Olfactory Neuroblastoma with Intracranial Extension

Abstract

Two cases of olfactory neuroblastoma with intracranial extension are described. The radiological features, including those of magnetic resonance (MR) imaging, are emphasized. On plain X-rays, the nasal cavity, ethmoid, sphenoid, and/or frontal sinuses were opacified. Erosion of the bony confines of the sinuses and orbit was seen in Case 1, but no bony destruction was observed in Case 2 despite intracranial tumor invasion via the seemingly intact cribriform plate. Angiography showed tumor staining in the ethmoid sinus, and in Case 1 tumor vessels were also found in the base of the frontal lobe. Computed tomography (CT) disclosed a large, soft, enhanced tissue mass occupying the nasal cavity and paranasal sinuses and extending into the anterior cranial fossa. In Case 1, MR images (0.5 Tesla) with a short spin echo sequence (repetition time [TR], 600 msec; echo time [TE], 26 msec) and a long spin echo sequence (TR, 2100; TE, 30, 60, 90) were obtained. T1-weighted images delineated the tumor accurately in relation to the normal architecture. T2-weighted images revealed widespread brain edema, with the tumor recognizable as a mass of low signal intensity within the high-intensity region of brain edema. The CT and MR imaging findings are by no means specific to olfactory neuroblastoma. However, both modalities, particularly MR imaging, are of special value in demonstrating the precise extent of the tumor in three dimensions.