Invasive sinonasal adenocarcinoma with an absent olfactory bulb: a case report

Abstract

Sinonasal adenocarcinomas are rare, locally invasive tumours. In this case the symptomatic profile was unusual and the diagnosis was missed at the primary care stage. Interestingly this would be the first documented case with an absent ipsilateral olfactory bulb. A 55-year old male presented with symptoms of behavioural change and mild headaches. He was later found to have a large Sinonasal adenocarcinoma which penetrated the skull base. This was treated by a combined craniotomy and endonasal approach. Sinonasal adenocarcinomas are unusual tumours and further research is required in order to clarify management strategies and prognosis. This interesting case was more unusual again given its presentation, extent and absence of the olfactory bulb. Importantly for primary care physicians the initial diagnosis was considered psychiatric rather than organic; despite there being specific features of the presentation which were suggestive of an intra-cranial lesion.

Figure 1:

Left image: Coronal pre-operative T1 weighted MRI scan showing extension of the lesion from right nasal cavity to frontal lobe. Right image: Axial pre-operative T1 weighted MRI scan with contrast demonstrates the cystic compartment and mass effect of the lesion.