A Case Report of an Adenoid Cystic Carcinoma of the Nasosinus with Orbito-Encephalic Invasion

Background: Adenoid cystic carcinomas are malignant epithelial tumors that arise from the major and accessory salivary exocrine glands. They represent 0.15% of malignant tumors of the head and neck. Their localization in the nasal cavity is poorly understood and is rare. Case Report: We report the case of a 26-year-old patient who presented with a bilateral and progressive decrease in visual acuity, an increasing right lateronasal swelling with nasal syndrome and intracranial hypertension syndrome. Clinical examination found an extensive mass in the middle part of the right side of the face, with signs of local superinfection. We noted signs of bilateral compression of the optic nerves and bilateral oculomotor paralysis by involvement of the 3rd and 6th cranial nerves. Orbitofacial and cranial computed tomography performed with intravenous contrast confirmed the presence of an extensive tumor which was classified as T4bN2c. The anatomopathological exam of intranasal biopsy of the tumor suggests adenoid cystic carcinoma. Palliative care was put in place after a multidisciplinary decision due to the tumor’s extensive invasion and unresectable nature. Conclusion: Adenoid cystic carcinomas remain tumors with a poor prognosis. Non-specific symptoms and slow evolution of this disease are a source of delayed diagnosis. Orbitofacial and cranial imaging could highlight the lesion and its extension. The anatomopathological exam could determine the histological nature of the tumor. The multidisciplinary decision fixes the patient’s treatment.