Intestinal-type adenocarcinoma (ITAC) is unusual in the nasal cavity and paranasal sinuses. The author presents 17 patients seen over a 32-year period. The majority of patients were initially seen with nasal obstruction or epistaxis, with a mean duration of symptoms of 6.8 months. The male-female ratio was 9:8, and ages ranged from 31 to 80 years. None of the patients in this series were woodworkers. The risk for developing ITAC in woodworkers is 70-500 times that in nonwoodworkers, and the prognosis for the former is significantly better (50% 5-year survival) than in sporadically occurring cases (2040% 5-year survival).
Radiographically, soft tissue density was shown in the nasal cavity or maxillary and ethmoid sinuses with bony destruction in the majority of paranasal sinus tumors. Therapy was variable, including intranasal excision, medial maxillectomy, irradiation, chemotherapy, or a combination of these. Thirty-eight percent of patients developed local occurrences; 12% had cervical lymph node metastases at diagnosis or subsequently; and 25% developed distant metastases.
The author also reviewed 196 cases from the English-language literature and found the male-female ratio to be 83: 17; the local recurrence, 58%; and incidence of cervical lymph node metastases, 8%. Sixtythree percent of patients died of their disease, and at least 19 of the tumors occurred in woodworkers.
Because of the variation in therapy, it is difficult to draw conclusions about the optimal therapy for these tumors. The origin of ITAC is controversial; some believe they arise from "ectopic endoderm," whereas, others propose differentiation from a multipotential stem cell.