Abstract

Amaleteenagerpresentedwitha2-monthhistoryof recurrentepistaxis andnasal congestion.Nasal endoscopydemonstrateda2-cm friable mass in the left nasal cavity. A computed tomographic scan revealeda2.3-cmsoft-tissuedensity in the left nasal cavity (Figure, A) and amagnetic resonance imaging scan confirmedby this delineating a heterogeneously enhancing mass, without clear attachments to thenasal septum(Figure,B).Findings fromapositronemission tomographic scan were negative. The patient was brought to the operating room where he underwent nasal endoscopy with resection of the left nasal cavity lesion and adjacent septum. Histologic findings revealed a carcinomawithbasaloid features,composedofundifferentiatedcellswith hyperchromatic nuclei arranged in ribbons. Therewasbriskmitotic activity and areas of tumor necrosis (Figure, C). There was no perineural invasion, and themarginswere negative after resection. Results froma immunohistochemical stain forp16werepositive(Figure, D). The patient was disease free at his 6-month follow-up. What is your diagnosis? A

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