Sinonasal intestinal-type adenocarcinoma involvement of the paranasal sinuses

Abstract

We present a patient with a biopsy-proved sinonasal intestinal-type adenocarcinoma who presented with moderate confusion. He was found to have bifrontal hemorrhages, which to our knowledge has not been previously described in the literature for this entity. Intestinal-type adenocarcinoma should be in the differential diagnosis of aggressive lesions in the base of the skull with intracranial spread from the paranasal sinuses.

Fig 1.

Axial MR images show a bifrontal lesion. A, T1-weighted (602/12/1 [TR/TE/NEX]) image shows the lesion with areas of high signal intensity. B, Postgadolinium T1-weighted (602/12/1) image shows enhancement of the paramidline portion of the lesion (arrows). C, T2-weighted (5000/96/1) image demonstrates areas of low signal intensity corresponding to the areas of high signal intensity on the T1-weighted images. Note the edema surrounding the lesion.

Fig 2.

Sagittal MR images before (left) and after (right) the administration of a gadolinium-based contrast agent demonstrate an enhancing lesion extending from the ethmoid sinuses to the parenchyma of the frontal lobes.

Fig 3.

Coronal postgadolinium T1-weighted (519/12/2) MR image shows the lesion extending from the ethmoid sinuses to the skull base and intracranially to the frontal lobes.

Fig 4.

Axial CT scan demonstrates a bifrontal high-attenuating lesion.