Just another everyday ENT case or surprisingly different: Unilateral nasal blockage and cephalgia

The NUT-Midline-Carcinoma (Nuclear protein in testis) is a rare entity, usually affecting children or young adults due to a translocation process resulting in a fusion of BRD4 and NUT gen. It involves midline-structures of the head and neck region, as well as the mediastinum and thorax. The prognosis is unfavorable.

A 67-year-old woman complained about nasal obstruction and cephalgia. Rhinoscopy showed a polypoid structure subtotal misplacing the left nasal cavity. CT scan revealed a nasopharyngeal tumor with hemisinusitis and intracranial extension. The histological analysis of a biopsy revealed parts of a NUT-Carcinoma. Based on a tumor board vote a combined lateral rhinotomy and a endoscopic resection of the tumor up to 1cm below the skull base was performed, followed by a further resection of the neurosurgeons and an adjuvant radiochemotherapy.

There are only rare cases of NUT carcinomas, especially affecting patients of advanced age. To date the exact prevelance is unknown. NUT-Carcinomas of the sinonasal tract are rare. Only 2 % of sinonasal Carcinomas revealed a NUT-Carcinoma after immunhistochemistry. NUT-Carcinomas seem to be a diagnostic challenge due to strong and diffuse immunreactivity to p63, which can also occur in squamous cell or undifferentiated carcinomas. NUT Carcinoma should be considered as a differential diagnosis in cases with highly aggressive and undifferentiated carcinomas even in elderly patients.

Poster-PDF A-1644.pdf

Publication History

Article published online:
07 August 2020