PAPILLARY SQUAMOUS CARCINOMA OF PARANASAL SINUS-AN UNCOMMON HISTOLOGICAL VARIANT

Papillary Squamous cell carcinoma is an uncommon histological variant Squamous cell carcinoma (SCC) of the upper aero-digestive tract (UADT). It rarely involves the paranasal sinuses. We report an aggressive case of papillary SCC of the left maxillo-ethmoid complex in a 59 year old male, who presented with rapidly progressive left cheek swelling and nose block. Biopsy revealed diagnosis of Papillary Squamous cell carcinoma arising in a transitional papilloma. The contrast enhance CT scan showed heterogeneously enhancing large lobulated soft tissue mass is seen involving the left maxillary sinus, left nasal cavity, left ethmoidal sinuses and left frontal sinus with extensions as.Superiorly, there was destruction of inferior wall of left orbit with loss of fat plane between the inferior oblique and inferior rectus muscles possibly infiltrating and pushing the globe superolaterally. Inferiorly, with destruction of inferior wall of left maxillary sinus and extending along alveolar process of left maxilla is seen.Patient underwent left subtotal maxillectomy (Pre-maxilla preservation) and orbital exenteration with endoscopic fronto-spheno-ethmoidal clearance. The resected margins were found to be free from tumour. The patient underwent postoperative Chemo-radiotherapy. Patient developed recurrence at orbital apex with extension to Middle cranial fossa after four months following post operative radiotherapy with a histopathological diagnosis of well differentiated carcinoma and was advised cyber knife treatment at another center. The patient did not undergo cyber knife treatment and came back after one month and was started on palliative chemotherapy, but expired after 2 months. The case is presented for its rarity and aggressive behavior.