Sinonasal adenocarcinoma

Case contributed by Dr Ian Bickle

Presentation

Right nasal blokage for several weeks. Now right sided facial swelling. Infection or tumour?

Patient Data

Age: 65 years
Gender: Female
CT

Large enhancing mass with bulk dimensions of 7.3 x 4.3cm centred on the right nasal canal and maxillary sinus.The mass occcupies 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 tumour extends almost to the orbital apex and anterior to the globe with a resultant right proptosis.

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

Obstructive fluid in the right maxillary and sphenoid sinuses.

MRI

MRI SINUSES AND BRAIN

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

The mass occcupies 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 tumour 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. Tumour involves both frontal extra-dural spaces, on the right compressing, and the susppicion or dural infiltration the right close to the vertex.

Obstructive fluid in the right maxillary and sphenoid sinuses.

Case Discussion

Endoscopic biopsy:  sinonasal adenocarcinoma

Compare and contrast with this case.

Sinonasal squamous cell carcinoma V sinonasal adenocarcinoma.

Notice the adenocarcinoma is centred on and involves the nasal canal vis-a-vis the squamous cell carcinoma which is sinus centred.

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Case information

rID: 58776
Published: 14th Mar 2018
Last edited: 14th Mar 2018
System: Head & Neck
Inclusion in quiz mode: Included

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