A Very Rare Case of Metastases to the Nasal Cavity from Primary Rectal Adenocarcinoma

Nasal cavity as the first site of metastases from colorectal adenocarcinoma without metastases elsewhere is generally unheard of and very rare with only a few cases reported in world literature. The diagnostic dilemma and therapeutic challenge are significant when encountered in clinical practice, especially to differentiate it from a primary nasal pathology. Histopathological examination and immunohistochemistry play an important role. We report an unusual and interesting case of adenocarcinoma rectum with nasal metastases. A 65-year-old male was treated for adenocarcinoma rectum with radiotherapy, surgery and chemotherapy and was disease-free for 9 months post-treatment completion. Subsequently, he presented with nasal bleeding and on evaluation was found to have a nasal mass. Histopathological examination and immunohistochemistry confirmed the mass to be a metastasis from the earlier rectal adenocarcinoma. He received palliative haemostatic radiotherapy for bleeding from the nasal mass and was then treated with 6 cycles of 5-fluorouracil and irinotecan-based palliative chemotherapy. The patient achieved a good level of palliation, had near-complete regression of nasal mass on imaging with no new sites of metastases and hence was placed on regular follow up.