Primary adenocarcinoma of the maxillary sinus simulating an osteosarcoma. (Imaging Clinic).

Adenocarcinomas of the paranasal sinus are uncommon, accounting for less than 1% of all malignancies and from 5 to 20% of all carcinomas of the sinonasal area. (1,2) We examined a white 82-year-old woman who had a 2-year history of nasal obstruction and numbness localized to the right cheek. Computed tomography (CT) revealed the presence of a bone tumor that featured an osteoid matrix. The tumor had spread into the posterior portion of the right maxillary sinus and extended into the hard palate and ptery goid fossa (figure). There was aggressive bone destruction. These radiologic features were consistent with those of a de novo osteosarcoma. (3)

On physical examination, we noted a fullness of the right gingivobuccal sulcus that arose from the right maxillary sinus. A discrete area of paresthesia confined to [V.sub.2] distribution was elicited. A biopsy and subsequent maxillectomy were performed, and the final pathology identified an infiltrative, poorly differentiated adenocarcinoma. The mass extended into both the soft and hard palates and the right inferior turbinate, and it exhibited significant perineural invasion, including that of the orbital nerve.

From the Department of Otorhinolaryngology (Dr. Roth and Dr. Friedlander) and the Department of Radiology (Dr. Palacios), Louisiana State University Health Sciences Center, New Orleans.

References

(1.) Moran CA, Wenig BM, Mullick FG. Primary adenocarcinoma of the nasal cavity and paranasal sinuses. Ear Nose Throat J 1991; 70:821-8.

(2.) Cawte T, Taskin M, Kacker A, Wahl S. Low-grade a adenocarcinoma of nasal passages. Otolaryngol Head Neck Surg 1997; 117: 116-9.

(3.) Harnsberger HR. Sinonasal imaging issues in sinusitis. In: Harnsberger HR, ed. Handbook of Head and Neck Imaging. 2nd ed. St. Louis: Mosby, 1995:339-95.