Sinonasal undifferentiated carcinoma with a frozen globe

A 42-year-old previously healthy woman presented with a 5-week history of headache, facial numbness, proptosis, motility restriction, and visual loss. CT showed soft-tissue infiltration involving the posterior ethmoids, pterygopalatine fossa, and posterior inferior orbit. Histopathologic analysis of a biopsy specimen disclosed a highly aggressive and undifferentiated neoplasm with an immunophenotype and ultrastructural features consistent with an epithelial origin, which was most consistent with a diagnosis of sinonasal indifferentiated carcinoma. The tumor was unresectable and the patient was started on a course of radiation and chemotherapy.