Otolaryngology–Head and Neck Surgery (2008) 139, 472-473

CASE REPORT

Intestinal-type ethmoid adenocarcinoma in

sinonasal polyposis
Rosa Hernández, MD, Miguel Armengot, MD, PhD,
Consuelo Calabuig, MD, PhD, and Jorge Basterra, MD, PhD, Valencia, Spain

N asal polyposis (NP) is a chronic inflammatory dis-

ease of the sinonasal mucosa. Its etiology remains
unknown but is likely multifactorial. It is considered a
subgroup of chronic rhinosinusitis.1 Bilateral NP does
not usually present a problem with the differential diag-
nosis, while one must consider a tumor with a unilateral
presentation. In addition, typical NP is a benign inflam-
matory disease, but in rare cases it may appear with a
neoplasm.2
In this article, we report a typical clinical case of
bilateral NP with a concomitant intestinal-type adenocar-
cinoma. This justifies a systematic histopathologic exam-
ination in all polyp surgery. The case has been studied
under conditions with the approval of the Institutional
Research Committee of the General University Hospital
of Valencia.
A 59-year-old male patient, without relevant clinical
antecedents or a history of wood dust exposure, came to us
with a complaint of bilateral nasal obstruction and hyposmia Figure 1 Preoperative coronal CT showing the complete opaci-
for six months. Ten years earlier, he was assessed for nasal fication of all of the paranasal sinuses, without bony erosion,
polyps and underwent endoscopic sinonasal surgery. Nasal which was suggestive of NP.
endoscopic exploration revealed extensive polyp tissue fill-
ing both nasal cavities. Maxillofacial computed tomography
(CT) demonstrated complete opacification of all of the para- DISCUSSION
nasal sinuses, without bony erosion (Fig 1). These clinical
This case illustrates the necessity of analyzing all of the
findings suggested recurrent nasal polyps. Treatment was
tissue samples obtained from polypectomies, even in bilat-
planned according to international protocols.1 After no re-
sponse to medical management, endoscopic sinonasal sur- eral polypectomies.3 Although the incidence of malignancy
gery was performed. At surgery, the tissue in the top left in bilateral NP is rare, all polypoid masses in the nasal
ethmoid was friable and nodular, unlike the tissue of a cavity or sinuses cannot be presumed to be benign.4
benign polyp. It was removed with a microdebrider and a Intestinal-type adenocarcinomas of the nose and sinuses
biopsy specimen was sent. Histopathology analysis identi- are rare, accounting for less than 4% of all sinonasal can-
fied an intestinal-type adenocarcinoma next to a transitional cers. They share histopathologic features with gastroenter-
area consisting of inflammatory polyp tissue (Fig 2). A ologic adenocarcinomas and may appear sporadically or as
positron emission tomography (PET-CT) was performed metastases from glandular tumors. Their etiopathology is re-
and ruled out the presence of other metastases or a primary lated to wood dust exposure. The initial localization is more
tumor. A left posterior ethmoidectomy via a lateral rhi- frequent in the ethmoid sinus, although such tumors can
notomy and postoperative radiation were used to eliminate originate in any paranasal sinus or in the nasal cavity. They
the tumor. Follow-up detected tumor recurrence two years are silent clinically for long periods and are discovered
later. when their size reaches the middle meatus.2 Signs that

Received January 16, 2008; revised March 13, 2008; accepted March
20, 2008.

0194-5998/$34.00 © 2008 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.
doi:10.1016/j.otohns.2008.03.022
Hernández et al Intestinal-type ethmoid adenocarcinoma . . .
Figure 2 Histologic examination reveals connective tissue with
edema and inflammatory cells, and some glands and capillaries
(typical of NP) covered with columnar epithelium at the basal level
and superficially with intestinal-type epithelium showing malig-
nant transformation (arrows).
suggest malignancy, such as unilateral nasal obstruction,
bleeding, rhinorrhea, epistaxis, and unilateral neurologic
alterations or recurrent facial pain, often are initially ab-
sent.4 None of these manifestations was present in our case.
Intestinal-type adenocarcinomas are locally aggressive,
more so than other sinonasal adenocarcinomas, with a re-
currence rate of 53% despite treatment and a 25% five-year
survival rate. Surgery is considered the standard treatment.
The difficulty in obtaining a radical resection has increased
the use of multimodality therapy, including chemotherapy
and radiotherapy.5
CONCLUSION
Although rare, NP can coexist with tumor pathology and
unexpected relevant findings may be identified during the
473
routine histologic examination of nasal polyp specimens.
For a correct diagnosis, all nasal polyps removed at surgery
should be sent for histopathologic examination.
AUTHOR INFORMATION
From the ENT Department (Drs Hernández, Armengot, and Basterra) and
Pathology Department (Dr Calabuig), General and University Hospital of
Valencia and Valencia Medical School.
Corresponding author: Rosa Hernández, Valencia General Hospital, C/ Ramón y
Cajal, 38-B, 46470 Catarroja (Valencia), Spain.
E-mail address: r.hernandez.orl@gmail.com.
AUTHOR CONTRIBUTIONS
Rosa Hernández, writer, data collection; Miguel Armengot, surgeon
reviewer; Consuelo Calabuig, writer; Jorge Basterra, surgeon, re-
viewer.
FINANCIAL DISCLOSURE
None.
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