Unusual Presentations of Sinonasal Undifferentiated Carcinoma

Conclusion: SNUC is a highly aggressive malignancy that originates in the paranasal sinuses. It can present as lesions outside the sinuses including the brain, the pituitary gland, and the clivus. Patient 1 was a previously healthy 63 year old male who presented with insatiable thirst for several months and right-sided frontal headaches. He went to his primary care physician who found that he had unexplained hypotension. He was then hospitalized and underwent a general workup that included a computed tomography of the head which showed a sellar mass. A MRI demonstrated an enhancing mass measuring 14mm that filled the sella turcica and extended into the right cavernous sinus. At the same time the patient was found to have panhypopituitarism. There was no history of nasal obstruction, facial pain, rhinorrhea or epistaxis. His past medical history was significant for diabetes mellitus type II and erectile dysfunction. His visual fields and cranial nerves were intact. Shortly thereafter the patient underwent tumor resection through an endoscopic transphenoidal approach. Final post operative pathology indicated SNUC within the nasal polyps and the sellar mass. Tissue specimens revealed extensive infiltration by an undifferentiated carcinoma. He was treated with postoperative chemotherapy and radiation. He died of his disease four months late.