Adenocarcinomas, behind squamous cell carcinomas (SCC), are the next most common type of cancer in the nose and paranasal sinuses, affecting around 10-20 out of every 100 people (10-20%) diagnosed with sinonasal malignancies.

Adenocarcinoma starts in the gland cells (adenomatous cells) that are scattered around the surface tissues inside the nose. These cells produce mucus (phlegm). Ethmoid sinus is the most common location (40%) for non-salivary gland type adenocarcinoma, followed by nasal cavity (25%) and maxillary antrum (20%).

Symptoms usually include benign conditions, including rhinorrhea, nasal obstruction and epistaxis. Exposure to wood dust is a risk factor for ethmoid sinus adenocarcinoma while other significant etiologic associations include: alcohol and cigarette smoking, formaldehyde, and leather dust.

Adequate surgical resection is the usual treatment while advanced stage disease is treated by surgery and radiation therapy.

Case Examples

Case Example 1:

32-year-old female who presented with 1-year nasal obstruction and congestion. On endoscopic exam and evaluation, it was noted she had large adenoids. Shortly afterwards, at an outside institution, she underwent an endoscopic resection of the adenoids through the mouth and it was noted during surgery that some of the tissue appeared to be suspicious. The tissue was sent for a biopsy and the pathology demonstrated a malignant tumor, it was confirmed to be polymorphous low-grade adenocarcinoma located in her nasopharnyx. Outside CT and MRI scans obtained helped identify the exact location of the tumor.

The patient had no work history or activity with significant exposure to noxious chemicals or a family history of anything of this nature.

Polymorphous low-grade adenocarcinoma is considered to be relatively resistant to radiation therapy and it was subsequently decided a complete surgical excision was preferred. A month after the initial discovery of the malignant tumor she was brought to the operating room for an endoscopic resection of the tumor from the nasopharynx by an otolaryngology surgeon. This type of surgery is known as a ‘nasopharyngectomy’.

Both during surgery and on final pathology, all the margins came back negative for cancerous cells. Additionally, a postoperative PET scan demonstrated the cancerous cells of the tumor had not spread.

Since the surgery 1 year ago, she continues to do well. She has routine visits every 3 months for cancer surveillance, and a recent MRI demonstrated no evidence of recurrence.

Case Example 2:

59-year-old female who presented initially 3 years ago with history of a resection of an adenocarcinoma done at an outside institution and complaints of nasal congestion, frontal headaches and a diminished sense of smell. Pathology was consistent with poorly differentiated adenocarcinoma. She had a CT and MRI scan done at our institution to determine the exact size and location of the tumor and underwent an endoscopic re-resection of the tumor through the nose and sinuses by an otorhinolaryngology surgeon. A PET scan following surgery indicated the cancerous cells of the tumor had spread to her lymph nodes and she began radiation therapy one month later.

She is followed routinely by an otolaryngologist and has periodic MRI scans for tumor surveillance. She completed her radiation therapy three years ago, three months after surgery. She is doing well today with no signs of tumor recurrence.

How Surgery is Performed