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Lui CG, Badash I, Tang L, Mark ME, Batra PS, Wrobel BB. Ectopic Olfactory Neuroblastoma: Systematic Review of a Rare Clinical Entity among Sinonasal Tumors. J Neurol Surg B Skull Base 2024; 85:109-118. [PMID: 38463937 PMCID: PMC10923629 DOI: 10.1055/a-1993-7790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Ectopic olfactory neuroblastoma is an uncommon manifestation of an already rare neoplasm. We aimed to systematically review the literature for cases of ectopic olfactory neuroblastoma to better characterize this rare disease entity and to present two new case reports. Methods A search of the PubMed and Embase databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify English-language articles reporting cases of ectopic olfactory neuroblastoma, published from 1955 through November 2021. Results Sixty-six cases of ectopic olfactory neuroblastoma were identified in 62 articles including the current review. Ectopic olfactory neuroblastoma arose in a wide age range (2-89 years) without significant sex predilection. It occurred most commonly in the ethmoid (25%), maxillary (25%), and sphenoid (16%) sinuses. Seventy-three percent of cases presented with low Hyams grade (I and II). The most common symptoms were nasal obstruction (32%) and epistaxis (32%). Paraneoplastic syndromes were observed in 27% of patients. The most common treatment was surgical resection followed by adjuvant radiotherapy. Overall, 76% of all patients were disease-free at the time of last follow-up. Locoregional recurrences and distant metastases were found in 19 and 5% of cases, respectively. Conclusion This systematic review describes previously reported cases of ectopic olfactory neuroblastoma, a disease entity with poorly understood characteristics. Physicians should consider olfactory neuroblastoma in the differential diagnosis for sinonasal masses, as their ectopic presentation may present considerable diagnostic and therapeutic difficulties. Patients with olfactory neuroblastoma may benefit from long-term follow-up and routine endoscopic examinations for surveillance of ectopic recurrences.
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Affiliation(s)
- Christopher G. Lui
- Department of Otolaryngology - Head & Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Ido Badash
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Liyang Tang
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Michelle E. Mark
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Pete S. Batra
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Bozena B. Wrobel
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
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Doyle JJ, Hashimie Y, Metting A. An olfactory neuroblastoma presenting as posterior reversible leukoencephalopathy syndrome. Proc AMIA Symp 2021; 34:724-725. [PMID: 34733002 DOI: 10.1080/08998280.2021.1953878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Olfactory neuroblastomas are rare malignancies of the nasal and sinus cavities. They have been associated with paraneoplastic syndromes due to secretion of adrenocorticotropin hormone (ACTH) or antidiuretic hormone. These associated paraneoplastic syndromes can present with a wide variety of symptoms that can make diagnosis of the underlying tumor difficult. Here we present the case of a 23-year-old woman who had a seizure due to the development of posterior reversible leukoencephalopathy syndrome because of secondary hypertension due to Cushing's syndrome, which was in turn found to be due to ectopic ACTH production from a metastatic olfactory neuroblastoma.
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Affiliation(s)
- James J Doyle
- Department of Internal Medicine, Baylor Scott & White Medical Center - Temple, Temple, Texas
| | - Yasmeen Hashimie
- Department of Hematology-Oncology, Baylor Scott & White Medical Center - Temple, Temple, Texas
| | - Austin Metting
- Department of Internal Medicine, Baylor Scott & White Medical Center - Temple, Temple, Texas
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Abe H, Suwanai H, Kambara N, Sano K, Shikuma J, Akaoka H, Kanazawa A, Hirai H, Miwa T, Nagao T, Odawara M. A Rare Case of Ectopic Adrenocorticotropic Hormone Syndrome with Recurrent Olfactory Neuroblastoma. Intern Med 2021; 60:105-109. [PMID: 32921682 PMCID: PMC7835471 DOI: 10.2169/internalmedicine.2897-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 40-year-old woman who had a history of recurrent olfactory neuroblastoma presented with full moon face, central obesity, buffalo hump, impaired glucose tolerance and bilateral cervical lymph node swelling. Laboratory tests showed morbidly elevated levels of adrenocorticotropic hormone (ACTH) and cortisol, which were not suppressed by high-dose (8 mg) dexamethasone. Biopsies of the enlarged cervical lymph nodes revealed ACTH-positive metastatic olfactory neuroblastoma, and ectopic ACTH syndrome was diagnosed. Metyrapone was used to suppress cortisol production and resulted in decreased levels of ACTH and cortisol. Bilateral cervical tumor resection further reduced the ACTH and cortisol levels, accompanied by a reduction in the metyrapone dosage. Cushing's syndrome was alleviated through ACTH-producing tumor removal.
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Affiliation(s)
- Hironori Abe
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Japan
| | - Hirotsugu Suwanai
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Japan
| | - Nodoka Kambara
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Japan
| | - Koji Sano
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Japan
| | - Junpei Shikuma
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Japan
| | - Hiroaki Akaoka
- Department of Diabetes, Metabolism, Endocrinology, Tokyo Medical University Hachioji Medical Center, Japan
| | - Akira Kanazawa
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Japan
| | - Hideaki Hirai
- Department of Anatomic Pathology, Tokyo Medical University, Japan
| | - Takashi Miwa
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Japan
| | - Masato Odawara
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Japan
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Tan H, Chen D, Yu Y, Yu K, He W, Cai B, Jiang S, Tang Y, Tong N, An Z. Unusual ectopic ACTH syndrome in a patient with orbital neuroendocrine tumor, resulted false-positive outcome of BIPSS:a case report. BMC Endocr Disord 2020; 20:116. [PMID: 32736557 PMCID: PMC7393836 DOI: 10.1186/s12902-020-00590-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 12/31/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cushing's syndrome has been described as a complex endocrine disorder characterized with high cortisol concentration. Correct and early diagnosis of Cushing's syndrome is challenging. According to the latest guideline, bilateral inferior petrosal sinus sampling (BIPSS) is considered to be the gold standard for the differential diagnosis. However, in some unusual cases, this method may be false positive. Here, we presented a rare case of orbital neuroendocrine tumor secreting adrenocorticotrophic hormone with false positive inferior petrosal sinus sampling. CASE PRESENTATION A 48-year-old woman was admitted to West China Hospital of Sichuan University, presenting with fatigue, whole body edema for 1 year, alopecia and skin pigmentation for 5 months. Hormonal profiles including plasma cortisol and adrenocorticotrophic hormone (ACTH) measurements and low-dose dexamethasone inhibition test suggested that the patient had Cushing's syndrome. However, during tumor location phase, the results of high-dose dexamethasone inhibition test (HDDST) contradicted desmopressin (DDAVP) stimulation test. Thus, BIPSS was employed, and its results indicated a pituitary origin. Interestingly, MRI of sellar region showed an innocent pituitary but caught a serendipitous lesion in the lateral rectus muscle of left eye, which was later proved to be an orbital neuroendocrine tumor secreting ACTH by pathological and immunohistochemical results. ACTH level of the patients was < 0.1 ng/L and cortisol level was 51.61 nmol/L 1 week after surgery. At 24 months follow-up, the patient appeared stable with no complaints nor any symptoms of Cushing's syndrome, including moon face, purple striate and central obesity. The patient's life quality also improved significantly. CONCLUSION We reported a rare case of endogenous Cushing's syndrome due to ectopic ACTH secreting from an orbital neuroendocrine tumor. This unique case of orbital EAS suggests that orbital venous blood backflow, owning to abnormal anatomic structures, may possibly lead to false positive BIPSS results.
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Affiliation(s)
- Huiwen Tan
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Dawei Chen
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yerong Yu
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Kai Yu
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Weiming He
- Division of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Bowen Cai
- Division of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Su Jiang
- Division of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Ying Tang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Nanwei Tong
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhenmei An
- Division of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
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Chung YS, Na M, Ku CR, Kim SH, Kim EH. Adrenocorticotropic Hormone-Secreting Esthesioneuroblastoma with Ectopic Cushing's Syndrome. Yonsei Med J 2020; 61:257-261. [PMID: 32102127 PMCID: PMC7044685 DOI: 10.3349/ymj.2020.61.3.257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/14/2022] Open
Abstract
Esthesioneuroblastoma as a source of ectopic Cushing's syndrome is rare, and to the best of our knowledge, only 20 cases have been reported worldwide. A 46-year-old healthy man visited a local clinic for general weakness and hyposmia, and underwent examination with serial endocrinological workup and brain imaging. 68Gallium-DOTA-TOC positron emission tomography scan was helpful where diagnosis of sellar MRI and inferior petrosal sinus sampling were discordant. Combined transcranial and endoscopic endonasal approach surgery was performed, and a diagnosis of esthesioneuroblastoma was given.
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Affiliation(s)
- Young Soo Chung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Minkyun Na
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Cheol Ryong Ku
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Pituitary Tumor Center, Severance Hospital, Seoul, Korea
| | - Se Hoon Kim
- Pituitary Tumor Center, Severance Hospital, Seoul, Korea
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
- Brain Tumor Center, Severance Hospital, Seoul, Korea
| | - Eui Hyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
- Pituitary Tumor Center, Severance Hospital, Seoul, Korea
- Brain Tumor Center, Severance Hospital, Seoul, Korea.
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