Sinonasal intestinal-type adenocarcinoma.

Adenocarcinoma accounts for 10 to 20% of all primary malignant tumors of the nasal cavity and paranasal sinuses. (1) A type of adenocarcinoma called intestinal-type adenocarcinoma--so called because its histologic pattern is similar to that of an adenocarcinoma of the colon--accounts for 3 to 4% of all sinonasal malignancies. (2) Intestinal-type adenocarcinoma occurs sporadically as an occupational hazard of inhaling wood dust; it is most common in men 50 to 60 years of age. (3,4)

We evaluated a 56-year-old man who had a proven histologic diagnosis of sinonasal intestinal-type adenocarcinoma. The patient had been treated at another institution with chemo- and radiotherapy 6 months prior to the current admission. He came to our institution with signs of recurrence and a change in mental status. Areview of his original computed tomography (CT) scan (figure) revealed the presence of a large, destructive lesion that involved the sinonasal area and extended into the anterior cranial fossa, a significant degree of associated vasogenic edema in the adjacent frontal lobes of the brain, and signs of hemorrhage. A recent chest x-ray revealed multiple metastatic lesions in both lungs. Of interest, the patient was a furniture worker, and he had a 15-year history of exposure to wood dust. No evidence of gastrointestinal or colonic malignancy was noted.

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Histologically, an intestinal-type adenocarcinoma can be confused with metastatic disease from the gastrointestinal tract. Among other sites from which neoplasms metastatic to the sinonasal area originate are the kidneys, lungs, breasts, testes, uterus, thyroid, adrenal glands, skin, and pancreas. Intestinal-type adenocarcinoma must also be pathologically differentiated from mucoepidermoid carcinoma and low-grade adenocarcinoma. (1) Sinonasal melanoma, aggressive fungal infections, and hemorrhagic metastatic lesions could have similar imaging characteristics, as occurred in our patient.

References

(1.) Sklar EM, Pizarro JA. Sinonasal intestinal-type adenocarcinoma involvement of the paranasal sinuses. AJNR Am J Neuroradiol 2003:24:1152-5.

(2.) Sanz JJ, Martinez R Aguilar E et al. [Sinonasal intestinal-type adenocarcinoma: Report of 7 cases]. Acta Otorrinolaringol Esp 2000;51:599-602.

(3.) Steinhart H, Bohlender J, Pahl S, et al. A second primary intestinal-type adenocarcinoma of the sinonasal tract induced by wood dust. Rhinology 2000;38:204-5.

(4.) Moor JC, Moor JW, Scott E Mitchell DA. Mucinous intestinal type adenocarcinoma of the sinonasal tract secondary to passive wood dust inhalation: Case report. J Craniomaxillofac Surg 2004;32: 228-32.

Enrique Palacios, MD, FACR; Rafael Rojas, MD

From the Department of Radiology, Tulane University Medical Center (Dr. Palacios), and the Department of Radiology, Louisiana State University Health Sciences Center (Dr. Rojas), New Orleans.