A 60-year-old woodworker (exposure to hardwood dust) presents with progressive right-sided nasal obstruction and bloody nasal discharge. CT shows a destructive mass of the right ethmoid sinus. The MOST likely histological type is:

• A Squamous cell carcinoma
• B Melanoma
• C Esthesioneuroblastoma (olfactory neuroblastoma)
• D Adenocarcinoma (intestinal-type or ITAC) ✓

Explanation

Occupational exposure to hardwood dust (and also leather dust, nickel refining) is a well-established risk factor for sinonasal intestinal-type adenocarcinoma (ITAC). These tumors arise from the ethmoid sinuses predominantly and may express intestinal markers (CDX2, CK20). They are classified by the Kleinsasser and Schroeder classification. While SCC is the most common sinonasal malignancy overall, the occupational hardwood dust association specifically points to ITAC in this clinical scenario.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.