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
From the case:
Sinonasal nonkeratinizing squamous cell carcinoma
{"current_user":null,"step_through_annotations":true,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_examine_pipeline_reports":false,"can_pin":false},"extraPropsURL":"/studies/126526/annotated_viewer_json?lang=us"}
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".
Unable to process the form. Check for errors and try again.