Adenoid Cystic Carcinoma of the Nasal Septum: A Rare Case Report

Vollständiger Abstract

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Adenoid cystic carcinoma (ACC) is a rare malignant epithelial tumor arising predominantly from salivary glands. Sinonasal involvement is uncommon, and primary ACC originating from the nasal septum is exceedingly rare. Its slow growth and nonspecific symptoms make the diagnosis difficult. A 60-year-old male presented with progressive right-sided nasal obstruction for two years associated with intermittent epistaxis, rhinorrhea, sneezing, and dull aching nasal pain. Clinical examination revealed a pinkish irregular mass occupying the right nasal cavity and deviating the nasal septum toward the contralateral side. Contrast-enhanced computed tomography demonstrated a heterogeneously enhancing soft tissue lesion involving the right nasal cavity with focal erosion of the nasal septum without evidence of sinus or orbital extension. Surgical excisional biopsy under general anesthesia with intraoperative frozen section analysis was planned. Frozen section suggested Adenoid Cystic Carcinoma, following which complete endoscopic excision with margin assessment was performed. Histopathological examination confirmed cribriform-type adenoid cystic carcinoma. Postoperative PET-CT showed no locoregional or distant metastasis. The patient was subsequently referred for adjuvant radiotherapy following multidisciplinary tumor board discussion. Primary ACC of the nasal septum is exceptionally rare. This case emphasizes the importance of considering malignancy in patients with persistent unilateral nasal symptoms and demonstrates the value of frozen section analysis in guiding surgical management.