48yo female, sent for ultrasound +/- FNA for ?cervical lymphadenopathy. Ultrasound showed multiple enlarged hypervascular lymph nodes, and uncomplicated biopsy was performed. A CT of the skull base and neck was recommended. The midline sagittal reconstruction shows an avidly enhancing lesion in the cribriform plate region destroying the anterior skull base and infiltrating the basal frontal lobes and the superior nasal cavity. Axial and coronal reconstructions showed invasion of both orbits, and extensive multilevel cervical lymphadenopathy. Several marginal fluid-filled compartments were noted at the infiltrating tumour margin adjacent to the brain, with adjacent vasogenic oedema. The appearances are typical of esthesioneuroblastoma, which was confirmed on FNA.

Esthesioneuroblastoma (otherwise known as “olfactory neuroblastoma”) is a rare neoplasm thought to arise from the olfactory epithelium. Despite its rarity, it has a relatively typical appearance on imaging. It is usually highly malignant and because of its location is usually very locally advanced by the time of diagnosis, with brain and orbital invasion occurring commonly and early.

Credit: Dr Jason Wenderoth