Author(s)
Taylor Lee Powell, BS MS
Mark Landry, MD
Michael T. Yim, MD
Cherie-Ann Nathan, MD
Affiliation(s)
Louisiana State University Heath Shreveport;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to describe the clinical features, common treatment, and expected course of sinonasal intestinal type adenocarcinoma (ITAC), as well as the potential for late term recurrence, up to a decade later as seen in this specific case.
Objectives: Summarize literature concerning diagnosis and management of sinonasal ITAC and describe a case of recurrent sinonasal ITAC a decade after initial treatment despite negative surveillance scopes and imaging.
Study Design: Case report and literature review.
Methods: Electronic medical record review and database review of relevant literature of sinonasal ITAC.
Results: While adenocarcinoma accounts for 10-20% of primary nasal cavity neoplasms, intestinal type is more rare and accounts for around 4%. These tumors are locally aggressive, rarely metastasize, and are commonly associated with inflammation secondary to chronic wood and leather dust exposure. Typical treatment includes excision and adjuvant radiotherapy. Given its aggressive nature, mean disease free survival is around 32 months. Little is described about the potential for long term recurrence with continued environmental exposures. We present a case of an 85 year old gentleman with sinonasal ITAC, early stage, resected with negative margins in 2013. He did report exposure to wood dust. This patient received no adjuvant therapy and subsequent surveillance scopes and imaging were negative for disease. Ten years later, after developing epistaxis refractory to conservative treatment, endoscopic examination and biopsy revealed sinonasal ITAC with similar histology in the same location, demonstrating the potential for long term recurrence.
Conclusions: Sinonasal ITACs are known to be locally destructive and often carry a poor long term survival rate. Given the relative scarcity combined with their aggressive nature, less is documented about long term recurrence potential. This case presentation demonstrates the need to consider long term surveillance in patients with treated sinonasal ITAC, especially with chronic environmental exposures.