Intestinal Type Adenocarcinoma

ICD-O:8144/3

This is a tumour with histological features resembling colorectal adenocarcinoma [126, 220]. It is considered to originate through intestinal metaplasia of the ciliated respiratory cells lining the schneiderian membrane. This tumour is the most common type of sinonasal adeno-carcinoma, representing about 6-13% of malignancies developing in the sinonasal tract [41, 105, 216]. Metastasis from gastrointestinal adenocarcinoma should be ruled out before a tumour is labelled as a primary of this region. These tumours are strongly associated with exposure to different types of dust, mainly hardwood, but also softwood dusts, as well as leather dust [4, 5, 47, 102, 123, 124, 142]. About 20% of sinonasal intestinal-type adenocarcinomas seem to be sporadic, without evidence of exposure to industrial dusts [4].

Grossly, they have a fungating appearance with either polypoid or papillary features. Occasionally, they may have a gelatinous consistency resembling a mucocele. The most common location is the ethmoidal region [17]. Histologically, the tumour is mainly composed of columnar mucin-secreting cells and goblet cells [17]. Some well-differentiated tumours may also contain resorptive cells, argentaffin cells and Paneth cells. Endocrine-amphicrine enteric differentiation may occasionally be found [222]. Metaplastic and atypical changes have been observed in adjacent pre-neoplastic epithelium [270]. These tumours

Table 2.3. Olfactory neuroblastoma. Hyams Grading Scheme [122].

Histologic grades

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