Exophytic Growth Research Articles

Imaging findings of gastric glomus tumors.

Sparse literature describes the imaging findings of gastric glomus tumors (GGT), focusing on benign tumors. We are not aware of prior radiology reports on malignant GGT. The aim of the study was to determine whether it is possible to differentiate between benign and malignant GGT on CT or MR. Institutional radiology and pathology databases were queried for the diagnosis of GGT between January 2010 to December 2023. Of 22 identified subjects, five were excluded due to non-availability of preoperative CT or MR images and three due to lack of pathological confirmation in our institution. The study cohort comprised of 14 patients (males = 6) with median age of 65 years (range 31 to 79 years). Two abdominal radiologists in consensus reviewed all relevant CT and MR images. There were 10 benign and 4 malignant GGT. Benign tumors were smaller than malignant GGT (median size of 2.0cm vs. 5.3cm, p = 0.03), more likely to exhibit homogeneous hyperenhancement (9/10 vs. 0/4, p < 0.01), and demonstrated intramural rather than exophytic growth. There was no substantial difference in T2 signal or diffusion restriction between benign and malignant GGT. On follow up, benign GGT were essentially stable in size, while malignant GGT grew. A biopsy proven GGT larger than 5cm or showing necrosis is likely to be malignant. This is important since preoperative endoscopic ultrasound-guided fine needle aspiration may be indeterminate for malignancy.

The CT and pathological features of intestinal inflammatory myofibroblastic tumor

AbstractTo explore computed tomography (CT) findings and pathological features of intestinal inflammatory myofibroblastic tumors (IMT). A retrospective review was conducted on the CT features of five patients with pathologically confirmed IMT, which were then compared with the corresponding pathological findings. The study included four female and one male patients. The tumors were located in the rectum (n = 1), small intestine (n = 2), or cecum (n = 2). One patient exhibited a cystic solid mass with exophytic growth and the solid components showed moderate enhancement. Additionally, flaky low‐density, marginal line‐like calcified shadows were observed around the lesions. Two cases presented as solid masses within the lumen of the intestinal tract, showing obvious non‐uniform enhancement along with visible enhancement shadows of small blood vessels. One patient had a metastasis. In two other cases, solid masses grew outside the lumen of the intestinal tract, demonstrating progressive and delayed enhancement on enhanced scans, as well as local nodular enhancement and ring enhancement. These two cases also exhibited focal sarcomatoid lesions, along with their respective IMTs. Histologically, these tumors mainly consist of proliferating spindle myofibroblast cells accompanied by variable infiltration by interstitial inflammatory cells, such as fibroblasts. Immunohistochemical analysis revealed positive staining for smooth muscle actin (SMA) in ~80% of the cells tested, while vimentin staining was positive in ~60% of the cells. Intestinal IMT is an extremely rare tumor with imaging features that can reflect the underlying pathological characteristics to some extent, thus aiding diagnosis.

Sinonasal Squamous Cell Carcinoma with DEK::AFF2 Rearrangement : An Aggressive Cancer with Bland Morphology.

DEK::AFF2 squamous cell carcinoma is a recently described cancer entity, with 29 cases reported to date. Occasionally, these carcinomas appear deceptively indistinguishable; however, specific morphological and phenotypic features suggest the presence of this rearrangement. However, the prognostic value of this diagnosis remains unclear. We aimed to report a new case series with histological, molecular, and clinical features. We collected data from 15 patients and investigated their phenotypes, including the expression profiles of CK7, P63/P40, PDL1, AFF2, and P16, morphological features, and associated prognostic data. We analyzed these data along with the previously published data. Most of these cases exhibited indicative morphological features, such as exophytic and endophytic papillary growth, nuclear monomorphism, and abundant neutrophil-rich inflammatory infiltrates. Immunohistochemical analysis revealed the expression of AFF2 and squamous cell markers in all the patients. Overexpression of P16 was not detected, whereas CK7 and PDL1 were expressed variably. In our study cohort, a 50% progression or recurrence rate, 25% lymph node metastasis, 17% distant metastasis, and 18% disease-related death were identified, with a short follow-up time. DEK::AFF2 squamous cell carcinoma incidence is probably underestimated. The low-grade appearance of these tumors sometimes limits their detection. The rates of recurrence and metastasis seem to be high despite an often bland morphology. We propose AFF2 immunohistochemistry as an effective tool, and a diagnostic algorithm has been established to support accurate diagnosis of these tumors.

Verrucous carcinoma on lateral tongue in association with oral submucous fibrosis: A rare case report

Oral verrucous carcinoma (VC) is a rare tumor, which a clinical variant of well differentiated oral squamous cell carcinoma characterized by exophytic growth or cauliflower like growth in appearance. It establishes in older individuals, who has habit of chronic tobacco chewing and predominance in males. Oral submucous fibrosis (OSMF) is a chronic, insidious, potentially malignant disorder associated with betel nut chewing habit. The development of oral squamous cell carcinoma (OSCC) is seen in one-third of the OSMF patients, but the development of VC is rarely seen in such patients. In the literature a very few cases of OSMF with VC are reported. Here, we present such a rare case in a 25 years old female patient with VC in conjunction with OSMF.

Challenges in Distinguishing Rectal Leiomyosarcoma from Ovarian Malignancy: A Diagnostic Conundrum

Introduction: Rectal leiomyosarcoma is a rare malignant mesenchymal tumor accounting for &lt;0.1% of all malignant colorectal neoplasms and carries a grave prognosis. Case Presentation: A 50-year-old postmenopausal, P3L3 woman presented with complaints of abdominal pain for two months, dark-colored loose stools, 10-15 episodes per day for 2-3 months, and gradual weight loss for 4-5 months. On ultrasonography and MRI of the pelvis, a large irregular lobulated ill-defined solid lesion was seen arising from the right side of the pelvis measuring 14x8x14cm. The right ovary was not observed to be separate from the mass. There was omental thickening and peritoneal deposits with ascites. The final impression suggested a right-sided malignant ovarian mass with peritoneal dissemination (ORADS-5) with a differential leiomyosarcoma. Her tumor markers (CA- 125; CA19-9, and CEA) were raised. Given the strong dilemma between ovarian malignancy and leiomyosarcoma and the advanced stage of the disease, the patient was planned for an ultrasound-guided biopsy of the lesion. The histopathological report revealed atypical spindle cell proliferation with myoid features with the presence of multiple mitotic figures. The diagnosis of rectal leiomyosarcoma was further confirmed with immunohistochemical tests, which were positive for actin and desmin and negative for CD 117 and S100. The patient was referred to oncosurgeon for further management and was planned for surgical resection followed by chemotherapy with intravenous doxorubicin. Conclusion: Rectal leiomyosarcoma is commonly misdiagnosed as ovarian malignancy because of its exophytic growth and similar clinical features at the time of the presentation. Hence, clinicians must be aware of these differentials for the successful management of cases.

A case report on the simultaneous occurrence of cancer in The Tongue and Breast

Squamous cell carcinoma (SCC) affecting the tongue commonly emerges along its lateral border, yet occurrences specifically on the dorsum, especially at the midline, are notably rare. This study delves into the incidence rates of SCC localized on the tongue, alongside an investigation into simultaneous lesions of the breast. 50-year-old female presented with an ulcerative growth on the left side of the tongue, accompanied by speech difficulty and chewing discomfort persisting for a month. Previous history included breast surgery five years prior, along with ongoing diabetes medication. No history of habits, trauma, or prior ulcer formation was reported. Clinical examination revealed a whitish-yellow, firm, ulcerative lesion extending on the left lateral tongue surface, measuring 7.2x3.1x2.5cm with an exophytic growth of 4.7x2.1cm. The lesion, extending to the dorsal tongue surface, displayed erythematous flooring interspersed with slough and pale mucosa. Limited tongue movement and palpable submandibular nodes were noted. Initial diagnostic findings indicated stage IV metastatic carcinoma of the tongue (T4aN2M1). pathology revealed severe epithelial dysplasia with an invasive pattern in the form of islands, demonstrating altered cellular features, pleomorphism, inflammatory infiltrate, vascularity, and areas of hemorrhage. Lymph nodal analysis showed metastatic deposits in one of three left level II B lymph nodes.

Papillary Variant of Oral Squamous Cell Carcinoma of Alveolar Mucosa- A Case Report and Review

Papillary Squamous Cell Carcinoma (PSCC) is a less frequent subtype of Squamous Cell Carcinoma (SCC) with a more favorable prognosis compared to conventional oral squamous cell carcinoma. PSCC has a distinctive exophytic and papillary projection. The upper aerodigestive tract is the most commonly affected site with a higher incidence of occurrence in the larynx. The papillary variant of oral squamous cell carcinoma involving gingiva or alveolar ridge is relatively uncommon and less reported. Other differential diagnosis of papillary gingival masses is reactive gingival lesions and fungal infections. An accurate diagnosis is vital for both therapeutic and prognostic purposes. This article describes the case of papillary variant oral squamous cell carcinoma in a 75-year-old male in the maxillary alveolar region depicting histopathological features of exophytic growth with hyperplastic stratified squamous epithelium with basaloid cells invading the underlying connective tissue.

Role of magnetic resonance imaging to differentiate between borderline and malignant serous epithelial ovarian tumors.

We aimed to differentiate serous borderline ovarian tumors (SBOT) from serous epithelial ovarian carcinomas (SEOC) using morphological and functional MRI findings, to improve the patient management. We retrospectively investigated 24 ovarian lesions diagnosed with SBOT and 64 ovarian lesions diagnosed with SEOC. Additional to the demographic and morphological findings T2W signal intensity ratio, mean apparent diffusion coefficient (ADCmean) and total apparent diffusion coefficient (ADCtotal) values were analyzed and compared between two groups. Bilaterality, pelvic free fluid presence, serum CA-125 level (U/mL), presence of pelvic peritoneal implant were in favor of SEOC. Lower maximum size of solid component and solid size to maximum size ratio, dominantly cystic and solid-cystic appearance, exophytic growth pattern, presence of papiller projection and papillary architecture and internal branching pattern, higher T2W signal intensity ratio, ADCmean and ADCtotal values were in favor of SBOT. Our study revealed that morphological and functional imaging findings were valuable in differentiating BSOT from SEOC.

Squamous cell carcinoma of the cystic duct: A case report and literature review.

Pure squamous cell carcinoma (SCC) of the gallbladder is a rare malignant biliary tract tumor predominantly found in the body and neck of the gallbladder. However, its occurrence in the cystic duct is even rarer. Given its rarity, no established guidelines or consensus currently exist regarding the treatment of pure SCC of the gallbladder. We report an unusual case of SCC originating from the cystic duct with the intent of providing insights into the therapeutic approach for this type of malignancy. A male patient presented to our hospital with acute cholecystitis. Unexpectedly, imaging revealed gallbladder malignancy. Pathologic examination after surgery confirmed SCC of the cystic duct. Despite elevated bilirubin levels, we were able to exclude hilar involvement, enabling radical tumor resection. Intraoperatively, we discovered that the tumor was located in the cystic duct, a site associated with a high likelihood of invasion into neighboring organs. The tumor demonstrated a predominantly exophytic growth pattern, which prompted us to refrain from extending the resection range, thereby striking a balance between complete tumor removal and surgical trauma. We performed liver wedge resection only to ensure a negative resection margin while preserving the anatomical structure to the greatest extent possible. Postoperative recovery was rapid and uncomplicated. Pathological examination confirmed pure SCC, which led us to initiate a regimen of nab-paclitaxel and cisplatin, which is known to be effective in other organ SCCs. Remarkably, the patient experienced a rare and severe posttreatment cardiovascular event. Consequently, we switched the patient to a chemotherapy regimen of gemcitabine and cisplatin, which ultimately yielded positive clinical outcomes. no evidence of tumor recurrence was observed within 1 year after surgery. The diagnosis and therapeutic strategy for rare tumors such as gallbladder SCC should be meticulously tailored based on their unique characteristics to optimize postoperative patient outcomes.

Photogallery. Juvenile hemangiomas

Juvenile hemangiomas can occur from the first months of life, with the prevalence of superficial juvenile hemangiomas (76.1%), more often solitary (83.3%).&#x0D; Female infants predominate among the patients, with a 2:1 ratio.&#x0D; Localization on the skin of the face and scalp is determined in 30% of cases; the remaining juvenile hemangiomas are located on the skin of the trunk and extremities.&#x0D; Hemangiomas are mostly peripheral and small in size (1020 mm), superficially and up to 5 mm deep.&#x0D; The most frequent complication of juvenile hemangiomas is ulceration, both as a consequence of exophytic growth and treatment methods.&#x0D; The predominance of arterial intramedullary blood flow was found at ultrasound diagnosis, however, variants of 2-phase blood flow can also occur, which requires additional ultrasound examination of all cases of juvenile hemangiomas.&#x0D; We offer the publication of a photo gallery on this problem.

"Free-Floating Anus": A Flap-Free Approach for Definitive Excision of Circumferential Giant Condyloma Acuminata.

Giant condyloma acuminata (GCA), or Buschke-Löwenstein tumor, is a rare exophytic cauliflower-like growth in the anogenital region. The spectrum of treatment options is wide, ranging from the application of topical ointments to the performance of an abdominoperineal resection. Currently, wide local excision is the most common approach and may entail the creation of a protective loop ileostomy or implementation of flaps or grafts that facilitate closure. We describe a unique surgical approach for the management of circumferential GCA void of the use a protective loop ileostomy, flaps, or grafts. Our report highlights that the implementation of a radical, circumferential, wide excision resulting in "free-floating anus" and healing via secondary intention can ultimately lead to excellent functional and cosmetic results and therefore may be considered a minimally invasive surgical option for patients afflicted with a large, circumferential GCA.

Goldilocks principle of minimally invasive surgery for gastric subepithelial tumors.

Minimally invasive surgery had been tailored to individual cases of gastric subepithelial tumors (SETs) after comparing the clinical outcomes of endoscopic resection (ER), laparoscopic resection (LR), and hybrid methods. To study the use of Goldilocks principle to determine the best form of minimally invasive surgery for gastric SETs. In this retrospective study, 194 patients of gastric SETs with high probability of surgical intervention were included. All patients underwent tumor resection in the operating theater between January 2013 and December 2021. The patients were divided into two groups, ER or LR, according to the tumor characteristics and the initial intent of intervention. Few patients in the ER group required further backup laparoscopic surgery after an incomplete ER. The patients who had converted open surgery were excluded. A logistic regression model was used to assess the associations between patient characteristics and the likelihood of a treatment strategy. The area under the curve was used to assess the discriminative ability of tumor size and Youden's index to determine the optimal cut-off tumor size. One-hundred ninety-four patients (100 in the ER group and 94 in the LR group) underwent tumor resection in the operating theater. In the ER group, 27 patients required backup laparoscopic surgery after an incomplete ER. The patients in the ER group had small tumor sizes and shorter procedure durations while the patients in the LR group had large tumor sizes, exophytic growth, malignancy, and tumors that were more often located in the middle or lower third of the stomach. Both groups had similar durations of hospital stays and a similar rate of major postoperative complications. The patients in the ER group who underwent backup surgery required longer procedures (56.4 min) and prolonged stays (2 d) compared to the patients in the LR group without the increased rate of major postoperative complications. The optimal cut-off point for the tumor size for laparoscopic surgery was 2.15 cm. Multidisciplinary teamwork leads to the adoption of different strategies to yield efficient clinical outcomes according to the tumor characteristics.

Morphological characteristics and diagnostic criteria of traditional serrated adenoma

Traditional serrated adenomas (TSAs) are extremely rare polyps from the group of serrated polyps of the colon. TSAs is no more than 5 % of all colon polyps. A relatively small number of studies have been devoted to this histological variant, at the same time, some aspects of the morphological diagnosis of TSA still remain undisclosed. Purpose: to conduct a clinical and morphological analysis of cases of TSAs.Materials and methods. The study included 57 cases of TSAs diagnosed in the period from 2021 to 2023. In the cases detected during this period, the results of histological and endoscopic studies were analyzed.Results. The age of patients ranged from 44 to 78 years and averaged 61.7 years. The ratio of men and women is 1:1.8. Most TSAs were found in the rectum (n = 28) and sigmoid colon (n = 20). In 8 cases, the tumor was localized in the descending part and the splenic flexure of the colon. In 1 observation, a tumor was found in the cecum. The sizes of the polyps ranged from 0.5 cm to 3.5 cm. In 22 cases, the composition of the polyp included tubulovillous adenomas (16 cases) and hyperplastic polyps (6 cases) in addition to TSAs. In 5 cases, foci of highly differentiated adenocarcinoma were detected in the TSAs material.Conclusion. TSAs has characteristic morphological features with a serrated exophytic growth pattern, cytoplasmic eosinophilia and the presence of ectopic crypts. Due to the difficulties of morphological diagnosis, TSAs in some cases remains undiagnosed. At the same time, due to the increased malignant potential, TSAs requires special vigilance on the part of pathologists and clinicians.

Difficult glottis: Diagnostic dilemma in viewof the clinical presentation.

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; The taxonomy of vocal fold lesions has been refined, and it serves as a common descriptive language for diagnosis, treatment algorithms, and reporting of outcomes. However, we observe rare cases when numerous pathologies overlap, resulting in an unclear and complicated clinical presentation of the glottis.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of this paper is to present cases of overlapping etiopathological factors which poses a challenge when making a diagnosis and referring a patient for adequate treatment.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Material and method:&lt;/b&gt; The study presents different photographs of the glottis, including some unique and unusual images in which overlapping pathologies were captured. The photographs are accompanied by case descriptions, comments, and pathological analyses.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Four selected photographs showed a bunch of exophytic growth lesions with foci of whitish plaques, covered by yellowish crusts, with thinned, reddened vocal folds presenting foci of leukoplakia. The study discussed possible causes of vocal folds edema, diffuse erythema, presence of crusts or exudate, whitish debris/plaques or development of leukoplakia, non-neoplastic ulceration, as well as injected and reddened mucous membrane. Chronic infectious laryngitis, idiopathic ulcerative laryngitis, and drug-induced laryngitis were also mentioned. The study also raised the issues concerning diabetics and patients treated with inhaled corticosteroids, including candidiasis and primary aspergillosis of the larynx.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; To conclude, everyday clinical practice involves encountering cases of unclear onset and course, with complicated presentation of the glottis. Therefore, comprehensive history-taking and thorough investigation of systemic causes are of immense importance. Recommended management includes conducting the most meticulous differential diagnosis, implementing treatment for the most likely cause, and, whenever possible, refraining from biopsy in order to avoid permanent damage to vocal cords.&lt;/br&gt.

Metaplastic squamous cell carcinoma caricaturing as tuberculous mastitis-A vicissitude of clinical diagnostic misadventure

Tuberculous mastitis and invasive breast cancers are known to co-exist or occur in the breast independently of each other, albeit the former being less common in developed countries. Tuberculous mastitis with its clinical presentation and morphological features can caricature invasive breast carcinoma. The overlapping features of tuberculous mastitis and metaplastic squamous cell carcinoma often lead to, if no due clinical diligence and discretion is used, bewildering misinterpretation with the vicissitude of diagnostic implications of tuberculous mastitis ensuing catastrophic and perilous ramifications. A 42-year-old woman presented with exophytic growth with extensive areas of ulceration. Clinically, the lesion was diagnosed as disseminated tuberculous mastitis based on clinical and morphological features, which was surgically resected. On histological examination, the lesion was diagnosed as invasive metaplastic squamous cell carcinoma. Thecase being presented here displays the vagary involved in clinical diagnosis of tuberculous mastitis inasmuch as it often shares clinical and morphological features with a devastatingly perilous variant of invasive duct carcinoma, metaplastic squamous cell carcinoma, the inadvertent eschewing of or misapprehending of which may engender devastating prognostic implications.

Sebaceous cell carcinoma of the scalp in a young male: A rare case report

Sebaceous carcinoma is a rare locally aggressive neoplasm of the sebaceous gland, which occurs frequently in elderly males. It constitutes 0.2 to 4.6% of all the malignant cutaneous tumours and occurs commonly in the periocular area. Scalp is a rare site for this tumor. Here we report a case of sebaceous carcinoma in a young 28 years old male patient who presented with firm to hard exophytic growth over right posterior occipital region with enlarged suboccipital and post auricular lymph nodes. Wide local excision was done and a diagnosis of sebaceous carcinoma of the scalp with lymph node metastasis was rendered after histopathological and Immunohistochemical examination.

Cotyledonoid dissecting leiomyoma in pregnancy: a case report

Cotyledonoid dissecting leiomyoma (CDL) is a rare variant of uterine leiomyoma characterized by intramural dissection within the uterine corpus and a distinctive gross appearance resembling the cotyledons of the placenta. Despite their alarming, sarcomatous appearance both macroscopically and radiographically, these tumors are typically associated with bland histologic findings. Approximately 70 cases of CDL have been described in the literature. This case represents the second described case of CDL in pregnancy, the first in which a pregnancy was carried to term. A 28-year-old primigravid was incidentally found to have a massive, exophytic growth of the uterus on ultrasound with concomitant 14-week intrauterine pregnancy. The pregnancy was monitored with serial growth ultrasounds. She was delivered at 37 weeks via Cesarean section. After being lost to follow-up, the patient presented 2.5 years later with worsening abdominal fullness and persistent uterine mass.

A Patient With Exophytic Primary Optic Nerve Sheath Meningioma: Stratified Risk of Surgery Based on the Morphology.

Primary optic nerve sheath meningioma (pONSM) is one of the most challenging tumors to manage. Although surgical excision may be considered a treatment option to maintain visual function, the safety of surgery remains debatable due to the non-negligible risk of optic nerve injury. pONSM often grows concentrically around the optic nerve; however, it can also demonstrate an exophytic growth from the optic nerve. The risk of surgical excision of pONSM may vary based on the tumor's growth pattern and area of contact with the optic nerve; however, there has been no detailed report on risk stratification to date. The authors present an illustrative case of an exophytic pONSM which was removed surgically without complications, suggesting that tumor morphology may also influence the surgical risk. In this report, the imaging and intraoperative features of exophytic pONSM are presented in detail, and the risk factors for complications are discussed.

Do Exophytic and Endophytic Patterns in Borderline Ovarian Tumors Have Different Prognostic Implications? A Large Multicentric Experience.

Borderline ovarian tumor (BOT) accounts for 15-20% of all epithelial ovarian tumors. Concerns have arisen about the clinical and prognostic implications of BOT with exophytic growth patterns. We retrospectively reviewed all cases of BOT patients surgically treated from 2015 to 2020. Patients were divided into an endophytic pattern (with intracystic tumor growth and intact ovarian capsule) and an exophytic pattern (with tumor growth outside the ovarian capsule) group. Among the 254 patients recruited, 229 met the inclusion criteria, and of these, 169 (73.8%) belonged to the endophytic group. The endophytic group showed more commonly an early FIGO stage than the exophytic group (100.0% vs. 66.7%, p < 0.001). Furthermore, tumor cells in peritoneal washing (20.0% vs. 0.6%, p < 0.001), elevated Ca125 levels (51.7% vs. 31.4%, p = 0.003), peritoneal implants (0 vs. 18.3%, p < 0.001), and invasive peritoneal implants (0 vs. 5%, p = 0.003) were more frequently observed in the exophytic group. The survival analysis showed 15 (6.6%) total recurrences, 9 (5.3%) in the endophytic and 6 (10.0%) patients in the exophytic group (p = 0.213). At multivariable analysis, age (p = 0.001), FIGO stage (p = 0.002), fertility-sparing surgery (p = 0.001), invasive implants (p = 0.042), and tumor spillage (p = 0.031) appeared significantly associated with recurrence. Endophytic and exophytic patterns in borderline ovarian tumors show superimposable recurrence rates and disease-free survival.

Differentiated Papillary NUT Carcinoma: An Unexpected, Deceptively Bland Presentation of a Sinonasal Carcinoma

BackgroundIn recent years, the list of tumor entities in the sinonasal tract has significantly expanded, requiring advanced diagnostic testing. We report the case of a 32-year-old patient with an unusual NUT carcinoma originating in the maxillary sinus, which showed extensive well-differentiated, papillary squamous morphology, similar to the spectrum of the recently described DEK::AFF2 fusion-associated carcinoma.MethodsWe performed immunohistochemical and molecular studies including EBV- and HPV-testing, as well as DNA/RNA next generation sequencing.ResultsThe tumor showed predominantly exophytic papillary growth with mature squamous differentiation. An additional component harbored atypical, less differentiated basaloid tumor cells with infiltration of the adjacent stroma. Conspicuous inflammation was evident. There was no evidence of HPV DNA or EBV RNA. Next-generation sequencing revealed a NUT::NSD3 gene fusion corresponding to (“speckled-type”) immunopositivity of NUT in the tumor cells.ConclusionsWe describe a NUT::NSD3 gene fusion-associated NUT carcinoma of the sinonasal tract with a deceptively well-differentiated papillary growth pattern, thus expanding the morphological spectrum of this typically poorly differentiated neoplasm.