Navigating the diagnostic spectrum and challenges of rare sinonasal tumors: Lessons from a tertiary centre
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1Cellular Pathology, North West London Pathology (NWLP), Hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, Lab Block, London, United Kingdom.
Background:
The sinonasal tract harbors a histopathologically diverse and uncommon group of neoplasms that pose significant diagnostic challenges due to overlapping morphological features and nonspecific clinical presentations.
Aims:
This study aims to elucidate the clinicopathological and histopathological spectrum of rare sinonasal tumors seen at a tertiary care centre, with a specific focus on diagnostic pitfalls and the systematic approach necessary for accurate classification.
Settings And Design:
A retrospective, descriptive clinicopathological case series conducted at a high-volume tertiary care referral centre in London.
Materials And Methods:
All sinonasal tumor biopsies accessioned over one calendar year (November 2024 to October 2025) were reviewed. Non-malignant lesions and inverted papillomas were excluded. Thirty-two tumors, including rare lesions like sinonasal melanomas, angiosarcoma, olfactory neuroblastoma, sinonasal glomangiopericytoma (SNGP), adenoid cystic carcinoma, and rare subtypes of squamous cell carcinomas (SCC), were analyzed. Two unclassifiable neoplasms, despite extensive ancillary testing, were also included.
Statistical Analysis:
Descriptive statistics were employed to summarize demographic, clinical, and pathological parameters.
Results:
These cases exemplified major diagnostic dilemmas, particularly in differentiating small round blue cell, spindle cell, and salivary gland-type tumors. A systematic, tiered immunohistochemistry (IHC) approach was instrumental in establishing definitive diagnoses in most cases. However, two tumors remained unclassifiable even after comprehensive IHC and molecular analysis, emphasizing the limitations of current diagnostic tools.
Conclusions:
Rare sinonasal tumors remain a formidable diagnostic challenge due to their rarity and morphological overlap. Accurate diagnosis necessitates clinicopathological correlation, judicious use of IHC panels, and awareness of rare entities to prevent misclassification and ensure optimal patient management.
