Thorotrast-induced multiple carcinomatosis of the frontal sinus.

A 78-year-old black man (Figure 1) presented with a two-month history of a slowly growing, painless mass over the right frontal sinus. He denied any history of decreased vision, headache, epistaxis, trauma, nasal discharge, or obstruction. Thirty years earlier he had a sinus irrigation with an unknown substance for sinusitis. On physical examination he had a subcutaneous 4 x 4 cm., firm, fixed, and slightly tender mass in the area of the right frontal bone. There was slight proptosis of the right eye, but visual acuity and extra-ocular movements were intact. Nasal examination revealed bilateral nasal polyps. The remainder of his physical examination, including neurologic examination, was within normal limits. On admission he had a hypochromic, normocytic anemia thought to be secondary to a bleeding polyp of the colon. Sinus roentgenograms demonstrated a lytic lesion in the right frontal area (Figure 2). Tomography revealed a lesion in the right frontal sinus with destruction of the anterior and posterior walls. Although carcinoma was suspected, a diagnosis of mucocele or pyocele