Sinonasal nonkeratinizing squamous cell carcinoma

Case contributed by Yaïr Glick
Diagnosis certain

Presentation

Confusion for the past 3 weeks, exacerbated for the past 2 days and accompanied by dizziness. Proptosis of right eye.

Patient Data

Age: 70 years

Strongly, heterogeneously enhancing mass, centered in the right maxillary sinus.
The mass

  • exhibits foci of necrosis (i.e. non-enhancing, measuring approximately 30 HU)
  • invades the ipsilateral intraconal orbit, involves the inferior rectus muscle and is tangential to the lateral rectus muscle, with resultant right eye proptosis
  • fills the inferior orbital fissure
  • invades the masticator space-infratemporal fossa and abuts the lateral pterygoid plate
  • bulges into the nasal cavity; the right inferior nasal turbinate enhances heterogeneously, possibly representing mass extension
  • The left part of the sphenoid sinus is opacified by a thick secretion, probably representing fungal sinusitis; mucocele is another possibility

Case Discussion

The patient had an MRI scan (unavailable) which showed essentially the same findings and then went on to have a resection. 

Histopathology report

Right side maxillary sinus: involved by invasive sinonasal non-keratinizing squamous cell carcinoma, transitional cell type. Foci of conventional SCC (less than 5%) seen. Desmoplastic stromal cell reaction noted. No necrosis seen.

Immunohistochemistry

  • p63: positive
  • p16: negative
  • Ki67: up to 50%
  • p53: up to 80%, mutated type

N.B. "transitional cell-type SCC" has been abandoned in favor of "nonkeratinizing SCC".

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