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Sinonasal adenocarcinoma

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Right nasal blockage for several weeks. Now right-sided facial swelling. Infection or tumor?

Patient Data

Age: 65 years
Gender: Female
ct

Large enhancing mass with bulk dimensions of 7.3 x 4.3 cm centered on the right nasal canal and maxillary sinus. The mass occupies and expands the right nasal canal extending both the ethmoidal and frontal sinuses bilaterally. It displaces the nasal septum to the left.

Destruction of the medial wall of the right maxillary sinus and anterior wall of the right sphenoid sinus. The mass extends into the right extraconal space through the maxillary wall defect and infiltrates the medial rectus muscle and abuts the optic nerve. The tumor extends almost to the orbital apex and anterior to the globe with a resultant right proptosis.

The planum sphenoidale is destroyed, with a 2 cm defect, as is the inner table of the skull at the level of the frontal sinus. Tumor involves both frontal extra-dural spaces, on the right compressing the dura.

Obstructed fluid in the right maxillary and sphenoid sinuses.

mri

MRI SINUSES AND BRAIN

Large enhancing mass with bulk dimensions of 7.3 x 4.3 cm centered on the right nasal canal and maxillary sinus.

The mass occupies and expands the right nasal canal extending both the ethmoidal and frontal sinuses bilaterally. It displaces the nasal septum to the left.

The mass extends into the right extraconal space and infiltration of the medial rectus muscle and abuts the optic nerve between 2-5 o'clock. The tumor extends almost to the orbital apex. Right proptosis.

The planum sphenoidale is destroyed, as is the inner table of the skull at the level of the frontal sinus. Tumor involves both frontal extra-dural spaces, on the right compressing, and the suspicion or dural infiltration the right close to the vertex.

Obstructed fluid in the right maxillary and sphenoid sinuses.

Case Discussion

Endoscopic biopsy:  sinonasal adenocarcinoma

Compare and contrast with this case (sinonasal squamous cell carcinoma vs. sinonasal adenocarcinoma).

Notice the adenocarcinoma in this case is centered on and involves the nasal canal, whereas the squamous cell carcinoma in the linked case is sinus centered.

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