PMC10208755_01
Endonasal scope of the right nasal cavity showed a dark-looking mass (yellow arrow) with purulent discharge under being mixed with blood stain. S: nasal septum; IT: inferior turbinate; MT: middle turbinate.
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Nasal endoscopy revealed a mass filling in the nasal cavity on the right side, and a physical exam was otherwise unremarkable (Figure 1).
Computed tomography scans (upper left and right) and magnetic resonance imaging T1 (lower left) and T2 (lower right) of the destructive mass (red asterisk) in the right sphenoid sinus extending to different sinuses and the infratemporal fossa.
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Magnetic resonance imaging (MRI) of the facial area showed a large enhancing destructive mass extending along the sphenoid, posterior ethmoidal, and right maxillary sinuses, with the extension along the posterior aspect of the nasal cavity and the right infratemporal fossa with an apparent large right retropharyngeal lymph node with significant enhancement in the postintravenous contrast (Figure 2).
Photomicrographs of the nasopharyngeal biopsy showing (a) infiltrative malignant neoplasm admixed with mixed chronic inflammatory cell infiltrate (H&E stain; 10x); (b) tumor cells with moderate amphophilic cytoplasm, vesicular nuclei, and prominent nucleoli; (c) lymphoplasmacytic cell infiltrate (arrow; H&E stain; 20x), with tumor cells showing cytoplasmic positivity for CK8/18 (IHC; 20x); (d) tumor cells with nuclear positivity for EBER (in situ hybridization for Epstein-Barr virus; 20x).
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Immunohistochemistry findings were positive for Epstein-Barr virus (EBV) and CK8/18 and negative for CK5/6, P63, chromogranin, synaptophysin, and CD56 (Figure 3).