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Rhinolith Induced by a Foreign Body.

He introduced the term infantile myofibromatosis, referring to the fact that this solitary form most affected children 2 years old or younger (89% of 60 subjects). He also documented the high frequency of the solitary form (75%) and noticed that most involved anatomical sites are head and neck area, (in particular skull, eye socket, and parotid gland) with a recurrence of 35%. Other cases of oropharyngeal solitary myofibromatosis have been previously described, but it is the first case of soft palate involvement. Diagnosis is challenging, since this tumor can be misdiagnosed with other lesions affecting oropharyngeal area such as the following: (a) fibrosarcomas that present low-contrast enhancement after in CT scan, whereas in MR, they show hypoisointensity of signal in T1and T2-weighted images for collagen producing a few enhancement, irregular borders, and bone erosion signs; (b) rhabdomyosarcomas that present similar features of signal intensity to squamocellular neoplasms with hypointensity of signal in T1-weighted, which can vary the regular hyperintensity of signal linked to the physiologic presence of mucous glands; (c) minor salivary gland adenomas in the soft and hard palatal region have been reported too; and in this case, some neoplasms have demonstrated intermediate intensity of signal in T1 compared with muscle and fatty tissues, and a high intensity in T2 with irregular borders depending on the neoplasms histotype. Whereas malignant neoplasms show irregular borders, the MR shows the internal structure of minor salivary gland tumors in a multidirectional view, with the ability of finding out neoplasm. In our experience, we have noticed that many radiologic features of an initial CT examination had lead to a wrong diagnosis. It is known that this kind of lesions shows intense enhancement after contrast material injection, but it is not a specific finding. Reports about MR examinations in infantile myofibromatosis are rare and with different pathways. The signals range from low-intensity foci on T1-weighted images and bright signal on T2-weighted images to a ‘‘target’’ appearance before and after gadolinium described by other authors. The MR examination leads to obtain a reliable diagnosis. The inhomogeneity of signal in the involved tissue in T2 and the high cellularity associated to lower contents of collagen result in another benign parameter as well. Benign nature of the lesion was suspected because of the absence of perilesional edema, distinct limits, and the homogeneous enhancement after contrast injection. The hypothesis based on MR examination result was confirmed by complete excision during the surgical procedure and the absence of relapse 8 years after surgery. Excision in free margin represents the only strategy of treatment in similar conditions. In conclusion, even if infrequent, infantile myofibromatosis has to be suspected in case of soft tissue mass affecting the oropharyngeal area in young patients. Correct clinical and radiological preoperative assessments represent the key points to perform the right treatment. Magnetic resonance imaging seems to be the best diagnostic option, allowing for exclusion of the malignancy of the lesion. Resection in free margins is the treatment of choice to avoid recurrence. Andrea Romano, MD Fondazione San Raffaele Ceglie Messapica, Italy