Features of low-grade synonasal carcinoma diagnosis and treatment: clinical case

Introduction: About 90% of all malignant tumors of the skull anterior base are presented by nasal cavity carcinomas or paranasal sinuses cancer. Frequently, prolonged bacterial rhinosinusitis with unilateral opacification can be the primary manifestation of a neoplastic process. An important diagnostic method for sinonasal malignancy identification is a computed tomography of the paranasal sinuses. The diagnosis can be confirmed by the biopsy taken from the nasal cavity tissue with uneven contours and contact bleeding. However, only 80% of the cases are correctly confirmed histologically due to the specifics of morphological types of the disease, the localization of lesions, the tumor differentiation grade, and the quality of the sampling material. If the neoplastic process is localized in the olfactory area, it is necessary to perform a thorough differential diagnosis between neuroectodermal lesions and undifferentiated sinonasal tumors since the histological diagnosis accuracy greatly influences the patients’ treatment strategy and the 5-year survival prognosis. Clinical case: female patient with an undifferentiated sinonasal carcinoma underwent treatment at the Department of Otorhinolaryngology of the First State Medical University, St. Petersburg. The main difficulties of diagnosis and verification were analyzed based on clinical and laboratory data. The neoplastic process in the nasal cavity was suspected for the first time only during the remission between relapsed acute rhinosinusitis with the use of cone-beam computed tomography. The main indications for biopsy were: the existence of a defect on the left cribriform plate of the nasal cavity and the endoscopic picture with an polyp-like lesions. Primary histology confirmed the diagnosis of esthesioneuroblastoma. Complete removal of the lesion was not complicated by nasal liquorrhea and did not require plastic repair of the cribriform plate. An intraoperative biopsy revealed low-grade sinonasal carcinoma, which required subsequent chemoradiation therapy.

Conclusion: Recurrent unilateral inflammation of the nasal cavity and paranasal sinuses should be differentiated with the neoplastic process that must be morphologically confirmed.

Key words: endoscopy, rhinosinusitis, esthesioneuroblastoma, undifferentiated sinonasal carcinoma The authors declare no conflict of interest. Source of financing: not specified.

For citation: Karpischenko S.A., Cherebillo V.Yu., Shumilova N.A., Puzakov N.S., Stancheva O.A., Danilova D.M. Features of low-grade synonasal carcinoma diagnosis and treatment: clinical case. Head and neck Russian Journal. 2019;7(2):42–51 (in Russian).

The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.