What happened, in summary

A 58-year-old man was referred to a head and neck clinic after 4 months of persistent right-sided nasal discharge. He also had reduced smell and taste and numbness over the right upper cheek. Examination found a large ulcerated mass in the right nasal cavity. Further investigation identified small cell lung cancer as the most likely primary cancer, with metastatic spread to the nasal cavity. The tumor showed positive staining for CD56, chromogranin and synaptophysin. The patient received palliative chemoradiotherapy and initially had an excellent response, with near-total resolution of both the nasal cavity mass and the chest mass. He then remained in remission for 12 months. Follow-up imaging later showed an aggressive recurrence in the nasal cavity. Further palliative chemotherapy was offered, but he declined it. He died 2 months after the recurrence, 14 months after the original diagnosis. The nasal cavity metastasis made this an unusual presentation, because nasal symptoms were what first brought him to medical attention.