Mariappen, Suraien and Lim, Walter Yung Chwen and Ng, Pui Foong and Maruthamuthu, Thevagi and Rozhan, 'Atikah
(2025)
A case report on sinonasal undifferentiated carcinoma: a surgeon’s challenge or simply treatment challenges.
Journal of Cancer and Tumor International, 15 (4).
pp. 71-78.
ISSN 2454-7360
Abstract
A 38-year-old Chinese gentleman presented to a private healthcare facility with a chief complaint of
unilateral epistaxis, persisting for 2 months. An endoscopic examination revealed a polyp-like
structure in the left nasal cavity, which bled upon contact. The patient underwent endoscopic sinus
surgery and biopsy. Initial histopathological examination rendered as well differentiated squamous
cell carcinoma. Post operatively, despite persistent nasal symptoms, the patient defaulted on
treatment. Two months later, he presented to the emergency department with painless, progressive
left eye swelling, accompanied by left eye vision loss, reduced hearing, and tinnitus for 1
week. Examination revealed proptosis of the left eye, firm and non tender swelling over the left
maxillary region, and a fleshy mass occupying the entire left nostril. Imaging studies showed
extensive disease involving the nasal cavity, paranasal sinuses, left orbit with intracranial
extension, and bony erosions. Histopathological examination from a biopsy confirmed Sinonasal
Undifferentiated Carcinoma (SNUC). The patient was staged as cT4bN0M0 and planned
for chemotherapy but defaulted after 2 cycles due to intolerable side effects. He succumbed
to locally advanced disease a month later. SNUC is a rare and highly aggressive malignant
neoplasm originating from the epithelial lining of the paranasal sinuses and nasal cavity. Its
aggressive nature often results in large and extensive tumors at the time of diagnosis, with a
short duration of symptoms. While initial treatment involves surgical resection, complete tumor
removal is often challenging due to complex anatomy. Aggressive multimodality treatment is
recommended, although SNUC carries a high rate of local recurrence and increased morbidity and
mortality.
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