A Case of Sinonasal Low-Grade Nonintestinal Adenocarcinoma That Was Difficult to Diagnose Preoperatively

Abstract

We report a case of sinonasal low-grade, nonintestinal adenocarcinoma (LG non-ITAC). The patient, a 56-year-old woman, was referred to our university hospital for a left nasal tumor with nasal obstruction, epistaxis, and nasal discharge. Nasal endoscopy revealed a nasal polypoid tumor with a smooth margin occupying the left nasal cavity. The sinonasal tumor was diagnosed as an exophytic papilloma by histopathology. Sinonasal contrast computed tomography (CT) confirmed homogeneous opacification of the left frontal, maxillary, and ethmoidal sinuses. There was no evidence of a potential bone defect. T2-weighted magnetic resonance imaging (MRI) showed a relatively uniform high signal intensity area in the left maxillary and frontal sinuses. An area of high signal intensity was also found in a part of the left ethmoid sinus. Left transnasal endoscopic ethmoidectomy was performed under general anesthesia. The tumor in the nasal cavity was prone to bleeding. We defined the site of tumor attachment as the suprabullar cell. The anterior ethmoidal artery was exposed, and the tumor was carefully dissected and removed. Based on the findings of these radiological and histological examinations, the sinonasal tumor was diagnosed as a LG non-ITAC. Sinonasal non-ITAC is an adenocarcinoma without the histopathological characteristics of salivary or intestinal-type adenocarcinoma. Non-ITAC is additionally classified into the high-grade and LG types. LG non-ITAC is very uncommon. Thus far, there is only one published report in the literature on the clinical and therapeutic characteristics of LG non-ITAC in Japan. Non-ITAC has a good prognosis, with a low risk of metastasis. Therefore, it is imperative to suspect and distinguish non-ITAC from other sinonasal tumors with similar symptoms preoperatively.

Keywords

sinonasal adenocarcinoma - low-grade - non intestinal type

Publikationsverlauf

Eingereicht: 16. Januar 2023

Angenommen: 02. Juni 2023

Artikel online veröffentlicht:
15. Dezember 2023

• References

• 1 Tachino H, Takakura H, Shojaku H. et al. Case report: response to intra-arterial cisplatin and concurrent radiotherapy followed by salvage surgery in a patient with advanced primary sinonasal low-grade non-intestinal adenocarcinoma. Front Surg 2020; 7: 599392
• 2 Stelow EB, Brandwein-Gensler M, Franchi A. et al. Non-intestinal-type adenocarcinoma. In: El-Nagger AK, Chan JKC, Grandis JR. et al. eds. WHO Classification of Head and Neck Tumours. 4th ed.. Lyon: International Agency for Research on Cancer; 2017: 24-26
• 3 Bhaijee F, Carron J, Bell D. Low-grade nonintestinal sinonasal adenocarcinoma: a diagnosis of exclusion. Ann Diagn Pathol 2011; 15 (03) 181-184
• 4 Leivo I. Sinonasal adenocarcinoma: update on classification, immunophenotype and molecular features. Head Neck Pathol 2016; 10 (01) 68-74
• 5 Shojiroh M, Tahashi T, Toshitaka N. et al. Atlas of Differential Diagnosis of Tumor Pathology Head and Neck Tumors II [in Japanese]. Tokyo, Bunknodo: 2015: 65-70
• 6 Yue C, Piao Y, Bai Y, Liu H, Zhang L. Sinonasal low-grade non-intestinal-type adenocarcinoma: a retrospective analysis and literature review. Ann Diagn Pathol 2021; 52: 151709
• 7 Ozolek JA, Barnes EL, Hunt JL. Basal/myoepithelial cells in chronic sinusitis, respiratory epithelial adenomatoid hamartoma, inverted papilloma, and intestinal-type and nonintestinal-type sinonasal adenocarcinoma: an immunohistochemical study. Arch Pathol Lab Med 2007; 131 (04) 530-537
• 8 Dum D, Menz A, Völkel C. et al. Cytokeratin 7 and cytokeratin 20 expression in cancer: a tissue microarray study on 15,424 cancers. Exp Mol Pathol 2022; 126: 104762
• 9 Kaimaktchiev V, Terracciano L, Tornillo L. et al. The homeobox intestinal differentiation factor CDX2 is selectively expressed in gastrointestinal adenocarcinomas. Mod Pathol 2004; 17 (11) 1392-1399
• 10 Turri-Zanoni M, Battaglia P, Lambertoni A. et al. Treatment strategies for primary early-stage sinonasal adenocarcinoma: a retrospective bi-institutional case-control study. J Surg Oncol 2015; 112 (05) 561-567
• 11 Bignami M, Lepera D, Volpi L. et al. Sinonasal non-intestinal-type adenocarcinoma:a retrospective review of 22 patients. World Neurosurg 2018; 120: e962-e969
• 12 Choussy O, Ferron C, Védrine PO. et al; GETTEC Study Group. Adenocarcinoma of ethmoid: a GETTEC retrospective multicenter study of 418 cases. Laryngoscope 2008; 118 (03) 437-443
• 13 Knegt PP, Ah-See KW, vd Velden LA, Kerrebijn J. Adenocarcinoma of the ethmoidal sinus complex: surgical debulking and topical fluorouracil may be the optimal treatment. Arch Otolaryngol Head Neck Surg 2001; 127 (02) 141-146
• 14 Wenig BM. Neoplasms of the nasal cavity and paranasal sinuses. In: Atlas of Head and Neck Pathology. 2nd ed.. Philadelphia, PA: Elsevier; 2008: 63-153