Atypical Olfactory Neuroblastoma Presenting as Sinonasal Polyposis with Nasopharyngeal Extension: A Case Report

Jagdish Prasad Purohit, Chandra Bhan^*, Bhoopendra Singh, Ajay Pratap Singh, Siva Selvaraj, Manish Pandey, Vijay Krishna Sharma

Department of ENT, Head and Neck Surgery, MLB Medical College, Jhansi, India.

DOI: 10.4236/ijohns.2015.45064                

Abstract

Background: Olfactory neuroblastoma also known as Esthesioneuroblastoma (ENB) is a tumor arising from the basal layer of olfactory epithelium in the superior recess of the nasal cavity in the region of cribriform plate. Incidence peaks once in 11 - 20 years of age and again in 50 - 60 years of age. It is equally found in men and women. Aim: The main aim of this case report is to characterize the clinical features of ENB showing nasopharyngeal involvement and its importance in the differential diagnosis of sinonasal neuroendocrine malignancies. Case presentation: Two cases are reported. The first case was a 21-year-old male with symptoms of nasal obstruction, recurrent epistaxis, nasal discharge, headache and paresthesia over the face with an evolution of 1 year with no previous history of trauma. Diagnostic nasal endoscopy revealed reddish gray mass filling bilateral nasal cavities. Posterior rhinoscopy revealed mass coming through choanae and filling the nasopharynx. Endoscopic resection of tumor was done and postoperatively all the symptoms of the patient resolved. The second case was a 62-year-old male with complaints of nasal obstruction, nasal discharge, recurrent epistaxis, anosmia and difficulty in swallowing. On computed tomography, anteriorly, the mass was extending up to external nares and posteriorly up to the nasopharynx, superiorly up to nasal roof and inferiorly up to hard palate. No obvious erosion of floor of anterior cranial fossa was seen. No intracranial extension was seen. Surgery was advised but patient refused to undergo any treatment. Conclusion: This study highlights the characteristics and clinical features of ENB showing nasopharyngeal involvement and their importance in the differential diagnosis of sinonasal neuroendocrine malignancies.

Keywords

Esthesioneuroblastoma, Cribriform Plate, Neuroectodermal

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Lund, V.J. and Milroy, C. (1993) Olfactory Neuroblastoma: Clinical and Pathological Aspects. Rhinology, 31, 1-6.
[2]	Elkon, D. and Hightower, S.I. (1979) Esthesioneuroblastoma. Cancer, 44, 1087-1094. http://dx.doi.org/10.1002/1097-0142(197909)44:3<1087::AID-CNCR2820440343>3.0.CO;2-A
[3]	Palacios & Valvassori, 1998; Hwang, et al.; Tamase, et al., 2004; Lin, et al.; Ghaffar & Salahuddin, 2005; Yu, et al.; Iliades, et al., 2002; Thompson, 2009.
[4]	Dulguerov, P., Allal, A.S. and Calcaterra, T.C. (2001) Esthesioneuroblastoma: A Meta Analysis and Review. The Lancet Oncology, 2, 683-690. http://dx.doi.org/10.1016/S1470-2045(01)00558-7
[5]	Mills, S.E. and Frierson Jr., H.F. (1985) Olfactory Neuroblastoma: A Clinicopathological Study of 21 Cases. The American Journal of Surgical Pathology, 9, 317-327. http://dx.doi.org/10.1097/00000478-198505000-00001
[6]	Batsakis, J.G. (1979) Tumors of the Head and Neck. 2nd Edition, Williams and Wilkins, Baltimore, 338-349.
[7]	Wenig, B.M., Prasad, M.L., Dulguerov, P., Fanburg, J.C., Kapadia, S.B. and Thomson, L.D. (2005) Neuroectodermal tumors. In: Barnes, L., Eveson, J.W., Reichart, P. and Sidransky, D., Eds., WHO Classification of Tumors, Pathology and Genetics, Head and Neck Tumors, IARC Press, Lyon, 65-75.
[8]	Thompson, L.D. (2009) Olfactory Neuroblastoma. Head and Neck Pathology, 3, 252-259. http://dx.doi.org/10.1007/s12105-009-0125-2
[9]	Menon, S., Pai, P., Sengar, M., Aggarwal, J.P. and Kane, S.V. (2010) Sinonasal Malignancies with Neuroendocrine Differentiation: Case Series and Review of Literature. Indian Journal of Pathology & Microbiology, 53, 28-34. http://dx.doi.org/10.4103/0377-4929.59179
[10]	Zhang, M., Zhou, L., Wang, D.H., Huang, W.T. and Wang, S.Y. (2010) Diagnosis and Management of Esthesioneuroblastoma. ORL: Journal for Oto-Rhino-Laryngology and Its Related Specialties, 72, 113-118. http://dx.doi.org/10.1159/000278255
[11]	Tabyaoui, I., Tahiri-Jouti, N., Serhier, Z., Bennani-Othmani, M., Sibai, H., Itri, M., Benchekroun, S. and Zamiati, S. (2013) Immunohistochemical Expression of CD44s in Human Neuroblastic Tumors: Moroccan Experience and Highlights on Current Data. Diagnostic Pathology, 8, 39. http://dx.doi.org/10.1186/1746-1596-8-39
[12]	Gore, M.R. and Zanation, A.M. (2009) Salvage Treatment of Late Neck Metastasis in Esthesioneuroblastoma: A Meta-Analysis. Archives of Otolaryngology—Head & Neck Surgery, 135, 1030-1034. http://dx.doi.org/10.1001/archoto.2009.143
[13]	Kane, A.J., Sughrue, M.E., Rutkowski, M.J., Aranda, D., Mills, S.A., Buencamino, R., Fang, S., Barani, I.J. and Parsa, A.T. (2010) Post Treatment Prognosis of Patients with Esthesioneuroblastoma. Journal of Neurosurgery, 113, 340-351. http://dx.doi.org/10.3171/2010.2.JNS091897
[14]	Platek, M.E., Merzianu, M., Mashtare, T.L., Popat, S.R., Rigual, N.R., Warren, G.W. and Singh, A.K. (2011) Improved Survival Following Surgery and Radiation Therapy for Olfactory Neuroblastoma: Analysis of the SEER Database. Radiation Oncology, 6, 41. http://dx.doi.org/10.1186/1748-717X-6-41
[15]	Kadish, S., Goodman, M. and Wang, C.C. (1976) Olfactory Neuroblastoma. A Clinical Analysis of 17 Cases. Cancer, 23, 1571-1676. http://dx.doi.org/10.1002/1097-0142(197603)37:3<1571::AID-CNCR2820370347>3.0.CO;2-L