Sinonasal adenocarcinoma, intestinal type

Sinonasal adenocarcinoma, may be of intestinal or non-intestinal type.

Clinical features

80% of patients are male⁴. The ethmoid sinus is most often affected, followed by the nasal cavity and maxillary sinus. There is an association with exposure to hardwood dusts in the woodworking industry.

Histopathology

Most tumours resemble conventional colorectal adenocarcinoma. Some tumours are mucinous, including alveolar goblet cell and signet ring cell variants. Haemorrhage and necrosis may be extensive⁴.

Immunohistochemistry

	low-grade	intestinal type	non-intestinal type
CDX-2	0/104	15/15 (4 well-differentiated, 4 moderately differentiated, 4 poorly differentiated, 3 mucinous. 10 cases were diffusely and 5 cases focally positive)3, 7/9 (strong and diffuse in seven cases, focal and variable in one case, negative in one case. Cases include two mucinous and one signet ring cell tumour.)4	0/3 (one with features of carcinoma ex pleomorphic adenoma, one adenosquamous, one renal cell carcinoma-like)4
MUC2	0/104	8/9 (strong and diffuse in four cases, strong but focal in four cases, negative in one colloid tumour.)4, 4/45	1/3 (focally strong in one adenosquamous carcinoma)4, 0/35
Cytokeratin 7	9/10 (generally strong and diffuse in nine cases; the tenth case showed only focal staining.)4	5/51, 15/15 (14 cases were diffusely positive)3, 8/9 (staining extent varied, but was generally strong: five cases were positive for both CK7 and CK20)4, 5/55	3/31, 3/34, 3/35
Cytokeratin 20	0/104	5/51, 15/15 (11 cases were diffusely positive)3, 6/9 (staining diffuse and strong in sex cases, negative in three: five cases were positive for both CK7 and CK20)4, 5/55	0/31, 0/34, 0/35

Positivity of adenocarcinomas for CDX-2 and CK20, albeit with retention of CK7, at sites outside the gastrointestinal tract, may be a manifestation of the acquisition of an intestinal phenotype.

Differential diagnosis

• metastatic adenocarcinoma from colorectum: positive for CEA, whereas intestinal-type sinonasal adenocarcinoma is negative or only focally positive. Intestinal-type sinonasal adenocarcinoma is usually more strongly positive for chromogranin⁵ and NSE and is positive for CK 7.

• low-grade sinonasal adenocarcinoma

• metastases from lung, kidney or prostate.

• nasopharyngeal papillary adenocarcinoma

Prognosis

These are aggressive neoplasms, showing both local recurrence and metastases. The five year survival for sinonasal high grade intestinal type adenocarcinoma is less than 20%⁴.

References

¹Chu, P. G. and L. M. Weiss (2002). Keratin expression in human tissues and neoplasms. Histopathology 40(5): 403-39. (Summary data from multiple papers)

²Perez-Ordonez B. Special tumours of the head and neck. Current Diagnostic Pathology 2003;9:366-383.

³Franchi, A., D. Massi, et al. (2003). CDX-2 homeobox gene expression. Am J Surg Pathol 27(10): 1390-1.

⁴Cathro, H. P. and S. E. Mills (2004). "Immunophenotypic differences between intestinal-type and low-grade papillary sinonasal adenocarcinomas: an immunohistochemical study of 22 cases utilizing CDX2 and MUC2." Am J Surg Pathol 28(8): 1026-32.

⁵Krane JF, Modern Pathology 2000 13:139A (abstract)

⁶Choi, H. R., E. M. Sturgis, et al. (2003). "Sinonasal adenocarcinoma: evidence for histogenetic divergence of the enteric and nonenteric phenotypes." Hum Pathol 34(11): 1101-7.

This page last revised 6.9.2004.

©SMUHT/PW Bishop