Presentation
Left nasal obstruction and recurrent sinusitis.
Patient Data
Left nasal cavity irregular shaped soft tissue mass lesion obliterating the left nasal cavity. The lesion elicits isointense/high signal on T1 and low signal on T2 WI with heterogenous post-contrast enhancement. The lesion displaces and possibly infiltrates the adjacent nasal turbinates. It also encroaches upon the left ethmoid air cells and left maxillary antrum.
Bilateral maxillary, ethmoid, frontal and sphenoid sinusitis.
Mild bowing of the nasal septum to the right side.
Pathology after excision showed:
Gross
Multiple irregular rubbery grayish pink tissue pieces collectively measure 4.5 x 4.5 cm, admixed with bony tissue pieces measured 1.2x 1.0x 0.3cm.
Microscopic
Extensive necrosis entangles a tiny portion of viable tumor formed of papillary projections lined by columnar epithelial cysts with focal goblet cells with moderate hyperchromatic pleomorphic nuclei. There's focal extravasated mucinous material. There's a portion of bony tissue.
Diagnosis
Left nasal mass, biopsy, sino-nasal intestinal-type adenocarcinoma, grade I-II.
Case Discussion
Sinonasal adenocarcinomas are primary tumors of the sinonasal region with glandular differentiation. They are classified based on the glandular components as intestinal or non-intestinal subtypes. Intestinal type adenocarcinomas are strongly associated with wood dust exposure.These exposure-related sinonasal adenocarcinomas tend to appear in the ethmoidal sinuses and nasal cavity (which has a higher presence of inhaled promoters), whilst nonexposure-related adenocarcinomas arise more frequently in the maxillary sinus..
They show a heterogenous appearance with adjacent bone destruction.
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