Clinical and Endoscopic Findings
Due to the slow growth and the high vascularization of the tumor, unilateral nasal obstruction and epistaxis are the most frequent presenting complaints (DuLGuerov et al. 2001). Additional signs and symptoms are usually suggestive for an advanced-stage tumor. Olfactory neuroblastoma may also produce vasopressin, thus causing the syndrome of inappropriate antidiuretic hormone secretion (Osterman et al. 1986; Ahwal et al. 1994), characterized by hyponatremia without edema and increased urinary sodium loss (Vasan et al. 2004).
Palpable cervical nodes may be present at diagnosis. According to Levine et al. (1999), the rate of patients with nodal metastasis increases from 6% to 25% when the entire clinical history of patients is considered. These data are in keeping with those from Rinaldo et al. (2002a) and Ferlito et al. (2003), who extensively reviewed the literature and found an overall rate of lymph node metastases (synchronous and metachronous) from olfactory neuroblastoma of approximately 23%. At endoscopy, olfactory neuro-blastoma appears as a broad-based, highly vascularized mass, with polypoid appearance. It usually has an irregular, lobulated surface and a color varying from gray to red (Walch et al. 2000). Particularly in the early stages, the mass is typically confined to the olfactory cleft, but more advanced lesions frequently extend through the upper part of the nasal septum to involve both nasal fossae.
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