An Atypical Etiology of Anosmia

A 52-year-old Caucasian female with complaints of chronic nasal obstruction and anosmia was conservative treated for 2 years. The patient was sent to our tertiary care center after developing a forehead swelling and decreased visual acuity. Contrast-enhanced CT-Scan and MRI (Figure 1 & 2) showed a large nasal cavity tumor, achieving both frontal sinuses, with bone expansion and erosion, and infiltrating the anterior cranial fossa. A nasal endoscopic guided biopsy was performed under general anesthesia and the histologic findings revealed a sinonasal undifferentiated carcinoma (SNUC). According to the current TNM classification of sinonasal tumors, the neoplasm was classified as cT4b. Further staging excluded cervical or distant metastases. This tumor was also classified as C, according to the Kadish System. After a promptly case presentation on our tumor board, and because an R0 resection would not be possible, a decision was made against a surgical treatment. A primary radiochemotherapy was recommended and initiated.