Nasal Glioma

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342

NASAL

CLIOMA

3. Ilaworth,

J. C.,

and

Macdonald,

NI.

S.

:

Re-ducing sugars in the urine and blood of

pre-mature babies. Arch. Dis. Child., 32:417,

1957.

4. Crvboski,

J.

D., Zilis,

J.,

and Ma,

0.

H.

: A

stud of fecal sugars by high-voltage electro-phoresis. Gastroenterologv, 47:26, 1964.

5. NIabrv, C. C., Gryboski,

J.

D., and Karam, E.:

Rapid identification and measurement of mono- and oligosaccharides: An adaptation of

high-voltage paper electrophoresis for sugars

and its application to biologic materials.

J.

Lab. Clin. Med., 62:817, 1963.

6. Montgomery, E. M., and Hudson, C. S. : Rela-tions between rotatory power and structure

in the sugar group. XXVII. Synthesis of a

a new disaccharide ketose (lactulose) from lactose.

J.

Amer. Omem. Soc., 52:2101, 1930.

7. Adachi, S., and Patton, S. : Presence and

signi-Iiiaiice of lactulose in milk products: A re-Vi(’W.

J.

Dairy Sci., 44:1375, 1961.

8. Cerritsen, T., Lemli, L., Piacek, L.

J.,

and

Waisman, I I A. : The presence of lactulose in the urine of infants with lactosuria.

PEru-ATRICS, 32: 1033, 1963.

9. l)ahlqvist, A., and Cryboski,

J.

D. : Inability of

the lumn small-intestinal lactose to hydrolyze

lactulose (4-fl-D-galactopyranosyl)-D-fruc-tose). (In preparation).

Nasal

Glioma

An

intranasal

glioma

presenting

at birth

as a

readily visible polyp without any evidence of

nasal deformity is an uncommon lesion. The

P11P0Se

of

this

report

is

to

record

one

such

case

in

which

the

site

of

attachment

of

the

glioma to

the

brain

was

studied

at

operation.

CASE REPORT

On the day after his birth, August 26, 1958, a

boy (AR.) was referred to the Brisbane Children’s

hospital with a provisional diagnosis of nasal

encephalocoele. A reddish fleshy lump was to be

S(en just within the left nostril. There was no

other evidence of nasal abnormality, and, in

par-ticular, the nasal bridge was normal. No

neuro-logical abnormality was found. On these grounds

it was considered unlikely that the lesion was an

tncephalocoele, but air ventriculography through

the

anterior fontanelle was performed to exclude the possibility of a ventricular diverticulum from

the frontal horn. The ventriculogram was

com-pletely normal.

The child was then referred to an otorhino-larvngologist, Dr. Paxton Black, for treatment of the nasal lesion on its merits. The readily

acces-sible portion of the mass was excised on August

28 and submitted to microscopic examination. Dr. Margaret Mead reported as follows: “the ‘stalk’ is

composed of chronically inflamed nasal mucosa.

Close to the ‘stalk’ there is a very small nodule of glial tissue. This appears to be a small rest rather

than portion of a larger tumor” (Fig. 1).

A second biopsy specimen taken on September

8, confirmed the diagnosis of nasal glionia. “The

greater portion of the specimen is vascular granu-lation tissue but there are several fragments of

well differentiated glial tissue present and some

areas of calcification. Summary: Nasal Clioma.” Accordingly, on September 24, the whole mass

was excised. This procedure was quite uneventful except that traction upon the lesion during its de-livery caused bradycardia profound enough to alarm the anesthetist. The nasal cavity healed cleanly and the child was discharged from

Imos-pital.

histological examination was reported:

“Sections show glial fibers, numerous swollen astro-cytes, occasional small nerve cells, fibrovascular

tissue and nasal mucosa. The arrangement of cells

is irregular and the mucosa appears infiltrated by

the glial cells. The appearance is more suggestive

of a nasal glioma than an encephalocoele.”

The patient next presented at the age of 6 months, on March 13, 1959, with a mass again almost filling the left nasal cavity. On March 19 this lesion was again excised from the nose, and

traction upon it was again noted to cause profound

bradycardia. Thorough curettage of the roof of the

nose

caused

the escape of a stream of clear fluid.

The nasal cavity was packed, and the child was

referred back to the neurosurgeon for repair of the

cerebrospinal fluid leak.

On March 20, a left frontal osteoplastic flap was

cut and reflected, and the dura mater was opened.

The

brain

was

tense

due

to

distension of the

subarachnoid space. Several frontal polar veins

were divided to mobilize the frontal lobe, which

was retracted to expose the orbital roof and cribri-form plate.

About 1 cm anterior to the olfactory bulb, and

in line with its medial edge, there was a defect 4

mm

by

3 mm in size in the nasal roof, through

which the dura mater was continuous with

the

nasal

periosteum.

Through

this

opening passed a

narrow stalk from the frontal pole. The cerebral

end of this stalk expanded to a disk about 7-8

mm in diameter, which appeared gliotic and was quite tough. Normal cortex was excised around

this disk, which was then detached from the brain

(Fig. 2).

Traction on the stalk was then effective, together

with dissection, in delivering a small mass from

the nasal cavity. The nasal pack was then visible.

A piece of pericranium was used to patch the

de-feet, and the craniotomy was closed in the usual

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EXPERIENCE

AND

REASON-BRIEFLY

RECORDED

h

343

Ftc. I. i’hmree )l1otu1nicrographs slioving (a) islands of glial tissue in relationship to the nasal mimtzeosa;

(

I)) :5 t\l)iC1l field of glial tissue, and (c) an area containing several small nerve cells.

and the child I)1S remained t’el1 to the (late of

writing.

histological rcI)orts read: “Nasal biopsy: See-tion shows densely fibrosed nasal mucosa with a few small isolated foci of ghial tissue embedded in it. One fragment consists of glial tissue with a

few sniall cells resembling nerve cells. Brain tissue:

Sections show a small amount of sclerotic glial

tissue

firmly

adherent to fibrous vascularized

pia-arachnoid which contains a few inflammatory cells. No evidence of malignancy. No nerve seen in

serial 5((tiO115 through the reniainder of the tissue.”

COMMENT

Tile occurrence of cerebral tissue in extra-cranial sites has always excited interest. The

paper of Low, Scheinberg, and Anderseni

discusses the various propositions (1) that such tumors replesent neoplasia in rests of cerebral

tissue prematurely separated from the anterior

cerebral vesicle; (2) that the tumors are of the

nature of encephalocoeles; and (3) that such

tumors are independent, and autonomous in origin .

Russell

and

Rubenstein2

differentiate

nasal “gliomas” as a form of haniartoma, and

tuniors “which have an anatomical connection

with the brain, and are of the nature of

en-cavity

within

the lesion. (3) The growth of the

lesion at a rate in excess of that of the general

body growth after incomplete excision. (4) Its

attachment to the cerebrum as described in the

operation notes.

There are several features of particular

in-terest. The site of the defect in the nasal roof

through

which

the

lesion

passed

was

1 cm

anterior to the cribriform plate and well away

CORAMCN c5ICUM

eR.NP. DECtCT

C4CO ?LATE

2PWtMOiAL AJDC.E

FR0W1AL PaLm

GL%QMA

OLFACOP1 SL)L&

TtePa5.AL POLE

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344 NASAL

GLIOMA

from the foramen caecum. If the lesion is to

be

accounted

for

on

embryological

grounds,

then

it

would

seem

that

it

represents

tumor

growth of persistent glial tissue

in

the

region

of

the

olfactory

capsule

well

to

the

olfactory bulb itself. The

site

of attachment

to

brain anteromedial to the olfactory bulb

sug-gested

the

possibility

that

the

nervus

terminalis

might be represented by the lesion, but

his-tological examination failed to disclose any

nerve

fibers

within

the

specimen

removed.

However,

the

profound

bradycardia

caused

by

traction upon the lesion in the nose suggests

transmission of this tension to such a region as

the

perforated

substance

where

the

nervus terminalis is lost to view rather than

to non-specific

area

of frontal

cortex.

It is an

attractive

possibility

that

the

lesion

is in

fact

a glioma

of the

13th

cranial

nerve.

KENNETH

G.

JA.nssoN,

M.S.,

F.R.A.C.S.

Department

of

Neurology

and

Neuro-surgery, Brisbane Hospital and Brisbane

Children’s

Hospital,

Australia

Ladhope

131

Wickham

Terrace

Brisbane,

Australia

Prepared with the aid of a Grant from the

Margaret Hart Martin Bequest for Brain and

Cancer Research in the University of Queensland,

which is gratefully acknowledged.

REFERENCES

1. Low, N. L., Scheinberg, L., and Andersen,

D. H. : Brain tissue in the nose and throat.

Pram&mics,

18:254, 1956.

2. Russell, D. S., and Rubenstein, L.

J.

:

The

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1965;35;342

Pediatrics

KENNETH G. JAMIESON

Nasal Glioma

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