Small Cell Neuroendocrine Carcinoma of the Paranasal Sinuses with Unexpected Location and Clinical Presentation and Occupational Exposure: A Case Report

Abstract

BACKGROUND Small cell carcinoma (SCC) is usually aggressive and associated with a poor prognosis. This type of cancer is rarely found in extra-pulmonary or digestive-tract locations. This report describes an unusual presentation in terms of clinical symptoms and primary location (even among head and neck presentations), and unexpected occupational exposure. CASE REPORT This case report is a novel observation of SCC in the paranasal sinuses and is to the best of our knowledge the first case associated with occupational exposure to sawdust, with almost no ear, nose, and throat (ENT) symptoms related to the primary tumor location. Our patient had no past medical history and none of the usual risk factors, apart from a smoking history of 32 pack-years. He was not taking any regular treatment. The inaugural clinical presentation was mainly digestive, with neither ENT nor neurological symptoms. Diagnostic wavering ensued and numerous paraclinical tests were performed. This is one of the very few cases of an ethmoidal location ever reported for SCC. This cancer type is unusual in neck and head locations, but has occasionally been reported in the larynx and hypopharynx. To the best of our knowledge, this is only the second report of an ethmoidal location. In addition, this patient was a carpenter, implying exposure to sawdust, which is usually associated with adenocarcinoma of the ethmoid. We illustrate here that SCC, which has been described elsewhere without sawdust exposure, is also possible. CONCLUSIONS Exposure to sawdust should suggest a possible ethmoidal cancer location, even if there are few ENT symptoms. Adenocarcinoma is the most prevalent but clearly not the only possible histological pattern.

Figure 1.

Sagittal (A) and coronal (B) PET scan overall views showing initial multiple metastatic locations including liver nodules (red cross) and vertebral lytic lesions (yellow crosses).

Figure 2.

Axial PET scan view of head with primary tumor (A, B) and metastatic liver (C, D) showing both heterogeneous liver nodules with compression of the inferior vena cava (red crosses) and primary hypermetabolic lesion of left ethmoidal bone (green cross).