Presentation
Bilateral nasal obstruction, epistaxis, facial pain and vision changes.
Patient Data
A sphenoid sinus lesion of irregular morphology, partially defined borders, heterogeneous of hypointense predominance in T1, hyperintense in T2 and FLAIR, with small internal areas of restriction to the diffusion in DWI/ADC, presence of artifact of magnetic susceptibility in SWI sequence, in relation to remains of hemosiderin, which after applying paramagnetic contrast presents heterogeneous enhancement.
The lesion extends anteriorly into anterior and posterior ethmoid cells to Cottle's area V; superiorly with bone erosion of the anterior cranial fossa floor with intracranial extension contacting with straight gyres, laterally with bone erosion of the bilateral lamina papiracea displacing extraconal fat, optic nerves to its intracranial portions and medial rectus muscles; later with extension to sellar region not identifying gland pituitary. This lesion measures approximately 49 x 60 x 47 mm.
The patient underwent a rhinoscopy with a biopsy. This confirmed an intestinal-type nasal adenocarcinoma.
Case Discussion
This is a case of intestinal-type nasal adenocarcinoma, confirmed with histopathological and immunohistochemical results. In this case, the lesion is large and has intracranial extension, so the treatment is multidisciplinary, currently based on radiotherapy, hoping to obtain a reduction of the tumor to later consider continuing with chemotherapy or, alternatively, surgical resection. It is important to remember that it has a very poor prognosis when the base of the skull is affected.
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