![]() ![]() ![]() Alcian Blue/PAS stain for mucin was negative. Despite the low mitotic count and proliferation rate, focally vascular invasion, necrosis, and perineural invasion were seen. The proliferation index (assessed via Ki-67 immunostaining) was estimated to be 10–15%. There was mild nuclear pleomorphism with a low mitotic count (8 mitoses/50 hpf). The surface epithelium overlying the tumor was ulcerated, with squamous atypia ( Figure 3). Histological examination showed the mass to be comprised of fasiculated and streaming spindle-shaped cells admixed with epithelioid cells. The mass was fixed to the nasal vestibule medially and the cartilaginous septum. Intraoperative photo of the left nasal cavity mass. The diagnostic impression was spindle cell neoplasm, favoring carcinoma. The tumor was negative for melanoma markers (HMB-45, Melan-A, S100), smooth muscle actin (SMA), CD34, and myoepithelial markers (CD10, Calponin, p63 and GFAP). The cells were immunoreactive for Cytokeratin 7 (CK7), vimentin, and pan keratin AE1/AE3. Biopsy of the nasal mass showed a proliferation of spindle and epithelioid cells. Computed tomography (CT) of the face and neck with contrast showed the mass to be heterogeneously enhancing ( Figure 1). On nasal endoscopy, the patient had an ulcerated, friable, well-circumscribed mass confined to the left nasal vestibule and attached to the cartilaginous septum. He denied any dysphagia, odynophagia, change in voice, nasal obstruction, purulent rhinorrhea, anosmia, facial pain, or weight loss. Adjuvant radiation and/or chemotherapy have also been used anecdotally.Ī 29-year-old previously healthy man presented to our clinic with a 2–3 week history of intermittent epistaxis from the left nasal cavity. No definite treatment protocol exists for this unique entity, but we believe that this tumor should primarily be treated with aggressive, wide local excision. We present a rare case of nasal cavity SpCC. On literature review, only one previous case of SpCC confined to the nasal cavity was identified. Six months after surgery, the patient continues to have no evidence of disease. Immunohistochemistry was only positive for pancytokeratin AE1/AE3 and vimentin. Histologically, the mass had dyplastic squamous epithelium and spindle-shaped cells admixed with epitheliod cells. The patient underwent wide local excision of the mass via a lateral alotomy approach and reconstruction with a composite conchal bowl skin and cartilage graft. On physical examination, the patient had an ulcerated mass in the left nasal vestibule and a biopsy showed a proliferation of spindle and epitheliod cells. A 29-year-old male presented with intermittent epistaxis from the left nasal cavity. We present a case report of nasal cavity SpCC and review the literature on this rare entity. SpCC confined to the nasal cavity is extremely rare, with only one case having been previously reported. Spindle cell carcinoma (SpCC) is a unique variant of squamous cell carcinoma (SCC). ![]()
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