November 2023 Case
Contributors: Zaid N. Khreefa, MD, Rachna Jetly, MD, MPH
History:
A 36-year-old patient with no significant past medical history presented with chronic
nasal congestion, nasal bleeding, and decreased sense of smell for approximately four
months. Maxillofacial computed tomography scan revealed opacification of the right
maxillary sinus and nasal cavity by a high-density soft tissue lesion that filled
the sinus space, multifocally eroded into the sinus walls and extended into the alveolar
process of the right maxilla involving the roots of multiple right sided maxillary
molars. The patient underwent multiple biopsies of this lesion. Representative sections
stained with hematoxylin and eosin (H&E) and immunohistochemical stains for P63, NUT1
AND INSM1 are shown in the figures below.
Question:
Based on the clinical information and the provided images, what is the most likely
diagnosis?
A. Basaloid squamous cell carcinoma
B. Neuroendocrine carcinoma
C. NUT carcinoma
D. Sinonasal undifferentiated carcinoma
E. Adamantinoma-like Ewing sarcoma
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