Adenocarcinoma of Nasal Pits Rare Location About A Case

Volume 6, Issue 4, April – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Adenocarcinoma of Nasal Pits Rare Location about a

Case
Najoua. Belhaj(1.3) ; Mohammed. Anass. Benbouzid(2.3) ; Hanaa. Rahim(1.3) ; Mohammed Ali.Gliti(1.3) ;
Razika. Bencheikh(2.3) ; Leila. Essakalli. Houssyni(2.3)
1
Resident in otorhinolaryngology, Department of Otorhinolaryngology, Head
and Neck Surgery, Ibn Sina University Hospital, Rabat, Morocco
2
Professor of otorhinolaryngology, Department of Otorhinolaryngology, Head and Neck
Surgery, Ibn Sina University Hospital, Rabat, Morocco
3
Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
Corresponding author: BELHAJ NAJOUA
Abstract:- Primary adenocarcinomas of the sinuses and We report in this work the observation of a 38-year-old
nasal pits are rare tumors, accounting for 13% of patient who presented in a table of low abundance
nasosinusian carcinomas. We report in this work the individuals repeated unilaterally with homolateral nasal
observation of a young patient with no notable obstruction.
pathological history who presented one year prior to his
consultation a history of right unilateral nasal II. CASE REPORT
obstruction associated with a history of low homolateral
abundance epistaxis. Clinical and endoscopic This is a 37-year-old patient with no notable
examination objectified a red polypoid formation pathological history, occupation trader with a history of
occupying the majority of the right nasal cavity; on data straight unilateral nasal obstruction and a repeated low
from nasal imaging and endoscopy; the tumor is abundance epistaxis for a year; without other rhinological or
classified as T1N0M0; the patient benefited from an associated ophthalmological signs.
endoscopic first with a homolateral middle meatotomy; The clinical examination finds, on the general level a
the anatomopathological study objectified low-grade patient was in good hemodynamic state slightly discolored
adenocarcinoma. Post-operative surveillance based on with anemia at 10, on the rhinological plane, the
nasal endoscopy and imaging did not show signs of examination did not find deformation of the nasal pyramid
recurrence. or the nasogenian furrow with a nasal flow decreased to the
right relative to the left side where it was preserved, at the
I. INTRODUCTION nasal endoscopy an inflamed nasal mucosa was objectified
with the presence at the right nasal cavity of a polypoid
Adenocarcinoma originates in the glandular cells of formation with a base of implantation at the middle meat
nasal pits or paranasal sinuses. This type of tumor is most level, the cavum is free.
commonly seen in the upper nasal cavities and ethmoid
sinuses. Adenocarcinoma can develop slowly (low grade) or The rest of the clinical examination was normal, no
rapidly (high grade). Most adenocarcinomas of nasal pits or palpable cervical adenopathy.
paranasal sinuses are diagnosed in men and are strongly
associated with exposure to wood dust. Primary The injected naso-sinusian scanner objectified a mass
adenocarcinomas of the sinuses and nasal pits are rare of tissue density at the middle meat of the bulging right
tumors, accounting for 13% of nasosinusian carcinomas. nasal cavity in the choanas exerting a mass effect on the
The latest WHO 2005 classification distinguishes two types: sinus. Right maxilla with deviation from the media
intestinal type adenocarcinomas (ACTs) and non-intestinal wall.(figure1.2)
types, mainly represented by low-grade adenocarcinomas.
IJISRT21APR134 www.ijisrt.com 1024

ISSN No:-2456-2165
Figure 1 and 2: coronal and axial cuts of the patient's nasosinusian CT disease showing tissue density mass at the right nasal
cavity.

ISSN No:-2456-2165
III. DISCUSSION the presence of cystic formations. These are soft, crumbly
tumors that bleed easily, sessile or pediculated. They can
Sino-nasal malignancies account for 20% of these take on the deceptive aspect of a banal polyp (7). In
cancers in the literature. They develop at the ethmoid, 30% microscopy: the majority of cylindrical adenocarcinomas are
in the maxilla infrastructure, 40% in the maxillary sinus, intestinal. Their architecture is variable, often polymorphic:
10% in the nasal pits (1.2.3). Adenocarcinoma originates in tubular, papillary, micro cystic, or massive and containing
the glandular cells of the nasal pits or paranasal sinuses mucoscreating cells in varying numbers. The classifications
exactly from the gland overlapping cells. This type of tumor of these tumors in the literature reflect the polymorphism of
is most commonly seen in the upper nasal cavities and these tumors. The WHO 2005 classification distinguishes
ethmoid sinuses. Adenocarcinoma can develop slowly (low between intestinal adenocarcinomas (ITAC) and low-grade
grade) or rapidly (high grade). (2) non-intestinal adenocarcinomas, two entities with different
epidemiological, clinical and prognostic characteristics.
In most series, the age pyramid is not available. Only Low-grade adenocarcinomas retain a respiratory type
the average age at the time of diagnosis is most often cited: phenotype (CK20-/CK7-/CDX2-/villine-) while ITACs have
all authors find it around 60 years. The weakest extreme an intestinal morphology and phenotype (CK20-/CK7-
ages are to our knowledge 22, 31 and 37 years. The number /CDX2-/villine). The histological, ultrastructural and
of patients under the age of 40 is most often absent. The age phenotypic similarities between ITAC and colorectal
pyramids available among the different historical series adenocarcinomas raise the possibility of close
show that the vast majority of patients with this pathology carcinogenesis mechanisms. However, the literature review
are grouped between the 4th and 8th decade of life. (2.7) shows often contradictory results, suggesting a different
pathogenesis. Differential diagnoses of primitive
The role of wood dust in the carcinogenesis of ethmoid adenocarcinomas of the sinuses and nasal pits are
tumors was mentioned by Mourre and Portman in 1923. The represented by the other glandular lesions encountered in
International Agency for Research on Cancer in 1995 this topography: the adenomoid epithelial hamartoma,
concluded the causal relationship between exposure to wood inverted schneiderian papillomas, adenocarcinomas
dust and Nasosinusian cancer and classified wood dust as a developed at the expense of accessory salivary glands and
group 1 of carcinogens, such as the European Union. There more rarely otherwise metastases of adenocarcinomas. (1)
is also a high incidence relative to the general population of
adenocarcinoma in people exposed to leather treatments. The prognosis of the disease is not statistically related
Nickel was the first carcinogen described to be responsible to the duration of exposure to wood dust, nor to the age or
for ethmoid adenocarcinoma in 1963. Effective occupational sex of the patients. There is no survival difference between
prevention measures have made this cause of ethmoid high- and low-grade forms, between well- and little-
adenocarcinoma rare. Latency is reported in varying degrees differentiated forms, mucoid, papillo-tubular and papillary
between 10 and 30 years from the end of exposure to the intestinal forms. The prognostic value of the histological
first symptoms. Latency times can also be calculated from type is not determined for the colloid type (mucinux) and
the first day of exposure, on average 40 years, but with cells in chestnut rings. The prognosis of the disease is
extremes ranging from 7 to 70 years. (2) related to local recurrences and not to distant metastases.
The tumor stage is a prognostic factor. Brain and brain
The main purpose of the CT-MRI imaging assessment extension is the most important risk factor for recurrence.
is to determine the best therapeutic strategy (4). Once the The rare lymph node extension, as well as the invasion of
histological nature is established on biopsy, non-surgical the basifrontal canal and frontal sinus are factors that
tumors are directed to chemo and/or radiotherapy adversely influence survival. Tumor extensions to the orbit,
management. Tumor mapping helps define the operational sub temporal pit and sphenoid sinus are not routinely
tactic (first single or double path, extension to the orbit, the considered as factors of poor prognosis.
palate...). It gives the location, volume and extensions of the
tumor and allows to establish the parameters of irradiation The treatment meets several objectives:
for radiotherapy. It also serves as a reference to assess the  First, and where possible, the eradication of cancer.
tumor response to treatment (4).  To try to detect and treat a possible recurrence.
 Restore function and aesthetics.
Histologically; A wide variety of tumors are likely to  Ensure psychological care and follow-up of the patient.
develop in this site, where multiple epithelial, glandular,
conjunctiva, lymphoid or nerve histological structures are It appears that the combination of surgery followed by
normally present (5, 6). Only an anatomopathological radiotherapy is the standard treatment for facial mass
examination of the biopsy or the piece of exesesis can make adenocarcinomas (grade C).
the diagnosis. Epithelial tumors are distinguished from non-
epithelial tumors. (5.6). Conformational techniques with at best intensity
modulation appear to be current techniques to reduce the
They are predominant in the ethmoidal sinus and at side effects of radiotherapy in patients treated with
the upper nasal passages. Macroscopically: Adenocarcinoma postoperative irradiation for adenocarcinoma (grade B).
presents itself as a very limited tumor, rounded with an
ulcerated surface. At the cut, it is white-grey with sometimes

ISSN No:-2456-2165
Neoadjuvant chemotherapy does not provide a gain in [2]. Argumentaire bibliographique (106 pages, accessible
terms of specific overall survival and no recurrence at 5 sur demande auprès dusecrétariat de la SFORL)
years (grade C). On N: There is no indication for a Recommandation (25 pages, présent document)
prophylactic lymph node gesture in patients. Clinical and Synthèse (8 pages, accessible sur demande auprès de la
radiological n0. For the few patients with lymph nodes at the SFORL). Document finalisé en juillet 2009 par le
time of diagnosis a radical homolateral modified cervical Groupe de Travail, sous réserve de l’avis du comité de
recess followed by cervical radiotherapy is most often validation des recommandations HAS/INCa.
proposed. On M: Patients are cared for with a systematic [3]. Cogliano VJ, Baan R, Straif K, et al. Preventable
palliative purpose. exposures associated with human cancers. 2011. Dec.
Journal of the National Cancer Institute. Oxford
In the case of operable tumor: total macroscopic and University Press.103 : pp.1-13
microscopic exeresis surgery with safety margins followed [4]. www.info-radiologie.ch 2005-2009 : dernières
by radiotherapy on the tumor bed is the standard treatment modifications le 15/02/10.
for the curative adenocarcinomas of the ethmoid. (Grade C) [5]. Stevens A, Lowe J. Histologie Humaine. De Boeck
There is no standard first. Exeresis can be done by a Université, 1997 :159-162.
craniofacial, trans-facial or possibly by endonasal [6]. Carnot F. Aspects histologiques des tumeurs naso-
endoscopic surgery. Exeresis surgery must include ethmoïdales. Neurochirurgie 1997 ;43(2) :64-67.
rehabilitation procedures. [7]. Les tumeurs malignes naso-sinusiennes, à propos de
32 cas et revues de la littérature. THESE PRESENTEE
Some T1 and T2 lesions can be treated by surgery ET SOUTENUE PUBLIQUEMENT LE
alone provided a resection in healthy, broad limits, away 19/03/2015.Dr Jihane ALAMI
from the noble neighboring organs and subject to patient [8]. Stéphane Boudet : Tumeurs malignes naso-
compliance with rigorous post-therapeutic monitoring. sinusiennes. Thèse, 2000.
These indications should be discussed on a case-by-case
basis in CPR (professional consensus). There is no
indication of surgical prophylactic or radiotherapy treatment
on the lymph node areas of N0 patients regardless of the
tumor stage. (Grade B). If the tumor is inoperable, the
treatment is multimodal and should have the appropriateness
of concurrent radiation therapy or neoadjuvant
chemotherapy followed by radiotherapy on a case-by-case
basis, taking into account the morbidity of the different
treatments, the patient's age and his Karnowsky index. (2)
IV. CONCLUSION
Advances in imaging and anatomopathological

techniques make it possible to get as close as possible to the
nature and extension of these tumors, in order to adapt the
treatment as much as possible. In terms of therapeutics, the
various medical and surgical techniques, often associated,
allow to propose solutions adapted to the characteristics of
adenocarcinomas and patients, trying to keep maximum
efficiency and repair defects.
REFERENCES
[1]. Adénocarcinomes des fosses nasales et des sinus :

pièges diagnostiques des lésions glandulaires naso-
sinusiennes - 09/11/09 Doi :
10.1016/j.annpat.2009.07.007 Flora Poizat a, ⁎ ,
Aurélie Maran Gonzalez a, Pierre Raynaud a, Pierre
Baldet a, Renaud Garrel b, Louis Crampette b, Valérie
Costes aa Service d’anatomie et cytologie
pathologique, hôpital Gui-de-Chauliac, CHU de
Montpellier, 80, avenue Augustin-Fliche, 34295
Montpellier cedex 5, France .b Service d’ORL, hôpital
Gui-de-Chauliac, CHU de Montpellier, 80, avenue
Augustin-Fliche, 34295 Montpellier cedex 5, France.

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Volume 6, Issue 4, April – 2021 International Journal of Innovative Science and Research Technology

Adenocarcinoma of Nasal Pits Rare Location about a

IJISRT21APR134 www.ijisrt.com 1024

IJISRT21APR134 www.ijisrt.com 1025

IJISRT21APR134 www.ijisrt.com 1026

Advances in imaging and anatomopathological

[1]. Adénocarcinomes des fosses nasales et des sinus :

IJISRT21APR134 www.ijisrt.com 1027

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