Intestinal type of sinonasal adenocarcinoma with condylar metastases: A case report

Intestinal type sinonasal adenocarcinoma (ITAC) is a locally aggressive, rare malignancy occurring mostly in elderly males. It is the second most common sinonasal adenocarcinoma, with characteristic microscopic features in their marked resemblance to intestinal mucosa. It also has a well-documented association with prolonged occupational exposure to wood dust. Here we report a case of papillary variant of ITAC originating in the ethmoid sinus with metastasis to the mandibular condyle. A 53 year old male, bookseller by profession reported to outpatient department with difficulty in mouth opening since five months. On examination, he had swelling with pain and tenderness on the right side of face and the right temporomandibular joint (TMJ) area. The radiographs revealed a destructive mass in the right ethmoid sinus, encroaching into the maxillary antrum, orbit and nasal cavity along with beak like erosion of anteromedial aspect of the right condyle. The hematoxylin and eosin stained sections showed presence of glandular structures, recapitulating intestinal mucosal morphology and papillary arrangement of stratified tall columnar cells with dysplastic features. Immunohistochemical stain with CK20, CD-X2, CK7 and villin was positive. The patient was referred to oncology department for further treatment. This case reiterates the importance of proper clinical evaluation of the patient to consider profession related lesions. Metastases from Sinonasal adenocarcinomas can be considered for differential diagnosis for inability to open mouth.