Esthesioneuroblastoma Masquerading as Chronic Rhinosinusitis

Sylvia G Mcculloch,Desiree Hao,Harold Y Lau,Yves Starreveld,John T Lysack

doi:10.4236/crcm.2015.49060

Abstract

Background: Esthesioneuroblastoma, a rare tumour of the nasal vault, can present with symptoms that can be mistaken for common conditions such as chronic rhinosinusitis or recurrent epistaxis. Case presentation: A 52-year-old, previously healthy, Caucasian female presented to the emergency room with two months of nasal congestion and a spontaneous, protracted nosebleed that required a nasal clamp to settle. In the following months she had another episode of epistaxis in addition to fatigue, headaches, anosmia, difficulty breathing, worsening vision, weight loss and behavioral changes. Subsequent investigations led to the diagnosis of esthesioneuroblastoma. Conclusion: When patients present with recurrent epistaxis or chronic rhinosinusitis that does not respond to a reasonable course of medical therapy and/or have atypical associated symptoms, further investigations should be considered. The presences of red flags, such as weight loss, severe headaches, vision changes or bizarre behavior are also clues that alternate diagnoses and further additional workup should be considered.

Highlights

Esthesioneuroblastoma (ENB), known as olfactory neuroblastoma, is a rare tumour of the nasal vault
We describe the case of a female who initially presented with epistaxis and nasal congestion but, after the development of additional symptoms, was found to have advanced ENB
Multiple chemotherapy regimens have been reported in case series but, given the rarity of this malignancy, no one regimen has clearly emerged as being optimal [5] [9]-[13]

Summary

Introduction

Esthesioneuroblastoma (ENB), known as olfactory neuroblastoma, is a rare tumour of the nasal vault. Patients with nasal tumours often present with non-specific symptoms that can include unilateral (or bilateral) nasal congestion, epistaxis, and anosmia [1] which can initially be confused with much more common entities, such as chronic rhinosinusitis or recurrent epistaxis [3]. We describe the case of a female who initially presented with epistaxis and nasal congestion but, after the development of additional symptoms, was found to have advanced ENB. Esthesioneuroblastoma, a rare tumour of the nasal vault, can present with symptoms that can be mistaken for common conditions such as chronic rhinosinusitis or recurrent epistaxis. Conclusion: When patients present with recurrent epistaxis or chronic rhinosinusitis that does not respond to a reasonable course of medical therapy and/or have atypical associated symptoms, further investigations should be considered. The presences of red flags, such as weight loss, severe headaches, vision changes or bizarre behavior are clues that alternate diagnoses and further additional workup should be considered

Results

Discussion

Conclusion