Approach to a Unilateral Sinonasal Mass in a Pre-Adolescent Male: An Unusual Presentation of Allergic Fungal Rhinosinusitis

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The introduction may be improved with more recent references (2024) about "Allergic Sinusitis"

The authors presented a case report of a unilateral sinonasal mass in a pre-adolescent male, which was reported as an unusual presentation of allergic fungal rhinosinusitis with aspergilloma.

The topic is not original. However, it is relevant to alert physicians who treat similar cases and add one more report to a paucity of cases described.

The methodology is perfected. The authors write a brief introduction and then report the case with details. The images obtained by tomography and MIR are documented, and consistent photographs of the mass after surgical extraction are presented.

There is no official conclusion, just the recommendation based on their experience with this case about the importance of comprehensive diagnostic evaluation for sinonasal masses, emphasizing the need to consider allergic fungal rhinosinusitis in the differential diagnosis.

The references could be updated to one or two more recent papers. The authors can find them on Pubmed. It is not pertinent to the reviewer to cite them.

Author Response

Reviewer #1

 

The introduction may be improved with more recent references (2024) about "Allergic Sinusitis"

The authors presented a case report of a unilateral sinonasal mass in a pre-adolescent male, which was reported as an unusual presentation of allergic fungal rhinosinusitis with aspergilloma.

The topic is not original. However, it is relevant to alert physicians who treat similar cases and add one more report to a paucity of cases described.

The methodology is perfected. The authors write a brief introduction and then report the case with details. The images obtained by tomography and MIR are documented, and consistent photographs of the mass after surgical extraction are presented.

There is no official conclusion, just the recommendation based on their experience with this case about the importance of comprehensive diagnostic evaluation for sinonasal masses, emphasizing the need to consider allergic fungal rhinosinusitis in the differential diagnosis.

The references could be updated to one or two more recent papers. The authors can find them on Pubmed. It is not pertinent to the reviewer to cite them.

 

Response:

Thank you for the suggestion. Please see that an additional reference has been added in the introduction from a 2024 publication.

Reviewer 2 Report

Comments and Suggestions for Authors

1. The cardinal feature of JNA is widening of pterygopalatine fossa (PPF) that can be clearly seen in axial cuts of both CT and MRI. Unfortunately, the axial images were not uploaded.
2. The JNA appears as heterogenously hyperintense mass with intermittent flow voids. In the images provided by the authors , the proportion of voids (hallows) is much more than the proportion of hyperintensities. 

Comments for author File: Comments.pdf

Author Response

Reviewer #2

 

1. The cardinal feature of JNA is widening of pterygopalatine fossa (PPF) that can be clearly seen in axial cuts of both CT and MRI. Unfortunately, the axial images were not uploaded. Authors should mention what is the status of the PPF, PMF and ITF in this child? Request is to upload axial images as well.

 

Response:

Please see updated figures. Figure 2 has been added showing axial CT images which highlight the absence of widening of the PPF.

 

1. The JNA appears as heterogenously hyperintense mass with intermittent flow voids. In the images provided by the authors , the proportion of voids (hallows) is much more than the proportion of hyperintensities, which is unlikely. 

 

Response:

These images enabled us to exclude the diagnosis of JNA as they were not in keeping with JNA, but rather suggested AFRS which was confirmed on histology. The central signal voids seen on T2W images are characteristic of AFRS, and not of JNA. Hyperintensity of the peripheral mucosa on T2W images, and post-contrast enhancement on the T1W images suggests mucosal oedema which was again suggestive of AFRS. These images highlight that although the initial presentation was concerning of a JNA, the diagnosis was not JNA but rather AFRS.