Misdiagnosis of olfactory neuroblastoma.
OBJECTIVE
Olfactory neuroblastoma (ON) is a rare neoplasm arising from the olfactory epithelium and found in the upper nasal cavity. The authors studied the frequency with which ON is misdiagnosed with other tumors of the paranasal sinuses such as neuroendocrine carcinoma (NEC), pituitary adenoma, melanoma, lymphoma, and sinonasal undifferentiated carcinoma (SNUC). Based on the belief that misdiagnosis commonly occurs, they emphasized the importance of establishing the correct diagnosis, because the treatment regimens and prognosis of these tumor types are often significantly different.


METHODS
Twelve consecutive patients in whom ON was diagnosed were referred to the Department of Neurosurgery at the M. D. Anderson Cancer Center between January 1998 and March 2000. Demographic data were collected, physical findings and mode of treatments were documented, and neuroimaging studies were assessed. Pathologists at the authors' institute reviewed the histological specimens. Only in two of 12 patients was the diagnosis of ON confirmed. Lesions in 10 patients were misdiagnosed; there were two cases of melanoma, three cases of NEC, three cases of pituitary adenoma, and two cases of SNUC. Eight of 10 patients in whom lesions were misdiagnosed required significant alteration in the initially proposed treatment plan.


CONCLUSIONS
Neurosurgeons should be acutely aware of the variety of neoplasms that occur in the paranasal region. The correct diagnosis should be ensured before initiating treatment to provide the optimum therapy and spare the patients from needless and potentially toxic treatment.
Cohen
Zvi R
ZR
Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Marmor
Eric
E
Fuller
Gregory N
GN
DeMonte
Franco
F
D000236:Adenoma / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001766:Blindness / Q000209:etiology; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology; D018278:Carcinoma, Neuroendocrine / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D019090:Case Management; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D018304:Esthesioneuroblastoma, Olfactory / Q000175:diagnosis* / Q000473:pathology; D005005:Ethmoid Sinus / Q000473:pathology; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology; D007049:Iatrogenic Disease; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D009296:Nasal Cavity; D009669:Nose Neoplasms / Q000175:diagnosis* / Q000473:pathology; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D011832:Radiation Injuries / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000473:pathology; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D014750:Vincristine; D004317:Doxorubicin; D002945:Cisplatin