|Year : 2013 | Volume
| Issue : 1 | Page : 39-40
Adenoid cystic carcinoma of the nasal septum: A rare case report
Basavaraj P Belaldavar, Ritika Batra
Department of ENT, J.N. Medical College, KLE University, Belgaum, Karnataka, India
|Date of Web Publication||28-Mar-2013|
Basavaraj P Belaldavar
Department of ENT, J.N. Medical College, KLE University, Belgaum, Karnataka
Source of Support: None, Conflict of Interest: None
A 60-year-old male patient came to ENT OPD with complaints of left nasal obstruction from the last 5 years and moderate quantity of epistaxis from the last 4 months. It was associated with foul smelling mucopurulent rhinorrhea. On clinical examination, a fleshy mass was seen occupying the posterior part of left nasal cavity and displacing the septum on the right side. The mass was relatively painful, soft, and bleeding on touch. The provisional diagnosis of "vascular-tumor-like" angiofibroma was suspected. Diagnostic nasal endoscopy and CT scan PNS were done which revealed a mass occupying the left nasal cavity arising from the posterior part of septum along the choanae till the anterior part of sphenoid sinus. Biopsy of the same revealed an adenoid cystic carcinoma. Adenoid cystic carcinoma is uncommon and that too of the nasal cavity. The cases of the adenoid cystic carcinoma involving the nasal cavity usually involves the lateral wall and the involvement of the posterior part of nasal septum is extremely rare. Thus the presentation of this uncommon disease is discussed here.
Keywords: Adenoid cystic carcinoma, nose, nasal septum
|How to cite this article:|
Belaldavar BP, Batra R. Adenoid cystic carcinoma of the nasal septum: A rare case report. J Sci Soc 2013;40:39-40
| Introduction|| |
The incidence of malignant tumors from the nasal septum is quiet rare ranging from 2.7% to 8.4% of nasal and paranasal malignant tumors. Here we report an unusual case of adenoid cystic carcinoma of nasal septum. Based on literature review, we discuss the clinical, imaging, and histological features of this tumor as well as available treatments and prognostic factors.
| Case Report|| |
A 60-year-old male came to us with complaints of bilateral nasal obstruction from last 5 years and epistaxis from the same side since 4 months. Initially nasal block started on the left side which was insidious in onset, gradually progressive, and proceeded to complete nasal block on both sides from the last 2 years. The patient also complains of recurrent bleeding from left nasal cavity from the last 4 months. It was moderate in quantity with two to three episodes per day.
He consulted a local doctor for this who prescribed him medicines, after taking these medications bleeding stopped for few days but again recurred. On anterior rhinoscopy - mass was seen in posterior part of left nasal cavity displacing the septum on the right side, occupying floor and lateral wall of the nose. Mass was relatively painful and bleed on touch. Diagnostic nasal endoscopy revealed a greyish pink fleshy mass with an smooth surface arising from the left posterior end of nasal septum occupying the lateral wall and floor of the nasal cavity [Figure 1]. There was erosion of the posterior end of the septum; thus mass was seen in right nasal cavity [Figure 2]. Provisional diagnosis of the "vascular tumor" was made. Biopsy was taken from multiple sites and sent for HPR. X-ray PNS showed DNS to the right and haziness of left maxillary sinus without any erosion of the wall. CT PNS showed erosion of the inferior sphenoid wall with extension into sphenoid sinus. It showed no vascular invasion and no intracranial extension. USG abdomen and X-ray chest revealed no metastasis. Finally the diagnosis was made based on HPR which showed adenoid cystic carcinoma of cribriform type [Figure 3].
|Figure 1: Mass occupying the left nasal cavity arising from the posterior part of the septum along the choanae|
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|Figure 3: Histopathology showing adenoid cystic carcinoma of cribriform type|
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| Discussion|| |
Adenoid cystic carcinomas correspond to 1% of the head and neck region malignant tumors. It contributes 10% of all salivary gland tumors.  The peak incidence is found to be in the fourth to sixth decades and slight predominance in females. They usually arise in accessory salivary glands (60%), most common in the oral cavity (palate), rarely seen within the nasal cavity where the lateral nasal wall is the most common site. The incidence of malignant tumors from the nasal septum is very low ranging from 2.7% to 8.4% of nasal and paranasal malignant tumors. The biological behavior of Adenoid cystic carcinoma is characterized by slow growth rate, high tendency of local recurrence, and perineural spread. Three architectural growth patterns: cribriform, tubular, and solid (anaplastic) have been described. In one series 5-year recurrence rates of 59%, 89%, and 100% were reported for tumors with tubular, cribriform or solid growth patterns respectively.  Furthermore there is a higher incidence of metastases (most commonly to the lung) being associated with tumors with a solid growth pattern.  Among various treatment modalities, combined primary excision with postoperative radiotherapy appears to achieve more satisfactory local control when compared to either surgery or radiotherapy alone. 
| Conclusion|| |
Adenoid cystic carcinomas of the nasal cavity are uncommon and they usually involve the lateral wall of the nose. Adenoid cystic carcinoma involving the posterior part of nasal septum is extremely rare. Despite its rarity, adenoid cystic carcinoma should be taken into consideration in the differential diagnosis of a nasal tumor.
| References|| |
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[Figure 1], [Figure 2], [Figure 3]