Sinonasal carcinoma ex-pleomorphic adenoma: A case report

Introduction: Carcinoma ex-pleomorphic adenoma (CXPA) of the nasal cavity is an exceedingly rare malignancy with limited literature available regarding its diagnosis and management. This case report overviews the clinical course of a patient with a rare sinonasal CXPA. Case presentation: A 76-year-old female presented with an expanding nasal bridge mass over three months, preceded by 18 months of nasal pain, bilateral discharge, and headaches that were refractory to conservative therapies. Magnetic resonance imaging demonstrated a large, septal soft tissue mass associated with local bone and soft tissue invasion. Positron emission tomography did not identify regional or distant metastases. Excisional biopsy histopathology confirmed CXPA. The patient underwent wide local excision, with a frontoethmoidectomy and resections of the middle turbinate and cribriform plate, and subsequent craniofacial reconstruction. The postoperative course was uncomplicated and the patient was discharged on postoperative day six with a plan for adjuvant radiotherapy. Conclusion: CXPA is a rare but important differential diagnosis of minor salivary gland malignancies in the nasal cavity. Symptoms are non-specific and should be investigated when refractory to conservative therapies or there is clinical suspicion of malignancy. Tissue diagnosis and surgical intervention are the mainstays of management.