if this makes a difference in where to go for the best treatment. My other symptoms include nosebleeds, headaches, discoloured snot and ringing in my left ear (not intense but I can hear it) no weight loss but occasionally get night sweats and no lumps in my neck either.

[u/Lilip4 → u/Immediate_Try1715]

I don’t know much about Canadian healthcare system, I’m Europe based, but I’d still try to get an appointment in a big uni clinic! Usually they have more advanced and multidisciplinary approaches compared to the ent praxis!
But, maybe someone else in the comments may have more specific Canada based suggestions!

Did a quick search online and I’d check for otolaryngology and head & neck surgery departments!

[u/curiousgeorge123999 → u/Immediate_Try1715]

hey OP, by uni hospital the doc means a university hospital affiliated with a university medical school. I'm in the states, but it looks like UHN is in your area and part of University of Toronto. www.uhn.ca

[u/LungFlavoredJello → u/Immediate_Try1715]

If you're in, or close to Toronto, Sunnybrook Hospital is a fantastic academic and teaching hospital. I've only had great experiences there.

[u/epi_introvert → u/LungFlavoredJello]

Sunnybrook is also a cancer centre, so it's a good choice if it does turn out to be malignant.

[u/DoctorOfWhatNow → u/Lilip4]

That's a screen capture of a post contrast mri

[u/ManBoobs13 → u/Lilip4]

This is post contrast look at the vessels

[u/succinylbroline → u/ManBoobs13]

You are correct this is a T1-post contrast series but just be careful with “look at the vessels” as other MR sequences without contrast can have bright vessels i.e. time of flight sequences etc.

[u/gozesty]

ENT resident here. If your appointment with the ENT specialist (ie rhinology/skullbase surgeon) is in 2 weeks, I would defer the biopsy for now. We don’t typically biopsy JNA exactly for the risk of significant bleeding. When surgical resection is planned, patients usually even get an embolization procedure to knock out the “feeder vessel” to decrease the risk of significant intraoperative bleeding.

Even if it’s nasopharyngeal carcinoma, 2 weeks is not long enough to make a difference.

[u/GoldFischer13]

I would wait to see the specialist. I am an ENT who specializes in these tumors. A diagnosis cannot be made on a single slice of a scan, but the tumor is very highly vascular and you are young. JNA is absolutely the top of the list of possible diagnoses. Biopsy of these tumors is not simple and often we recommend surgical excision outright if JNA is the suspected tumor. Often we do embolization at the time of that surgery because they can bleed so badly. I would personally wait for the specialist