Olfactory Esthesioneuro-Epitheliomas

Abstract
Though tumors arising in the nasal cavity may occasionally be of neurogenic origin, this is unusual. According to a recent report from the Mayo Clinic (12) only 24 neoplasms of neurogenic origin in the nose and throat had been seen in that institution during the past twenty-seven years. The majority of nasal neurogenic tumors fall into two classes: nasal gliomas and olfactory esthesioneuro-epitheliomas. In 1924 Berger, Luc, and Richard (2) first described a patient with a nasal tumor that histologically seemed to be composed of neural elements. Since they thought that this tumor probably arose from the sensory cells of the olfactory mucosa, they gave it the name “olfactory esthesioneuro-epithelioma.” Since 1924, only 8 examples of this tumor have been reported in the French medical literature and none by American or British authors, although Stout (18) has had a personal experience with 6 cases. The nasal gliomas have been described with somewhat greater frequency, as Black and Smith (3) were able to collect 32 examples from the literature, to which they added 2 of their own. Aside from its rarity, the esthesioneuro-epithelioma is of interest because of its striking radiosensitivity, so that irradiation probably represents the preferred method of therapy. Case Report2 A. W., a 65-year-old white male, gave a nine-year history of trouble with his nose, beginning with nasal obstruction associated with frequent episodes of epistaxis. He consulted a physician, who discovered several large polypoid masses completely obstructing the right nasal fossa. He was admitted to a hospital where a polypectomy was performed. Histologically the excised tissue was interpreted as carcinoma. A more extensive surgical excision was recommended but was refused by the patient and he was referred for x-ray therapy. This was carried out in June 1942, 1,200 r each (measured in air) being given to a right and left lateral portal measuring 50 sq. cm., and 1,000 r to a 50 sq. cm. portal over the anterior nasal region. This was done with a 200-kv. x-ray machine, using a filtration of 1.0 mm. Al and 0.5 mm. Cu, with a half-value layer of 1 mm, Cu., at a distance of 50 cm. The treatment was fractionated into daily increments of 200 r, given over a total period of eighteen days. This resulted in the clinical disappearance of the polypoid masses in the nose and complete relief of the nasal obstruction. Three years later the patient again began to experience anosmia and obstruction in the right naris) associated with a thick nasal and postnasal discharge, which was occasionally blood-tinged. In August 1946, following a rather profuse nasal hemorrhage he returned for further x-ray therapy.