PMC3195981_01
CT scans taken in 2006 after the patient's initial referral to ENT. (a) CT scan showing a mass in the left nasal cavity, and (b) CT scan showing the mass in the left ethmoid sinus, The mass was initially thought to be an inverted papilloma, but following histology it was shown to be an intestinal-type adenocarcinoma.
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MRI imaging of the face/neck and CT of the thorax and abdomen displayed that the malignancy was confined to the left paranasal sinuses (Figure 1). 
CT scan taken in 2007 showing evidence of surgery in the patient's left nasal cavity. The lesion has been removed, and the maxillary ostium is widened.
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Despite being offered a craniofacial resection (CFR), for cosmetic reasons, the patient elected for endoscopic removal of the tumour, which was carried out in August 2006 (Figure 2).
(a) CT scan taken in 2007 showing soft tissue with bony wall destruction in the patient's left posterior ethmoid sinus, which was a recurrence of the malignancy and treated with topical chemotherapy. (b) MRI scan taken in 2008 showing an area of high signal in the patient's left maxillary antrum, indicating the need for a biopsy to be performed.
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However, the patient continued to experience left-sided dull facial pain, and on biopsy a recurrence of the tumour was found (Figure 3).