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Diverse Diagnosis of a Single Sinonasal Mass and how was Mystery Solved

Gayatri Gogoi, Saikia P, Borgohain M, Utpal Dutta and Daijy Kakoti

Background: Although the nasal cavity and paranasal sinuses occupy a relatively small anatomical space, they are the site of origin of some of the more complex, histologically diverse group of tumours in the entire human body. Carcinomas of the nasal cavity and paranasal sinuses account for 0.2-0.8% of all malignant neoplasms and 3% of those occurring in the head and neck. Sinonasal undifferentiated carcinoma is a very rare tumour with fewer than 100 reported cases.

Case report: In our case, a 50yr female came to the ENT OPD with a mass in the right nasal cavity with respiratory distress. CECT revealed an inverted papilloma or a malignant mass lesion. Histopathological examination of the resected specimen suggested that of Transitional Cell Carcinoma (TCC). Patient again presented after 6 months, with epistaxis and right maxillary growth. A punched biopsy specimen was sent which on histopathology suggested that of an inflammatory polyp. Whole specimen was resected after that and on haematoxylin and eosin section showed the picture of Undifferentiated Carcinoma. Immunohistochemical study helped in confirmation (CK positive).

Discussion: Sinonasal undifferentiated Ca is reported as high grade malignant neoplasm of nasal cavity of uncertain histogenesis. In our case diverse histopathological diagnosis was made in single tumour as TCC (September 2014) and SNUC (April 2015, final diagnosis) when section was taken from fully resected sinonasal mass. The picture was consistent with Inflammatory Polyp (March 2015) on punched biopsy specimen was examined. So at times HPE can be misleading. However IHC is confirmatory.

Conclusion: In limited biopsy material, differentiation of these tumour types can be challenging .The histopathology of entire tumour plays a primary role in establishing the correct diagnosis which often necessitates the use of adjunct studies that allow confirm differentiation among neoplasms.