Olfactory Neuroblastoma Masquerading As Benign Nasal Disease: A Case Report

Abstract

Background:
Olfactory neuroblastoma is a rare neuroendocrine malignancy of the sinonasal tract that frequently mimics benign nasal disease. Clinical features such as nasal obstruction, epistaxis or anosmia may overlap with inflammatory conditions. These overlapping clinical features require a high index of suspicion for early diagnosis and intervention. Advances in imaging, including 68Ga-DOTATATE PET-CT, have improved staging accuracy by targeting somatostatin receptor expression. Patients diagnosed at an early-stage disease can be managed by endoscopic resection often supplemented with adjuvant radiotherapy to optimize local control.

Case Report:

A 66-year-old African woman presented with a two-year history of progressive unilateral nasal obstruction and intermittent epistaxis. She was initially treated as a case of benign nasal polyp. Postoperative histopathology unexpectedly revealed Hyams Grade 2 olfactory neuroblastoma. Nasal endoscopy demonstrated a mass in the left middle meatus and CT imaging confirmed a well-defined lesion confined to the nasal cavity without bony erosion. 68Ga-DOTATATE PET-CT showed moderate tracer uptake without metastatic spread classifying the tumour as Kadish Stage A. The patient subsequently underwent endoscopic resection of the residual tumour, with histologically clear margins. Adjuvant intensity-modulated radiotherapy (60 Gy in 30 fractions) was administered to reduce recurrence risk while minimizing toxicity to adjacent optic structures. At 12-month follow-up, she remained disease-free with minimal treatment-related side effects.

Conclusion:
This case underscores the diagnostic challenges involved in management of olfactory neuroblastoma. It further highlights the importance of advanced imaging in cases presenting with persistent nasal masses. Endoscopic resection when combined with targeted radiotherapy offers excellent local control in cases diagnosed at an early-stage.