Synchronous adenocarcinomas of intestinal type of the inner nose and the colon

Summary

Intestinal types of adenocarcinoma of the inner nose and colorectal adenocarcinoma present a stupendous similarity of morphological and immunohistochemical features. The previously unpublished observation of a synchronous manifestation of both adenocarcinoma enabled us to compare the tumors using molecular and immunohistochemical methods. Polymerase chain reaction was performed in order to investigate microsatellite instability. Mutation of p53 and K-ras was examined by direct DNA sequencing. Chromosomal imbalances were investigated by comparative genomic hybridization. Histology and immunohistochemical reactions were nearly identical. PCR results revealed no microsatellite instability or loss of heterozygosity in any of the tumors. A p53 mutation in exon 5 could be detected in the colon tumor but not in the sinonasal carcinoma, while a K-ras mutation was only present in the tumor of the inner nose. The comparative genomic hybridization method revealed different chromosomal imbalances in the different tumors. Thus, the molecular pathologic data proved the presence of 2 independent primary adenocarcinomas of the intestinal type.

Introduction

Sinonasal adenocarcinoma of the intestinal type (SNAIT) show an astounding similarity with colorectal adenocarcinoma of the intestinal type (CRAIT) [1], [2], [3], [4], which is so distinct that a histopathologist, not being familiar with SNAIT, might take it for a metastasis of a CRAIT [5]. In this article, we present the synchronous manifestation of SNAIT and CRAIT proved by molecular diagnostics.

The male patient, born in 1934, worked as a cabinet maker from 1949 to 1994. Due to nasal respiratory problems, a biopsy was taken in November 2002 to clarify a polypoid mass in the inner nose. An adenocarcinoma was diagnosed. The operation, however, was delayed because the patient suffered from an acute perianal hemorrhage. Coloscopy with biopsy revealed an adenocarcinoma of the ascending colon. This adenocarcinoma was removed surgically at the end of November (tumor stage: pT3, pN0, cM0, R0). In mid-December, the tumor of the left nasal cavity and paranasal sinus was surgically removed through an external access (tumor stage: cT2). Afterward, a sinonasal irradation therapy was administered. Neither metastases nor tumor relapses were found for CRAIT or SNAIT in after-care examinations from 2003 to 2005.