Olfactory neuroblastoma (esthesioneuroblastoma) arises from which cell type, and what is its characteristic radiological appearance on MRI?

• A Schwann cells of olfactory nerve; heterogeneous mass with calcification
• B Squamous cells of nasal vestibule; exophytic mass with bone remodelling
• C Neuroendocrine cells of olfactory epithelium (Bowman's gland precursors); dumbbell-shaped mass straddling the cribriform plate with intracranial extension ✓
• D Plasma cells; diffuse infiltrative T2 hypointense mass

Explanation

Olfactory neuroblastoma (esthesioneuroblastoma) originates from the olfactory neuroepithelium (basal cells/stem cells) in the superior nasal vault at the level of the cribriform plate. Its hallmark MRI appearance is a dumbbell-shaped mass that straddles the cribriform plate with a component in the nasal cavity and an intracranial extension into the anterior cranial fossa, often with peripheral cyst formation at the intracranial tumour margin. It is classified using the Kadish staging system and managed with craniofacial resection or endoscopic resection combined with radiotherapy.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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