HPV-RELATED MULTIPHENOTYPIC SINONASAL CARCINOMA: AN AGGRESSIVE AND CHALLENGING CASE REPORT

Abstract

A 54-year-old male patient complained of self-limited epistaxis for two years, the symptoms worsening one year ago. Systemic arterial hypertension for 14 years was reported in the anamnesis. Physical examination revealed an irregular nodule in the left nasal fossa with yellowish secretion, friable to aspiration. MRI revealed an expansile image in the left nasal cavity, measuring 8.3 × 4.3 × 2.8 cm, extending into the nasopharynx, ethmoid, right nasal cavity, and cortical bone of the hard palate. An incisional biopsy was performed. Morphologically, a malignant cellular proliferation with solid basaloid appearance admixed with adenoid cystic-like areas. IHC were positive for AE1/AE3, CK7, p63, and calponin, with focal labeling for CD117 and α-SMA. p16 had diffuse cytoplasmic and nuclear positivity. Ki-67 index was 80%. The morphological and immunohistochemical aspects were conclusive for HPV-related multiphenotypic sinonasal carcinoma. Already in stage IV, the tumor was considered unresectable, and the patient is under oncological treatment and follow-up with chemoradiotherapy. A 54-year-old male patient complained of self-limited epistaxis for two years, the symptoms worsening one year ago. Systemic arterial hypertension for 14 years was reported in the anamnesis. Physical examination revealed an irregular nodule in the left nasal fossa with yellowish secretion, friable to aspiration. MRI revealed an expansile image in the left nasal cavity, measuring 8.3 × 4.3 × 2.8 cm, extending into the nasopharynx, ethmoid, right nasal cavity, and cortical bone of the hard palate. An incisional biopsy was performed. Morphologically, a malignant cellular proliferation with solid basaloid appearance admixed with adenoid cystic-like areas. IHC were positive for AE1/AE3, CK7, p63, and calponin, with focal labeling for CD117 and α-SMA. p16 had diffuse cytoplasmic and nuclear positivity. Ki-67 index was 80%. The morphological and immunohistochemical aspects were conclusive for HPV-related multiphenotypic sinonasal carcinoma. Already in stage IV, the tumor was considered unresectable, and the patient is under oncological treatment and follow-up with chemoradiotherapy.