Preoperative Nasal Endoscopy Research Articles

Papillary adenocarcinoma with oncocytic features arising from the ethmoid sinus

Objectives: We report a case of low-grade papillary adenocarcinoma with unique oncocytic features arising in the ethmoid sinus of a 72-year-old female. Methods: A review of the case history, pathological findings, and medical literature is performed. Results: A 72-year-old female presented with a 2-month history of progressive right-sided nasal obstruction. Preoperative nasal endoscopy showed a glistening, pink-red, soft mass arising from the middle meatus suspicious for inverting papilloma. Paranasal CT revealed a soft tissue density opacifing the right ethmoid sinus with ipsilateral maxillary and frontal sinus opacification. Complete endoscopic sphenoethmoidectomy was performed. Pathological examination of the surgical specimen revealed a low-grade papillary adenocarcinoma with oncocytic features. Special staining for MIB-1, p53, and Ki-67 was confirmatory. One year following surgical resection, nasal endoscopy revealed a recurrent mass in the surgical field; paranasal CT was confirmatory. A completion external and endoscopic ethmoidectomy was performed with complete removal of the neoplasm. Pathological examination revealed recurrent low-grade papillary adenocarcinoma. At 3 months postoperatively, the patient remains free from recurrent neoplasm. Conclusion: The management of ethmoid adenocarcinoma is dependent on the extent of disease and its pathological characteristics. Locally aggressive low-grade neoplasms, such as inverting papilloma, have been successfully treated with complete endoscopic resection with good rates of local control. Similarly, low-grade papillary adenocarcinoma has been successfully treated with endoscopic resection. In this case report, a rare oncocytic form of papillary adenocarcinoma is described that behaves similarly to other low-grade sinonasal papillary adenocarcinomas. Meticulous endoscopic surgical resection must be performed as local recurrence is common.

The importance of preoperative nasal endoscopy in patients with sinonasal disease

Functional endoscopic sinus surgery (FESS) has popularized the use of telescopes in sinus surgery and has emphasized the importance of nasal endoscopy and computed tomography (CT) in the evaluation of patients with diseases of the nose and paranasal sinuses. Variations in intranasal and sinus anatomy have been implicated in the etiology of chronic and recurrent sinusitis, and CT imaging has become an important diagnostic tool. Despite this, some patients present with symptoms and telescopic examination suggestive of sinonasal disease, yet demonstrate little abnormality on CT scan. The authors reviewed videoendoscopic and CT examinations of 100 consecutive patients with symptoms of sinus disease and found 9% of patients with abnormal telescopic examination in the context of negative CT findings. In those patients whose CT examinations were positive, telescopic nasal endoscopy was especially useful in delineating the type of soft tissue which obscured the area of the middle meatus. In those patients whose CT examinations were negative, telescopic examination demonstrated septal deflections, mucosal edema involving the middle meatus, as well as turbinate and adenoid hypertrophy. These findings demonstrate that telescopic nasal examination is an important diagnostic modality which often yields important information when evaluating patients with sinonasal disease.