Background: Sinonasal undifferentiated carcinoma (SNUC) are rare, highly aggressive neoplasms, predominantly affecting middle-aged individuals. We report its occurrence in an adolescent boy who was clinically suspected as juvenile nasopharyngeal angiofibroma (JNA). Clinical Description: A 13-year-old boy presented with headache and nasal blockage for 2 months with intermittent epistaxis. The child was otherwise stable and found to have diffuse swelling and fullness involving the right cheek and temporal region. On anterior rhinoscopy, there was a reddish, lobulated mass, with surface vascularity occupying the entire right nasal cavity, provisionally diagnosed as JNA. Management and Outcome: Imaging studies revealed enhancing mass involving the right nasal cavity, sphenopalatine fossa, and sphenoethmoidal recess with erosion of right lateral pterygoid plate, posterior wall of maxillary sinus as well as skull base erosion; findings not consistent with the benign JNA. A biopsy was done and histopathology along with immunohistochemistry helped in confirming the diagnosis of SNUC, stage IV. The child was started on induction chemotherapy with paclitaxel and carboplatin with radiotherapy at follow-up; symptoms abating by 4 months. Conclusion: The case creates awareness that a highly aggressive neoplasm like SNUC may be the cause of persistent headache, nasal blockage, and epistaxis in an adolescent, and may be misdiagnosed as JNA, if not evaluated thoroughly.
Mishra et al. (Tue,) studied this question.
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