Diseminación leptomeníngea en un carcinoma nasosinusal de tipo intestinal: una forma de presentación inusual

Could the extreme conformality achieved with proton therapy in paranasal sinuses cancers accidentally results in a high rate of leptomeningeal progression?

“…However, some reports described a handful of patients who failed distantly with isolated or diffuse leptomeningeal disease. [4][5][6][7][8][9] Overall, most of these patients had esthesioneuroblastoma, undifferentiated carcinoma, adenocarcinoma, and cancer with neuroendocrine differentiation. Interestingly, in a paper by Lucas et al 7 analyzing the outcome of eight pediatric or adolescent patients with esthesioneuroblastoma treated with proton therapy as part of their treatment, one had leptomeningeal progression (12.5%).…”

“…However, that could be very challenging from a technical and physical point of view because of the uncertainties related to overlapping fields that would require to include this volume as the RT planning start. This approach obviously finds at least two limits: one represented by the pediatric population, the other by the fact that, as reported by the authors of this article and others, [4][5][6][7][8][9] meningeal dissemination may occur also several years after treatment, therefore questioning the risk/benefit balance for PCI.…”

How Can an Intestinal-Type Adenocarcinoma Lead to Neurological Deficits?

“…Sinonasal tract adenocarcinomas may stem from respiratory surface epithelium or from the underlying seromucinous glands. These malignancies are divided into salivary- and non–salivary-type adenocarcinomas, the latter divided into intestinal- and non–intestinal-type adenocarcinomas 1–3 …”

“…These malignancies are divided into salivary-and non-salivary-type adenocarcinomas, the latter divided into intestinal-and non-intestinal-type adenocarcinomas. [1][2][3] Intestinal-type adenocarcinomas are aggressive neoplasms, more frequently localized in the ethmoid sinus (40%), followed by the nasal cavity (25%) and the maxillary antrum (20%). Those may invade adjacent structures, including orbit, pterygopalatine fossa, infratemporal fossa, and cranial cavity, by bone lysis and/or by perinervous and perivascular spread within the skull base foramina.…”