Purpose

To report two uncommon presentations of non-keratinizing sinonasal squamous cell carcinoma manifesting as medial orbital masses, and to highlight the role of early imaging, biopsy, and multidisciplinary care

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Methods

Retrospective review of two male patients presenting with medial orbital masses. Clinical evaluation, imaging of the orbit and paranasal sinuses, intraoperative findings, and histopathology were analysed. Outcomes at three-month follow-up were documented.

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Results

A 53-year-old male with prior fish-hook trauma presented with ptosis, medial canthal swelling, pigmentation, and mild proptosis. Computed tomography showed a medial orbital mass extending into the ethmoid and maxillary sinuses, initially suspected as an abscess. Biopsy confirmed non-keratinizing squamous cell carcinoma of sinonasal origin. Despite debulking and chemoradiation, magnetic resonance imaging showed rapid regrowth within two weeks with lacrimal sac infiltration, correlating with a Ki-67 index of 80%; p63 and cytokeratin were strongly positive. A 61-year-old male referred for epiphora had an ill-defined lesion extending from the lacrimal sac into multiple sinuses with bony erosion. Initial biopsy elsewhere suggested paraganglioma. Combined debulking with the rhinology team revealed a vascular lobulated mass; histopathology confirmed non-keratinizing sinonasal carcinoma. He underwent external beam radiotherapy with concurrent cisplatin followed by adjuvant paclitaxel and cisplatin, with no recurrence at three month

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Conclusion

Sinonasal carcinoma may present subtly with ocular symptoms and mimic lacrimal or infective pathology. Early biopsy, awareness of atypical presentations, and multidisciplinary care are essential for timely diagnosis and improved outcomes.

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Additional Authors

First name	Last name	Base Hospital / Institution
Anasua	Ganguly	LV Prasad Eye Institute

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