|IMAGES IN ACADEMIC MEDICINE
|Year : 2017 | Volume
| Issue : 2 | Page : 328-330
An interesting case of esthesioneuroblastoma
Department of Radiology, St. John's Medical College, Bengaluru, Karnataka, India
|Date of Web Publication||9-Jan-2018|
Dr. Reddy Ravikanth
St. John's Medical College, Bengaluru- 560 034, Karnataka
Source of Support: None, Conflict of Interest: None
Esthesioneuroblastoma was first described by Bergerand Lucin 1924, accounting for 3% of all intranasal tumors. Clinical staging system was proposed by Kadish et al. in 1976 and is used as the prognosis indicator. CT and magnetic resonance imaging are complementary examinations used for the diagnosis, staging and follow-up.
The following core competencies are addressed in this article: Medical knowledge, Patient care.
Keywords: Esthesioneuroblastoma, imaging, magnetic resonance imaging, tumor
|How to cite this article:|
Ravikanth R. An interesting case of esthesioneuroblastoma. Int J Acad Med 2017;3:328-30
| Case Presentation|| |
A 65-year-old elderly female with a 4-month history of right-sided nasal obstruction, rhinorrhea, and epistaxis presented to the Ear-Nose-Throat Department with complaints of decreased vision in the right eye and proptosis for 3 weeks. On clinical examination, a red-brown, polypoid mass located high in the right nasal cavity was visualized. Multidetector contrast-enhanced computed tomography (CT) of the paranasal sinuses revealed a solid, homogenously enhancing mass lesion occupying the superior nasal cavity and ethmoidal aircells [Figure 1], causing widening of the frontoethmoidal recess with extension into the frontal sinus [Figure 2]. Posterosuperiorly, the lesion was noted to cross the cribriform plate with extension into the anterior cranial fossa [Figure 3], with the involvement of the right olfactory bulb. Bony remodeling of the anterior ethmoidal cells, bony nasal septum causing deviation to the contralateral side with associated right proptosis, and remodeling of superomedial wall of the right orbit are shown in [Figure 4]. Biopsy taken from the lesion yielded characteristic histology with Homer Wright pseudorosettes and immunohistochemistry positive for cells of neuronal lineage. The tumor was completely excised by transnasal approach and the patient wa sreferred for radiotherapy.
|Figure 1: Sagittal contrast-enhanced computed tomography image of the brain demonstrating a homogenously enhancing mass lesion occupying the superior nasal cavity and ethmoidal air cells|
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|Figure 2: Axial contrast-enhanced computed tomography image of the brain demonstrating the mass lesion causing widening of the frontoethmoidal recess with extension into the frontal sinus|
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|Figure 3: Coronal contrast-enhanced computed tomography image of the brain showing extension of the mass lesion posterosuperiorly into the anterior cranial fossa through the cribriform plate|
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|Figure 4: Axial contrast-enhanced computed tomography image of the brain showing the mass lesion occupying the anterior ethmoidal cells with associated right proptosis|
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| Discussion|| |
Esthesioneuroblastoma is an uncommon malignant tumor that arises from the bipolar sensory receptor cells in the olfactory mucosa, which originate in the neural crest and differentiate into the olfactory sensory elements. Esthesioneuroblastoma was first described by Bergerand Lucin 1924, accounting for 3% of all intranasal tumors. Clinical staging system was proposed by Kadish et al. in 1976 and isused as the prognosis indicator. Stage A disease is confined to the nasal cavity. Stage B disease involves the nasal cavity and one or more paranasal sinuses. Stage C disease extends beyond the nasal cavity and the paranasal sinuses. Our case fits into Kadish Stage C. Large tumors are considered for preoperative chemotherapy and postoperative radiotherapy.
Esthesioneuroblastoma should be suspected in patients with persistent unilateral nasal obstruction and recurrent epistaxis, the latter reflecting the marked vascularity of the tumor. Associated anosmia is due to penetration of the tumor into the cribriform plate. CT is useful in the demonstration of bone destruction and calcifications within the mass and is a relatively specific diagnostic indicator of esthesioneuroblastoma. CT and magnetic resonance imaging are complementary examinations used for the diagnosis, staging, and follow-up. Negative prognostic factors in esthesioneuroblastoma include female gender, age over 50 years at presentation, tumor recurrence, metastasis, high-grade tumor, and Kadish Stage C at presentation.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]