Introduction:
Olfactory neuroblastoma is a rare malignant tumor originating from the olfactory epithelium of the nasal cavity. It accounts for approximately 3% of all nasal cavity tumors, with an estimated incidence of 1 in 2.5 million individuals annually. Typically diagnosed in patients aged 50–70 years, common presenting symptoms include nasal obstruction, epistaxis, anosmia, and, in advanced stages, orbital or intracranial extension. Diagnosis is based on histopathology, with treatment often involving surgery, radiation, and chemotherapy.
Case Report:
We report the case of a 63-year-old woman with a history of hypertension, ischemic heart disease, and stroke, presenting to oncology clinic with a three to four months history of left-sided nasal obstruction, anosmia, intermittent epistaxis, headaches, and progressive left eye proptosis. Computed tomography revealed a mass occupying the left nasal cavity and paranasal sinuses with local spread. Endoscopic surgical resection was performed and histopathology confirmed Hyams Grade IV, Kadish Stage C olfactory neuroblastoma, composed of uniform round blue cells with rosette formation, brisk mitosis, and necrosis. Immunohistochemistry was positive for synaptophysin, cytokeratin, CD56, and calretinin. Postoperative imaging showed residual disease, and a cycle of platinum-based chemotherapy with etoposide was given. Patient showed marked clinical improvement with visible tumor reduction and was discharged one week later in stable condition with plans to continue chemotherapy. However, she was lost to follow-up and reportedly died shortly after discharge, likely due to her comorbidities or chemotherapy intolerance. The exact cause of death is unknown, as no further evaluation or hospital contact occurred.
Conclusion:
This case highlights therapeutic challenges in managing advanced olfactory neuroblastoma in patients with multiple comorbidities. Although the patient initially responded well but loss to follow-up and an unknown cause of death emphasizes the need for multidisciplinary care and close monitoring to ensure better outcomes in patients with aggressive malignancies.