Missed Diagnosis of Intranasal Squamous Cell Carcinoma

Case Overview

This case involves a fifty-two-year-old male patient with a history of progressive left nasal obstruction and foreign body sensation that developed acutely over a few months. The patient underwent several endoscopic procedures to evaluate for possible obstruction. An endonasal excision of a left nasal polyp was conducted and a sample was sent to pathology for evaluation. The patient was not followed for eleven months and, in that time, a 1.9cm x 0.9cm mass went unrecognized and untreated. The mass was finally resected a year after the original presentation, but the pathology reports showed that irregular margins were present and the mass fully invaded surrounding tissue. By the time the mass was identified and resected, the patient had developed metastatic squamous cell carcinoma.

Questions to the Radiology expert and their responses

What is the standard of care in diagnosis of this disease from a radiology perspective?

The criterion standard to evaluate nasal lesions, especially nasal polyposis or sinusitis, is a thin-cut (one to three millimeters) CT scan of the maxillofacial area, the sinuses axially, and the coronal plane. Also, if an intraoperative image-guided system is used, a compatible CT scan should be performed. Plain film radiography has no significant value after polyps are diagnosed. Additionally, performing an MRI in patients with possible intracranial involvement or extension of benign nasal polyps is warranted. CT scan findings and MRI findings can help diagnose the polyp or polyps, define the extent of the lesion in the nasal cavities, sinuses, and beyond, and narrow the differential diagnosis of an unusual polyp or clinical presentation.

About the expert

This board certified diagnostic radiologist has been a clinician for 30 years, and is highly qualified to review this case. He is also a fellow of the American College of Radiology, and has been named as among America's Top Radiologists. Throughout his medical career, he has been appointed to such high ranking clinical positions as the medical director of a major regional healthcare center.