More than meets the eye

We report an extremely rare case of a hybrid tumour of the maxillary sinus. A 51-year-old man presented with a 6-week history of nasal congestion and epiphora. Radiological imaging demonstrated a maxillary sinus tumour, with extensive local invasion. Surgical excision included maxillectomy, left eye exenteration and free flap closure. Histology of the excised specimen showed a rare hybrid tumour containing adenoid cystic carcinoma, salivary duct carcinoma, epithelial-myoepithelial carcinoma and basal cell adenoma. Hybrid tumours are very rare tumour entities which are composed of at least two distinct tumour types. Each tumour entity conforms with a defined tumour type. The tumour entities of a hybrid tumour are not separated but have an identical origin within a definite topographical area. Diagnosis and appropriate management requires high index of suspicion, pathological endeavour to look for a more aggressive accompanying tumour and adequate oncological treatment according to the highest grade of tumour.

Sinonasal hybrid tumour involving the anterior skull base

Objective:We report a rare case of sinonasal hybrid tumour within an inverted papilloma.Method:The patient's case history and course of management are presented. The relevant medical literature are reviewed and discussed.Results:A 60-year-old man presented with unilateral nasal obstruction associated with anosmia. An ENT examination revealed a unilateral, left nasal mass. A provisional diagnosis of inverted papilloma was made. The patient underwent a transnasal endoscopic excision of the tumour, which was unfortunately complicated by a cerebrospinal fluid leak. Further treatment of this patient is described. We highlight the features of associated malignancy in inverted papilloma, and the importance of thorough histopathological examination of tissue specimens.Conclusion:Treatment of inverted papilloma with limited involvement of the skull base can be successfully achieved by endoscopic excision. A high index of clinical suspicion, together with meticulous histopathological examination, will enable diagnosis of associated malignancy. This will ensure that appropriate adjuvant treatment is given, resulting in a good clinical outcome.