A Rare Case of Metastases to Paranasal Sinus From Colonic Adenocarcinoma

Metastases of malignant tumors to the nasal cavity and paranasal sinuses are very rare. Metastases to these locations are usually solitary and produce similar symptoms to those of a primary sinonasal tumor. Pain, nasal obstruction, and epistaxis are the most common symptoms. Although any malignancy could potentially lead to metastasis to the paranasal sinuses, colo-rectal malignancy metastasizes to this site is rare. We report a case of metastatic adenocarcinoma of colorectal origin to the paranasal sinuses in a 55-year-old female who was initially diagnosed with adenocarcinoma of the colon with lung and liver metastasis. She subsequently developed metastasis to left ethmoidal and sphenoidal sinuses during treatment. A histologic study of the surgical specimen from the sinonasal cavity demonstrated a tumor identical to the patient's prior primary tumor of the colon. The sinonasal neoplastic tissue showed marked positivity for carcinoembryonic antigen and expressed cytokeratin 20, which differentiates metastatic colonic adenocarcinoma from primary intestinal-type adenocarcinoma (ITAC). She received palliative radiation therapy but died three months after the diagnosis. These subsets of patients have a poor prognosis. In the majority of patients, palliative therapy is the only possible treatment option. Nevertheless, whenever possible, surgical excision either alone or combined with radiotherapy may be useful for palliation of symptoms and, rarely, to achieve prolonged survival.