School of Medicine

Department of Pathology

November 2023 Case

Contributors: Zaid N. Khreefa, MD, Rachna Jetly, MD, MPH


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.



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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