Doctors at Sakra World Hospital have successfully treated a very rare case of sino-nasal vascular tumour on a 66-year old male in the city. The Phosphaturic Mesenchymal Tumour (PMT), Hemangio Pericytoma of Ethmoid Sinus was found in a 66-year-old male patient who was confined to a wheel-chair. Only 12 such rare cases of the tumour has been reported worldwide till date according to medical journals.

He is a writer and was bed-ridden for the last 6 months, who had undergone a hip replacement surgery after a fall in the bathroom two years ago. He should have completely recovered post-surgery but unfortunately his condition kept deteriorating. Visits to multiple hospitals neither identify the core issue nor treated his condition. His condition further worsened that he was confined to a wheelchair and had to be carried around even for his ablutions. Being the sole bread winner of the house he could not afford to be in this situation, over and above he was also diabetic, hypertensive and had a CABG (Coronary artery bypass grafting) done in past.  

The patient was referred to Prof.Dr.C.V. Harinarayan, Director Diabetes, Endocrinology and Osteoporosis, who identified the problem to be the loss of phosphorus from the body.  According to Dr. Harinarayan, ‘Phosphorus along with calcium, phosphate, vitamin D etc. are important components for the formation of the bones. In normal conditions the phosphorus is reabsorbed into the body by the kidneys, but in this case it was excreted resulting in soft bones.  Such a condition occurs due to the presence of a Phosphaturic Mesenchymal Tumour which is a rare benign tumour which inappropriately produces a substance known as FGF23 (Fibroblast Growth Factor 23) which decreases the rate of reabsorption of phosphorous in the body.’

Based on the above biochemical assessment a Positron Emission Tomography (PET) scan was conducted in order to locate the position of the tumour. The scan revealed a tumour at the base of the skull, very close to the eyes and base of the brain (Posterior Ethmoidal Sinus). The size and position of the tumour made it very complicated and required highly-skilled and experienced doctors to handle.

Based on the assessment and location of the tumour, the team at Sakra World Hospital performed a specialised CT scan and generated a 3D image of the tumour and decided on the complex procedure.  ‘Being a vascular tumour, the risk of blood loss could have been very high and any mishap could have led to serious damages to the eyes and the brain. The navigation assisted endoscopic procedure along with the CT scan helped in successfully performing the surgery with minimal blood loss and without any incisions,’ said, Dr. Honey Ashok, Senior Consultant - ENT, Head Neck Surgery & Head Neck Onco Surgery.

The patient showed signs of recovery within just a few hours of the surgery and laboratory tests showed a steady rise in phosphorus levels. The patient was discharged the very next day with advice for regular follow up. Now his FGF level has returned to normal.

“The past one year of my life has been a very difficult with what had taken place. Being confined to a wheel-chair and not being able to perform even the daily chores made me miserable. Visited many doctors and hospitals and unfortunately no one could locate the problem. I am thankful that Dr. Harinarayan and team who could not only locate the problem, but also through their expert advice and experience treat the same. I am able to walk again and can complete all my pending jobs,” says the cured male patient.

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Dr. Honey Ashok
Senior Consultant - ENT, Head Neck Surgery & Head Neck Onco Surgery

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Dr. Shantanu Tandon
Senior Consultant ENT & Head neck surgery

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Dr. Dali Chandran
Attending Consultant - ENT and Head Neck surgery

Dr. Divya .B
Attending Consultant - ENT and Head Neck surgery