Sinonasal Adenocarcinoma

Michelle A. Michel, MD

Key Facts

Terminology

Malignant neoplasm with glandular differentiation, or arising from surface epithelium or minor salivary rests

Imaging

Predilection for nasal cavity & ethmoid sinuses
May reach large size due to delay in diagnosis
- 75% with involvement of > 1 SN area at diagnosis
CT
- Well- to poorly defined soft tissue density mass
- Bone destruction > remodeling
MR
- Typically intermediate to hyperintense T2 signal
- Diffuse, heterogeneous enhancement

Top Differential Diagnoses

Sinonasal squamous cell carcinoma
Esthesioneuroblastoma
Sinonasal undifferentiated carcinoma
Sinonasal non-Hodgkin lymphoma

Pathology

Confusion remains regarding histologic classification of sinonasal adenocarcinoma
2 major subtypes
- Intestinal (related to wood dust exposure): Most frequent form colonic > solid > papillary > mucinous & mixed type
- Nonintestinal: Unrelated to wood dust exposure
Accounts for 15% of all SN cancers

Clinical Issues

6th decade most common
M > F (≈ 3:1)
Poor prognosis with higher grades, incomplete resection, & intracranial involvement
Complete surgical excision for cure

(Left) Axial CECT shows a large, heterogeneously enhancing adenocarcinoma filling the upper nasal cavity and ethmoid sinuses. There is anterior extension into the soft tissues of the nasal dorsum