A 67-year-old woman had been treated for 6 months with antihistamines, nasal steroids, and antibiotics for suspected sinusitis. When she continued to complain of progressive headaches, right-sided epiphora, and anosmia, limited computed tomography (CT) of the paranasal sinuses was obtained (figure 1). A diagnosis of right-sided ethmoid sinusitis was made, and the patient was referred to us for endoscopic sinus surgery. Findings on our review of the patient's sinus CTs were not consistent with the range and severity of her symptoms, so we obtained further imaging.
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CT of the orbits detected the presence of a mass that extended from the right ethmoid sinuses into the orbital apex, anterior cranial fossa, right frontal lobe, and sphenoid sinus (figure 2). Findings on endoscopic biopsy were consistent with squamous cell carcinoma (SCC). The patient underwent a craniofacial resection and postoperative radiotherapy.
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Malignant tumors of the ethmoid sinus account for a low percentage of head and neck cancers. When they do occur, SCC is the most common histologic subtype, followed by adenocarcinoma, adenoid cystic carcinoma, and several others. (1)
Like other sinonasal malignancies, SCC of the ethmoid sinus is often...