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Clinical Note |

Ethmoidal Lipid-Rich Carcinoma With Focal Glandular Structures

Hisashi Oshiro, MD; Junichi Nagao, MD; Yoji Nagashima, MD; Takahide Taguchi, MD; Shoji Yamanaka, MD; Yoshiaki Inayama, MD
Arch Otolaryngol Head Neck Surg. 2009;135(5):511-514. doi:10.1001/archoto.2009.27.
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Sinonasal malignant tumors constitute less than 1% of all neoplasms and approximately 3% of those of the upper aerodigestive tract.1 Sinonasal malignant neoplasms most commonly affect the maxillary sinuses (approximately 60%), followed by the nasal cavity (approximately 22%), ethmoidal sinus (approximately 15%), and frontal and sphenoid sinuses (<3%).1 Sinonasal neoplasms are diverse, with most being squamous cell carcinoma or variants (55%), followed by nonepithelial neoplasms (20%), glandular tumors (15%), undifferentiated carcinoma (7%), and miscellaneous tumors (3%).1 We describe an exceedingly unusual case of ethmoidal lipid-rich carcinoma with focal glandular structures. To our knowledge, such a case has not been documented in the literature to date.

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Figure 1.

Magnetic resonance imaging of the head showing a neoplastic lesion located in the left ethmoidal sinuses and protruding into the left nasal cavity (arrowheads). Fluid accumulation caused by outflow tract obstruction is evident in the left maxillary sinus (arrow). A, Coronal T1-weighted image. F indicates foot side; L, left; and R, right. B, Axial T2-weighted image.

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Figure 2.

Photomicrographs of the ethmoidal tumor. A, Tumor cells forming irregularly shaped, solid nests. Foci of necrotic or apoptotic cells with pyknotic nuclei are visible (hematoxylin-eosin, original magnification ×50). B, Tumor cells predominantly composed of clear, vacuolated cytoplasm and enlarged nuclei with prominent nucleoli. Small foci of glandular structures are visible at the lower right corner (arrows) (hematoxylin-eosin, original magnification ×100). C, Tumor cells containing cytoplasmic lipid (Sudan III stain of fresh-frozen tissue, original magnification ×100). D, Immunohistochemical photomicrograph of tumor cells showing widespread positivity for adipophilin in a manner consistent with intracytoplasmic vacuoles (original magnification ×100).

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Figure 3.

Transmission electron micrographs of the ethmoidal tumor. A, Tumor cells showing a large number of cytoplasmic lipid droplets (bar indicates 6.88 μm). B, Tumor cells forming a ductal space with microvilli on the apical side (bar indicates 1.72 μm).

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