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Nonintestinal Type Adenocarcinoma of the Ethmoid Sinus With Unusual Cribriform Histologic Pattern

Tukel, Matthew R. B.S.*; Adelman, Madeline J. B.S.*; Gladstone, Geoffrey J. M.D.†,‡; Appleford, Colin D.O.†,§

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Ophthalmic Plastic and Reconstructive Surgery: May/June 2021 - Volume 37 - Issue 3 - p e123
doi: 10.1097/IOP.0000000000001736
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A 63-year-old man presented with 4 years of progressive epiphora with recent evolution into hemolacria. Visual acuity and ocular motility were normal. Examination revealed a palpable, nonerythematous mass in the right medial canthal area, which burst upon gentle palpation with a green mucopurulent discharge. CT of the orbits revealed a large growth in the ethmoid sinus invading into the right medial orbit and extending into the maxilla (Fig. A). Endoscopic endonasal biopsy of the mass was performed. Histopathology showed a cribriform pattern, moderate grade nuclei with eosinophilic cytoplasm, and occasional necrosis (Fig. B–D). Immunohistochemistry stained positively for androgen, transcription factor GATA3, and receptor tyrosine-kinase HER2/Neu and negative for transcription factor CDX-2. Nonintestinal type adenocarcinomas mostly present with papillary, tubular, or glandular patterns on histopathology. Unusual morphologic variants post a diagnostic challenge. Careful microscopic analysis is key for differentiation of this tumor type from other similar sinonasal malignancies and for prognostication purposes.
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