Sinonasal Intestinal type Adenocarcinoma (ITAC) Our insights from a rare clinical case: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Sinonasal Intestinal type Adenocarcinoma (ITAC) Our insights from a rare clinical case: a case report Siri Krishna Kondreddy, Rohini Gandla, Chaitanya Varma Alluru, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6279957/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Intestinal-type adenocarcinoma is the second most common sinonasal adenocarcinoma. It develops through intestinal metaplasia of sinonasal epithelium, characterized by strong resemblance to carcinoma of colon and considered to be rare. These are aggressive tumours generally diagnosed in the advanced stage. Histopathological subtype is an important prognostic indicator. Case Report: A 51 year old male patient presented with complaints of right nasal obstruction since 4 months, history of blood stained nasal discharge occasionally. On nasal endoscopy, a single irregular exophytic mass bulging into nasal cavity originating from right side upper part of posterior nasal septum was seen. Excision of mass and right side full functional endoscopic sinus surgery with septoplasty were done. Histopathological examination showed invasive tumor arranged predominantly in papillary architecture with focal tubule formation and was diagnosed as sinonasal intestinal type adenocarcinoma, well differentiated, papillary subtype. Immunohistochemistry showed tumour is focal positive for CK7 and positive for CK20, CDX2, SATB2. Conclusion: Intestinal-type adenocarcinoma (ITAC) is the second most common type of sinonasal adenocarcinoma after adenoid cystic carcinoma and has better prognosis compared with squamous cell carcinomas. Standard treatment is surgical resection, with a minimally invasive endoscopic approach when possible, followed by chemoradiotherapy. Nasal mass Sinonasal mass intestinal-type adenocarcinoma ITAC Malignancy Radiotherapy Rhinology ESS Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Sinonasal tumors are rare forms of head and neck malignant neoplasms accounting for only 3% of head and neck cancers and adenocarcinoma accounts for only a small percentage (10% − 20%) of all sinonasal cancers, although it is the second most frequent histopathology type after squamous cell carcinoma [ 11 ]. Adenocarcinomas of the sinonasal tract may originate from respiratory surface epithelium or the underlying seromucinous glands. These are divided into salivary-type adenocarcinomas and non-salivary-type adenocarcinomas. The latter are further divided into intestinal-type and non intestinal-type adenocarcinomas. The WHO classifies sinonasal adenocarcinomas of surface epithelial origin in intestinal and non-intestinal types. [ 1 ] ITACs occur mostly in males with a wide age range and a mean of 50–64 years. ITACs are most frequently localized in the ethmoid sinus (40%), the nasal cavity (25%) and the maxillary antrum (20%). Occurrence of ITAC has a strong association with occupational exposure to hardwood dusts, long-term exposure to chromium and nickel has been incriminated. Carcinogenic compounds in occupational dusts have not been identified, but etiologic roles for tannins or chronic inflammation have been speculated. ITACs mimic the appearances of neoplastic large and small intestinal mucosa, and occasionally normal intestinal mucosa. [ 2 ] Based on histopathologic parameters, Dr. Barnes classified ITACs into five categories: papillary, colonic, solid, mucinous, and mixed subtypes. On the other hand, the classification of Kleinsasser and Schroeder subdivided ITACs into papillary-tubular cylindrical cell type (corresponding to papillary, colonic, and solid subtypes), alveolar goblet cell type and signet-ring cell type (both corresponding to mucinous subtype), and transitional type (corresponding to mixed subtype). The histologic subtypes have been reported to correlate with differences in clinical behaviour. [ 2 ] [ 4 ] [ 5 ] Table 1. Classification of Intestinal-type adenocarcinomas [ 3 ] [ 4 ] [ 5 ] CASE REPORT A 51 year old male patient presented with complaints of right nasal obstruction since 4 months and history of blood stained nasal discharge occasionally. He is a farmer by occupation. Anterior rhinoscopy shows deviated nasal septum to left with spur impinging on inferior turbinate. Neck examination shows no palpable lymph nodes. Diagnostic nasal endoscopy on right side a single irregular exophytic mass bulging into nasal cavity with necrotic and friable appearance, appears to originate from upper part of posterior nasal septum, extending between septum and middle turbinate was seen. On probe test, it is sensitive to touch, bleeds on touch, can be probed all around except superiorly, probably indicating the attachment of mass. On left side there is deviated nasal septum with spur. Computed tomography (CT) of the paranasal sinuses on right side shows soft tissue density in ethmoid, sphenoid, maxillary, frontal sinuses and nasal cavity, causing blockage of osteomeatal complex, fronto-ethmoidal and spheno-ethmoidal recesses with erosion of medial wall of maxillary sinus, widening of maxillary antrum, scalloping of midline septum and intact cribriform plate. Under general anaesthesia, decongestion of the nasal cavity was done. Under endoscopic guidance, mass is identified in the upper part of posterior nasal septum. The mass is firm to touch and bleeds on touch. It can be probed laterally, inferiorly but cannot be probed medially with pedicle of mass seen arising from the septum. Excision of mass and right side functional endoscopic sinus surgery were done. Excised mass was sent for biopsy. Histopathological sections revealed invasive tumor arranged predominantly in papillary architecture with focal tubule formation. Papillae are lined by columnar epithelial cells with mild eosinophilic cytoplasm, enlarged nuclei exhibiting hyperchromatism with pseudo stratification, increased nuclear to cytoplasmic ratio and inconspicuous nucleoli with interspersed goblet cells. Areas of mixed inflammatory infiltrates of lymphocytes, plasma cells, neutrophils, necrosis and hemorrhages noted. Impression was Sinonasal Intestinal-type Adenocarcinoma, Well differentiated, Papillary subtype (Grade 1). Immunohistochemistry of the tumour was positive for CK20, CDX2, SATB2 and focally positive for CK7. Hence, diagnosis of Sinonasal Intestinal-type Adenocarcinoma was confirmed. Patient received chemoradiotherapy (EBRT for 6 weeks along with weekly dose of Cisplatin) He is under regular follow-up and shows no signs of recurrence. DISCUSSION Adenocarcinoma accounts for 9% of sinonasal malignancies. Papillary adenocarcinomas are the least aggressive form. Sessile and mucoid adenocarcinomas have the worst prognosis [ 11 ] These grow silently with no symptoms, which leads to a late diagnosis and low survival rates. Nodes and distant metastases are rare at presentation. Patient survival depends on local control that is extremely difficult because of the anatomical proximity to orbit and brain. Local recurrence is frequent [ 12 ]. These tumors are consistently positive for CK20, CDX2, villin, MUC2, SATB2, variably positive for CK7 and CEA. Chromogranin + cells may be present. Diagnosis of ITAC from sinonasal non-intestinal adenocarcinomas is supported by immunohistochemistry [ 2 ] [ 6 ] [ 7 ]. Papillary subtype is associated with better prognosis, while mucinous and solid subtypes carry poor prognosis. TP53 is most frequently mutated (40–50%), while APC , KRAS , and BRAF mutations are found in some subsets [ 3 ]. Neoadjuvant chemotherapy with a platinum-based regimen can provide a survival benefit in selected ITACs with functional p53, whereas genetic and biological studies have identified alterations in the molecular pathways of EGFR, MET, and H-RAS, which might be considered as potential targets for biotherapy [ 8 ]. Prognosis ITACs aggressive neoplasms, with 53% of local recurrences, 8% (range 0–22%) cervical lymph node metastases, 13% (range 0–29%) distant metastases, and 60% mortality according to Barnes et al [ 4 ]. The survival rates for ITAC reported by Llorente et al at 5 and 10 years were 36% and 28% [ 9 ]. Well and moderately differentiated ITACs have a significantly better prognosis than poorly differentiated and mucinous tumours [ 10 ]. CONCLUSION Intestinal-type adenocarcinoma (ITAC) is the second most common type of sinonasal adenocarcinoma after adenoid cystic carcinoma. These have better prognosis compared with squamous cell carcinomas. Incidence is high among wood, shoe, leather, textile manufacturers and long-term exposure to chromium and nickel has been incriminated. The carcinogenic compounds have not been identified, but role of chronic inflammation has been speculated. Trans nasal endoscopic surgery is done in large majority of patients with ITAC; adjuvant radiotherapy is recommended in advanced stage and high-grade lesions. The high incidence of recurrent tumors requires regular and thorough follow-up. Abbreviations ITAC Intestinal-type adenocarcinoma EBRT External Beam Radiotherapy CK Cytokeratin SATB2 Special AT-rich sequence binding protein-2 Declarations Acknowledgements We would like to thank department of Anaesthesia and department of Pathology, Alluri Sitarama Raju Academy of Medical Sciences, Eluru. Authors’ contributions S.K.S evaluated the clinical findings and contributed to the manuscript, R.G evaluated the clinical findings and prepared the manuscript, C.V.A assisted the surgery and contributed to the manuscript, D.M performed the surgery and proofread final manuscript. The authors read and approved the final manuscript. Funding None Availability of data and material Not applicable Ethics approval and consent to participate Not applicable Consent for publication Verbal and written consent for publication was obtained from the patient Competing interests The authors declare that they have no competing interests. Author details 1 Assistant Professor, Department of Otorhinolaryngology‑ Head & Neck Surgery, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh, India. 2* Department of Otorhinolaryngology‑ Head & Neck Surgery, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh, India. 3 Department of Otorhinolaryngology‑ Head & Neck Surgery, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh, India. 4 Professor and Head, Department of Otorhinolaryngology‑ Head & Neck Surgery, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh, India. References Leivo I, Sinonasal Adenocarcinoma (2016) Update on Classification, Immunophenotype and Molecular Features. Head Neck Pathol 10:68–74. https://doi.org/10.1007/s12105-016-0694-9 Leivo I (2017) Intestinal-Type Adenocarcinoma: Classification, Immunophenotype, Molecular Features and Differential Diagnosis. Head Neck Pathol 11(3):295–300. 10.1007/s12105-017-0800-7 Epub 2017 Mar 20. PMID: 28321774; PMCID: PMC5550401 Perez-Ordoñez B (2009) Hamartomas, papillomas and adenocarcinomas of the sinonasal tract and nasopharynx. J Clin Pathol 62:1085–1095 Barnes L (1986) Intestinal-type adenocarcinoma of the nasal cavity and paranasal sinuses. Am J Surg Pathol. ;10(3):192–202. 10.1097/00000478-198603000-00006 . PMID: 3953940 Kleinsasser O, Schroeder HG (1988) Adenocarcinomas of the inner nose after exposure to wood dust. Morphological findings and relationships between histopathology and clinical behavior in 79 cases. Arch Otorhinolaryngol. ;245(1):1–15. doi: 10.1007/BF00463541. PMID: 2839136 Kennedy MT, Jordan RC, Berean KW, Perez-Ordoñez B (2004) Expression pattern of CK7, CK20, CDX-2, and villin in intestinal-type sinonasal adenocarcinoma. J Clin Pathol 57(9):932–937. 10.1136/jcp.2004.016964 PMID: 15333652; PMCID: PMC1770431 Franchi A, Miligi L, Palomba A, Giovannetti L, Santucci M (2011) Sinonasal carcinomas: recent advances in molecular and phenotypic characterization and their clinical implications. Crit Rev Oncol Hematol 79(3):265–277 Epub 2010 Sep 25. PMID: 20870420 Rampinelli V, Ferrari M, Nicolai P (2018) Intestinal-type adenocarcinoma of the sinonasal tract: an update. Curr Opin Otolaryngol Head Neck Surg. ;26(2):115–121. 10.1097/MOO.0000000000000445 . PMID: 29389737 José L, Llorente F, Núñez JP, Rodrigo (2008) Ramón Fernández León, César Álvarez, Mario Hermsen, Carlos Suárez, Sinonasal Adenocarcinomas: Our Experience, Acta Otorrinolaringologica (English Edition), Volume 59, Issue 5, Pages 235–238, ISSN 2173–5735. https://doi.org/10.1016/S2173-5735(08)70229-1 Adenocarcinoma of Ethmoid: A GETTEC Retrospective Multicenter Study of 418 Cases, Choussy O, Christophe Ferron MD, Pierre-Olivier Védrine MD, Bruno Toussaint MD, Béatrice Liétin MD, Patrick Marandas MD, Emmanuel Babin MD MD, PhD, Dominique De Raucourt MD, Emile Reyt MD, PhD, Alain Cosmidis MD, Marc Makeiff MD, Danièle Dehesdin MD, PhD, GETTEC Study Group Nasal cavity and paranasal sinus malignancy, Cyrus Kerawala, Peter Clarke and Kate Newbold, Watkinson, J.C., & Clarke, R.W. (Eds.) (2018) Scott-Brown's Otorhinolaryngology and Head and Neck Surgery, Eighth Edition: 3 volume set (8th ed.). CRC Press. https://doi.org/10.1201/9780429443558 Bernardo T, Ferreira E, Silva CJ, Monteiro E (2013) Sinonasal adenocarcinoma—experience of an oncology center. Int J Otol Head Neck Surg 2:13–16. http://dx.doi.org/10.4236/ijohns.2013.21005 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6279957","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":433000806,"identity":"9c68b371-7aa5-445f-9cf0-dfde61937276","order_by":0,"name":"Siri Krishna Kondreddy","email":"","orcid":"","institution":"Dr. NTR University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Siri","middleName":"Krishna","lastName":"Kondreddy","suffix":""},{"id":433000807,"identity":"3b0c7fe8-7072-4c4b-aa07-887739737c2c","order_by":1,"name":"Rohini 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nasal endoscopy on right side showing a single irregular exophytic mass bulging into nasal cavity\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6279957/v1/38613a2af60568e43e532ea0.png"},{"id":79320840,"identity":"2ddeaa33-3053-4883-bb47-6096054095f7","added_by":"auto","created_at":"2025-03-27 04:25:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":312008,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDiagnostic nasal endoscopy on right side showing a single irregular exophytic mass bulging into nasal cavity\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6279957/v1/618e6a304f7733a4d10762c3.png"},{"id":79320844,"identity":"f097aa66-f9e0-43e4-bfba-cab257e18253","added_by":"auto","created_at":"2025-03-27 04:25:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":342745,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAxial and Coronal CT of paranasal sinuses showing mass arising from septum on right side with soft tissue density in ethmoid, sphenoid, maxillary, frontal sinuses\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6279957/v1/82edffc12ec1d31c8356fcfd.png"},{"id":79320842,"identity":"94c54b58-b4e6-4da8-a6eb-3d2e4b3fa7f9","added_by":"auto","created_at":"2025-03-27 04:25:10","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":338437,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAxial and Coronal CT of paranasal sinuses showing mass arising from septum on right side with soft tissue density in ethmoid, sphenoid, maxillary, frontal sinuses\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6279957/v1/e067944375d32275638d89d4.png"},{"id":79320846,"identity":"569cb586-c103-496e-8fce-9df905be9111","added_by":"auto","created_at":"2025-03-27 04:25:10","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":616727,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHistopathological section showing well differentiated papillary architecture\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6279957/v1/45b90bc75849cf6948be654d.png"},{"id":86821530,"identity":"0e7cbed0-2a5d-4901-86da-689e5d286bf8","added_by":"auto","created_at":"2025-07-16 02:46:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2930821,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6279957/v1/4cf4ac2a-1cd5-4897-b08c-62410d0962c6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sinonasal Intestinal type Adenocarcinoma (ITAC) Our insights from a rare clinical case: a case report","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eSinonasal tumors are rare forms of head and neck malignant neoplasms accounting for only 3% of head and neck cancers and adenocarcinoma accounts for only a small percentage (10% \u0026minus;\u0026thinsp;20%) of all sinonasal cancers, although it is the second most frequent histopathology type after squamous cell carcinoma [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eAdenocarcinomas of the sinonasal tract may originate from respiratory surface epithelium or the underlying seromucinous glands. These are divided into salivary-type adenocarcinomas and non-salivary-type adenocarcinomas. The latter are further divided into intestinal-type and non intestinal-type adenocarcinomas. The WHO classifies sinonasal adenocarcinomas of surface epithelial origin in intestinal and non-intestinal types. [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003eITACs occur mostly in males with a wide age range and a mean of 50\u0026ndash;64 years. ITACs are most frequently localized in the ethmoid sinus (40%), the nasal cavity (25%) and the maxillary antrum (20%). Occurrence of ITAC has a strong association with occupational exposure to hardwood dusts, long-term exposure to chromium and nickel has been incriminated. Carcinogenic compounds in occupational dusts have not been identified, but etiologic roles for tannins or chronic inflammation have been speculated. ITACs mimic the appearances of neoplastic large and small intestinal mucosa, and occasionally normal intestinal mucosa. [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003eBased on histopathologic parameters, Dr. Barnes classified ITACs into five categories: papillary, colonic, solid, mucinous, and mixed subtypes. On the other hand, the classification of Kleinsasser and Schroeder subdivided ITACs into papillary-tubular cylindrical cell type (corresponding to papillary, colonic, and solid subtypes), alveolar goblet cell type and signet-ring cell type (both corresponding to mucinous subtype), and transitional type (corresponding to mixed subtype). The histologic subtypes have been reported to correlate with differences in clinical behaviour. [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e] [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e] [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;1. Classification of Intestinal-type adenocarcinomas\u003c/strong\u003e [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e] [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e] [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"CASE REPORT","content":"\u003cp\u003eA 51 year old male patient presented with complaints of right nasal obstruction since 4 months and history of blood stained nasal discharge occasionally. He is a farmer by occupation. Anterior rhinoscopy shows deviated nasal septum to left with spur impinging on inferior turbinate. Neck examination shows no palpable lymph nodes. Diagnostic nasal endoscopy on right side a single irregular exophytic mass bulging into nasal cavity with necrotic and friable appearance, appears to originate from upper part of posterior nasal septum, extending between septum and middle turbinate was seen. On probe test, it is sensitive to touch, bleeds on touch, can be probed all around except superiorly, probably indicating the attachment of mass. On left side there is deviated nasal septum with spur.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eComputed tomography (CT) of the paranasal sinuses on right side shows soft tissue density in ethmoid, sphenoid, maxillary, frontal sinuses and nasal cavity, causing blockage of osteomeatal complex, fronto-ethmoidal and spheno-ethmoidal recesses with erosion of medial wall of maxillary sinus, widening of maxillary antrum, scalloping of midline septum and intact cribriform plate.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eUnder general anaesthesia, decongestion of the nasal cavity was done. Under endoscopic guidance, mass is identified in the upper part of posterior nasal septum. The mass is firm to touch and bleeds on touch. It can be probed laterally, inferiorly but cannot be probed medially with pedicle of mass seen arising from the septum. Excision of mass and right side functional endoscopic sinus surgery were done. Excised mass was sent for biopsy.\u003c/p\u003e \u003cp\u003eHistopathological sections revealed invasive tumor arranged predominantly in papillary architecture with focal tubule formation. Papillae are lined by columnar epithelial cells with mild eosinophilic cytoplasm, enlarged nuclei exhibiting hyperchromatism with pseudo stratification, increased nuclear to cytoplasmic ratio and inconspicuous nucleoli with interspersed goblet cells. Areas of mixed inflammatory infiltrates of lymphocytes, plasma cells, neutrophils, necrosis and hemorrhages noted.\u003c/p\u003e \u003cp\u003eImpression was Sinonasal Intestinal-type Adenocarcinoma, Well differentiated, Papillary subtype (Grade 1).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eImmunohistochemistry of the tumour was positive for CK20, CDX2, SATB2 and focally positive for CK7. Hence, diagnosis of Sinonasal Intestinal-type Adenocarcinoma was confirmed. Patient received chemoradiotherapy (EBRT for 6 weeks along with weekly dose of Cisplatin) He is under regular follow-up and shows no signs of recurrence.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAdenocarcinoma accounts for 9% of sinonasal malignancies. Papillary adenocarcinomas are the least aggressive form. Sessile and mucoid adenocarcinomas have the worst prognosis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] These grow silently with no symptoms, which leads to a late diagnosis and low survival rates. Nodes and distant metastases are rare at presentation. Patient survival depends on local control that is extremely difficult because of the anatomical proximity to orbit and brain. Local recurrence is frequent [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese tumors are consistently positive for CK20, CDX2, villin, MUC2, SATB2, variably positive for CK7 and CEA. Chromogranin\u0026thinsp;+\u0026thinsp;cells may be present. Diagnosis of ITAC from sinonasal non-intestinal adenocarcinomas is supported by immunohistochemistry [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Papillary subtype is associated with better prognosis, while mucinous and solid subtypes carry poor prognosis. \u003cem\u003eTP53\u003c/em\u003e is most frequently mutated (40\u0026ndash;50%), while \u003cem\u003eAPC\u003c/em\u003e, \u003cem\u003eKRAS\u003c/em\u003e, and \u003cem\u003eBRAF\u003c/em\u003e mutations are found in some subsets [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Neoadjuvant chemotherapy with a platinum-based regimen can provide a survival benefit in selected ITACs with functional p53, whereas genetic and biological studies have identified alterations in the molecular pathways of EGFR, MET, and H-RAS, which might be considered as potential targets for biotherapy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrognosis\u003c/p\u003e \u003cp\u003eITACs aggressive neoplasms, with 53% of local recurrences, 8% (range 0\u0026ndash;22%) cervical lymph node metastases, 13% (range 0\u0026ndash;29%) distant metastases, and 60% mortality according to Barnes et al [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The survival rates for ITAC reported by Llorente et al at 5 and 10 years were 36% and 28% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Well and moderately differentiated ITACs have a significantly better prognosis than poorly differentiated and mucinous tumours [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIntestinal-type adenocarcinoma (ITAC) is the second most common type of sinonasal adenocarcinoma after adenoid cystic carcinoma. These have better prognosis compared with squamous cell carcinomas. Incidence is high among wood, shoe, leather, textile manufacturers and long-term exposure to chromium and nickel has been incriminated. The carcinogenic compounds have not been identified, but role of chronic inflammation has been speculated. Trans nasal endoscopic surgery is done in large majority of patients with ITAC; adjuvant radiotherapy is recommended in advanced stage and high-grade lesions. The high incidence of recurrent tumors requires regular and thorough follow-up.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eITAC Intestinal-type adenocarcinoma\u003c/p\u003e\n\u003cp\u003eEBRT External Beam Radiotherapy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCK Cytokeratin\u003c/p\u003e\n\u003cp\u003eSATB2 Special AT-rich sequence binding protein-2\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank department of Anaesthesia and department of Pathology, Alluri Sitarama Raju Academy of Medical Sciences, Eluru.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS.K.S evaluated the clinical findings and contributed to the manuscript, R.G evaluated the clinical findings and prepared the manuscript, C.V.A assisted the surgery and contributed to the manuscript, D.M performed the surgery and proofread final manuscript. The authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVerbal and written consent for publication was obtained from the patient\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Assistant Professor, Department of Otorhinolaryngology‑ Head \u0026amp; Neck Surgery, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh, India.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2* Department of Otorhinolaryngology‑ Head \u0026amp; Neck Surgery, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh, India.\u003c/p\u003e\n\u003cp\u003e3 Department of Otorhinolaryngology‑ Head \u0026amp; Neck Surgery, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh, India.\u003c/p\u003e\n\u003cp\u003e4 Professor and Head, Department of Otorhinolaryngology‑ Head \u0026amp; Neck Surgery, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh, India.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLeivo I, Sinonasal Adenocarcinoma (2016) Update on Classification, Immunophenotype and Molecular Features. 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(Eds.) (2018) Scott-Brown's Otorhinolaryngology and Head and Neck Surgery, Eighth Edition: 3 volume set (8th ed.). CRC Press. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1201/9780429443558\u003c/span\u003e\u003cspan address=\"10.1201/9780429443558\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernardo T, Ferreira E, Silva CJ, Monteiro E (2013) Sinonasal adenocarcinoma\u0026mdash;experience of an oncology center. Int J Otol Head Neck Surg 2:13\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.4236/ijohns.2013.21005\u003c/span\u003e\u003cspan address=\"10.4236/ijohns.2013.21005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"
[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nasal mass, Sinonasal mass, intestinal-type, adenocarcinoma, ITAC, Malignancy, Radiotherapy, Rhinology, ESS","lastPublishedDoi":"10.21203/rs.3.rs-6279957/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6279957/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eIntestinal-type adenocarcinoma is the second most common sinonasal adenocarcinoma. It develops through intestinal metaplasia of sinonasal epithelium, characterized by strong resemblance to carcinoma of colon and considered to be rare. These are aggressive tumours generally diagnosed in the advanced stage. Histopathological subtype is an important prognostic indicator.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Report:\u003c/strong\u003e A 51 year old male patient presented with complaints of right nasal obstruction since 4 months, history of blood stained nasal discharge occasionally. On nasal endoscopy, a single irregular exophytic mass bulging into nasal cavity originating from right side upper part of posterior nasal septum was seen. Excision of mass and right side full functional endoscopic sinus surgery with septoplasty were done. Histopathological examination showed invasive tumor arranged predominantly in papillary architecture with focal tubule formation and was diagnosed as sinonasal intestinal type adenocarcinoma, well differentiated, papillary subtype. Immunohistochemistry showed tumour is focal positive for CK7 and positive for CK20, CDX2, SATB2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIntestinal-type adenocarcinoma (ITAC) is the second most common type of sinonasal adenocarcinoma after adenoid cystic carcinoma and has better prognosis compared with squamous cell carcinomas. Standard treatment is surgical resection, with a minimally invasive endoscopic approach when possible, followed by chemoradiotherapy.\u003c/p\u003e","manuscriptTitle":"Sinonasal Intestinal type Adenocarcinoma (ITAC) Our insights from a rare clinical case: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-27 04:25:05","doi":"10.21203/rs.3.rs-6279957/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"
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