Late diagnosis of an occult tumour – what lessons can we learn?

Key Points

• Warns the reader that late presentation of maxillary sinus tumours is common due to the nonspecific nature of presenting symptoms.

• Stresses how performing a simple cranial nerve examination or diagnostic imaging can be key to a definitive diagnosis.

• Underlines how prompt communication between specialities and care providers is essential when presenting symptoms of facial pain are of an atypical nature.

Abstract

Objective Malignant tumours of the nasal cavity and paranasal sinuses are rare and late presentation of a maxillary sinus tumour is common due to the vague nature of the symptoms which can delay diagnosis.

Methods We report a female with a maxillary sinus tumour who was initially diagnosed with chronic idiopathic facial pain (CIFP) and sinusitis, which subsequently led to a delay in diagnosis and treatment of her tumour.

Results There was no clinical extra- or intra-oral pathology, however, she had varying clinical presentations of facial pain, anosmia, loss of gustatory function, and infra-orbital nerve paraesthesia. CT and MRI scans confirmed obliteration of the left maxillary sinus by a solid mass involving ethmoid and sphenoid sinuses and some cranial nerves. Biopsy confirmed a poorly differentiated carcinoma of the ethmoid and sphenoid sinuses and invasion of the cavernous sinus.

Conclusion A morbid, but hidden tumour was left undiagnosed due to the unusual presentation of the patient's symptoms. It is essential that all patients are managed holistically and thorough historical, clinical and radiographic examination and appropriate investigations are carried out to prevent unnecessary and potentially time-wasting treatment.