This is a case of pathologically proven olfactory neuroblastoma (esthesioneuroblastoma).

Gross pathologic examination of specimens removed from the left nasal cavity and skull base revealed multiple irregularly shaped fragments of soft tan and gray portions of tissue. Metastatic tissue from a mixed lytic and sclerotic L2 lesion was also analyzed. Histopathologic examination of the nasal cavity, skull base, and metastatic tissue demonstrated rare groups of abnormal small round blue cells with scant cytoplasm tissue that was highlighted by immunohistochemistry for CAM-5.2, CD56, Chromogranin, and Synaptophysin. The tissue was negative for TIF-1, P63, CK7, and CD99. These findings were consistent with olfactory neuroblastoma (esthesioneuroblastoma).

The patient eventually underwent palliative resection of this unresectable esthesioneuroblastoma with concurrent ligation of the left internal maxillary artery. The patient has been following with otolaryngology for periodic debridement due to nasal crusting and oncologic surveillance. 

Co-author:
Mason Soeder