Sinonasal adenocarcinoma

Sinonasal tract adenocarcinomas are uncommon malignant neoplasm that arises from the surface epithelium or serous mucous glands.  Three main subtypes exist: 1) low-grade (well-differentiated) 2) high-grade (poorly-differentiated) and 3) intestinal-type.  Shown here is a low-grade adenocarcinoma that shows both glandular and papillary growth.  Glands are lined by a single layer of non-ciliated cuboidal or columnar cells.

High-grade adenocarcinoma are invasive lesions that show a complex glandular pattern (left) with marked cellular pleomorphism and mitotic activity (right).  Cellular polarity is lost.

Sinonasal tract adenocarcinoma commonly occur in men in their sixth decade of life. Woodworkers and those who work in shoe and furniture industries who are exposed to hardwood dust, softwood, and leather have increased incidence of adenocarcinoma. Patients present with non-specific symptoms ranging from nasal obstruction to epistaxis. Treatment consists of complete surgical resection of the tumor. High-grade lesions require adjuvant therapy with radiation. Prognosis is excellent for low-grade adenocarcinoma. However, high-grade lesions have 80% 3-year mortality rate secondary to local invasion and metastasis.