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184 2015 Archives of International Surgery | Published by
Wolters Kluwer - Medknow
Mucoepidermoid carcinoma of the nasal cavitymimicking a simple
nasal polyp
ABSTRACT
Mucoepidermoid carcinoma (MEC) of the sinonasal area is very
rare and frequently misclassified. We report a 43-year-old
woman
who presented with persistent nasal blockage, epistaxis,
progressive right cheek swelling and ipsilateral proptosis. The
affected
eyes vision was low, to identifying only fingers at 6 m. She
also had hypoesthesia over the right cheek and distortion of
the
ipsilateral external nasal pyramid. There was also a fleshy mass
filling the right nasal cavity, causing the deviation of the
nasal
septum to the contra-lateral side. A diagnosis of a malignant
nasal mass was made. Following the nasal polypoidal mass biopsy
a
histological diagnosis of MEC was made. The patient had complete
evaluation including computed tomography scan of the sinuses
and underwent extensive surgical resection and postoperative
radiotherapy. The patient is doing well on follow-up.
Key words:Mucoepidermoid carcinoma, nasal polyp, sinonasal
carcinoma
Tokan Silas Baduku, Saadatu Ladan1, Mainasara Mohammed1, Joshua
Jibrin1
Department of Radiology, Kaduna State University, Kaduna,
1National Ear Care Centre, Kaduna, Nigeria
Address for correspondence:Dr. Tokan Silas Baduku,
Department of Radiology, Kaduna State University, Kaduna,
Nigeria.E-mail: [email protected]
Access this article online
Quick Response Code:Website:
www.archintsurg.org
DOI:
10.4103/2278-9596.167519
Case Report
Treatment options include surgery, radiation therapy, and
chemotherapy. A combination of these will produce more
excellent results.
We present the case of a 43-year-old female with sinonasal
MEC that mimicked a simple nasal polyp, but histology
gave a diagnosis. She was successfully operated upon
andsubsequently referred for radiotherapy.
Case Report
A 43-year-old female presented with a 4-year history
of recurrent rhinorrhea, and 3-year history of bilateral
alternating nasal blockage, worse in the right nasal
cavity, which had become persistent 6 months prior to
the presentation. She had associated blood-tinged nasal
discharge, postnasal drip, hyposmia, and hyponasal
Introduction
Mucoepidermoid carcinoma (MEC) is a common malignant
neoplasm of the salivary gland, with the parotid being the
main site of occurrence.[1]However, the sinonasal location
of this tumor is extremely rare,[2]constituting only 0.6%
of all MECs.[3]
Mucoepidermoid carcinoma is defined bythe WHO as a malignancy
consisting of mucous-secreting
squamous and intermediate cell types, usually arising
from the squamous, mucus-secreting cells of the salivary
glands, but can also be found in other organs such as the
lacrimal sac, larynx, lungs, thyroid, and the sinonasal
tract.[1]The management of MEC depends on its grade,
location and the extent of spread. Early diagnosis gives a
better prognosis. Also, a low-grade tumor will generally
have a good prognosis compared with a high-grade tumor.
How to cite this article:Baduku TS, Ladan S, Mohammed M, Jibrin
J.
Mucoepidermoid carcinoma of the nasal cavity mimicking a simple
nasal
polyp. Arch Int Surg 2015;5:184-6.
This is an open access article distributed under the terms of
theCreative Commons Attribution-NonCommercial-ShareAlike 3.0
License, which allows others to remix, tweak, and build upon
the
work non-commercially, as long as the author is credited and
the
new creations are licensed under the identical terms.
For reprints contact:[email protected]
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Baduku, et al.: Mucoepidermoid carcinoma of the nasal cavity
Archives of International Surgery / July-September 2015 / Vol 5
/ Issue 3 185
speech. She is a known hypertensive on antihypertensive
medication and neither smokes cigarette nor ingests
alcohol. Initial assessment revealed insensitive polypoidal
masses filling both nasal cavities that were not friable and
had no contact bleeding.
She was sent to the Radiology Department for sinus
radiographs and computed tomography (CT) sinuses
during which she absconded for 2 years after which
she reappeared. She represented with persistent nasal
blockage, epistaxis, progressive right cheek swelling and
ipsilateral proptosis. The affected eyes vision was low, to
identifying only fingers at 6 m. She also had hypoesthesia
over the right cheek and distortion of the ipsilateral
external nasal pyramid. There was also a fleshy mass
filling the right nasal cavity, causing the deviation of the
nasal septum to the left. There was also tenderness over
the right maxillary dentition, but no loose teeth, or
palatal
bulge were demonstrated. No cervical lymphadenopathywas
seen.
Plain radiographs showed opacification of all the paranasal
sinuses and the nasal cavities, more extensive to the right.
CT showed isodense, poor contrast enhancing masses
infiltrating the sinuses and the nasal cavities. There was
an erosion of the frontal, maxillary and nasal bones on the
right side, with mid-line deviation to the contra-lateral
side
[Figure 1]. The retro-antral fat, pterygoids and the base of
skull were intact.
The patient had a wide exenteration of the tumor via
anendoscopic approach and was referred for radiotherapy.
Histology showed an infiltrating tumor growing in singles,
sheets, tubules and trabeculae. It was composed of
epithelial cells with dark round nuclei, variable amounts of
amphophilic to clear cytoplasm. The stroma was lionized
and collagenous. The conclusion was a mucoepidermoid
carcinoma (MEC).
She was referred to the oncology unit where she had
radiochemotherapy. Follow-up visits to our clinic for the
last 8 months showed a stable middle-aged woman. She
is still being followed-up.
Discussion
Sinonasal malignancies account for
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Baduku, et al.: Mucoepidermoid carcinoma of the nasal cavity
186 Archives of International Surgery / July-September 2015 /
Vol 5 / Issue 3
presented with these symptoms probably because of
delayed presentation.
Conclusion
Sinonasal MEC is a rare tumor entity. Though rare, it should
be considered among the differentials of nasopharyngeal
tumors. Histology is required to confirm the diagnosis
while the tumor responds well to surgical resection and
radiochemotherapy.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conflicts of interest.
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