Palliative Surgical Decompression in a Patient with Sinonasal Nut Midline Carcinoma for Vision Protection: A Case Report

Nuclear protein of the testis (NUT) midline carcinoma is a rare malignancy uniquely defined based on genotype rather than histologic features, and it may involve any organ system, though it is often found in the midline sinus cavity and head and neck. Though there is a wealth of literature studying the vision outcomes after surgical resection of benign tumors (i.e., pituitary adenomas, meningiomas, and craniopharyngiomas), the same cannot be said of sinonasal malignancies, in which oncologic cure is typically the main goal of intervention. This case of a patient with NUT midline carcinoma helps to provide insight into the utility of palliative surgery in sinonasal malignancies, and it is the first report of such an approach for a NUT midline carcinoma in the current literature. There is no optimal management regimen for NUT midline carcinoma, and treatment is based on surgery, chemotherapy, radiation therapy, or a combination of these therapies. We present a case of a 22-year-old male presenting with rapidly progressive vision loss due to optic nerve and chiasm compression who underwent subtotal resection of NUT midline carcinoma via an expanded endoscopic endonasal surgery for vision protection and improvement in quality of life rather than oncologic cure. In an ever-changing healthcare landscape where value in quality is increasing, we believe surgical decompression of sinonasal malignancies leading to vision loss may play a valuable role in palliation.

Fig. 1 Preoperative coronal T1 with contrast showing nasal mass with invasion of RL medial orbits.

Fig. 2 Preoperative coronal T1 demonstrating mass encasing optic canals.

Fig. 3 Eight-month postoperative and postradiation coronal T1 with contrast demonstrating dramatic reduction of bilateral orbital apex tumor and nasal cavity mass.

Fig. 4 Eight-month postoperative and postradiation coronal T1 with contrast showing bilateral optic canals clear of disease.