A case of infantile neuroblastoma with intramucosal metastasis in a paranasal sinus

An 8-year-old boy with neuroblastoma of the right adrenal gland is reported . His initial treatment included chemotherapy and surgery, with complete re sponse (CR) being achieved at the initial site. A metastatic lesion was fou nd in the right maxillary sinus 32 months after his initial treatment. A ma ss in the right soft palate was detected and was clinically suspected of be ing a metastasis. The results of biopsy were negative and the differential diagnosis from the imaging studies of CT included odontogenic disease, fung al infection, paranasal sinus cyst or hematoma, and benign tumors. Open tra nsantral biopsy was done under general anesthesia, revealing severe inflamm ation in the right maxillary sinus as well as bone erosion. The histopathol ogical diagnosis was metastatic neuroblastoma from the adrenal lesion. The local field was irradiated with 20 Gy of linear accelarator (linac) radiati on, then the local field was eradicated. Extensive skeletal metastases were subsequently found by bone scintigraphy. Despite further treatment his gen eral condition deteriorated rapidly and he died 24 months after starting tr eatment. We review the previous reports and discuss metastasis to the sinus es. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.