Among sinonasal malignancies, adenocarcinomas account for the second most common entity after squamous cell carcinoma. They span a wide spectrum of neoplasms with heterogeneous features including intestinal-type adenocarcinoma (ITAC), non-intestinal-type adenocarcinomas (non-ITACs), and salivary-type adenocarcinomas. ITAC basically mirrors the histopathological aspects of gastrointestinal counterparts, showing variable tubulo-papillary, colonic, and mixed patterns with mucin production in 20% to 25% of cases. By contrast, non-ITACs do not show any differentiation toward intestinal or salivary phenotype, and they mainly represent a diagnosis of exclusion lacking a proper histopathological and molecular definition.