Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2022; 10(33): 12395-12403
Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12395
Multimodality imaging and treatment of paranasal sinuses nuclear protein in testis carcinoma: A case report
Wen-Peng Huang, Ge Gao, Yong-Kang Qiu, Qi Yang, Le-Le Song, Zhao Chen, Jian-Bo Gao, Lei Kang
Wen-Peng Huang, Yong-Kang Qiu, Qi Yang, Le-Le Song, Zhao Chen, Lei Kang, Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
Ge Gao, Department of Medical Imaging, Peking University First Hospital, Beijing 100034, China
Jian-Bo Gao, Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Author contributions: Huang WP, Gao G, Yang Q, Song LL Chen Z, and Qiu YK designed research; Huang WP, Gao G, Kang L and Gao JB performed research; Huang WP, Gao G and Kang L analyzed data; Huang WP, Gao G and Kang L wrote the paper.
Supported by The Beijing Science Foundation for Distinguished Young Scholars, No. JQ21025.
Informed consent statement: Written informed consent for publication of clinical details and/or clinical images was obtained from the parents of the participant. A copy of the consent form is available for review by the Editor of the journal.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lei Kang, MD, PhD, Doctor, Pharmacist, Professor, Department of Nuclear Medicine, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China. kanglei@bjmu.edu.cn
Received: August 21, 2022
Peer-review started: August 21, 2022
First decision: September 26, 2022
Revised: September 28, 2022
Accepted: October 26, 2022
Article in press: October 26, 2022
Published online: November 26, 2022
Abstract
BACKGROUND

Nuclear protein in testis (NUT) carcinoma is a rare aggressive malignant epithelial cell tumor, previously known as NUT midline carcinoma (NMC), characterized by an acquired rearrangement of the gene encoding NUT on chromosome 15q14. Due to the lack of characteristic pathological features, it is often underdiagnosed and misdiagnosed. A variety of methods can be used to diagnose NMC, including immunohistochemistry, karyotyping, fluorescence in situ hybridization, reverse transcription-polymerase chain reaction, and next-generation sequencing. So far, there is no standard treatment plan for NMC and the prognosis is poor, related to its rapid progression, easy recurrence, and unsatisfactory treatment outcome.

CASE SUMMARY

A 58-year-old female came to our hospital with a complaint of eye swelling and pain for 8 d. The diagnosis of NMC was confirmed after postoperative pathology and genetic testing. The patient developed nausea and vomiting, headache, and loss of vision in both eyes to blindness after surgery. Magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) performed after 1.5 mo postoperatively suggested tumor recurrence. The patient obtained remission after radiation therapy to some extent and after initial treatment with anti-angiogenic drugs and sonodynamic therapy (SDT), but cannot achieve long-term stability and eventually developed distant metastases, with an overall survival of only 17 mo.

CONCLUSION

For patients with rapidly progressing sinus tumors and poor response to initial treatment, the possibility of NMC should be considered and immunohistochemical staining with anti-NUT should be performed as soon as possible, combined with genetic testing if necessary. CT, MRI, and PET/CT imaging are essential for the staging, management, treatment response assessment and monitoring of NMC. This case is the first attempt to apply heat therapy and SDT in the treatment of NMC, unfortunately, the prognosis remained poor.

Keywords: Nuclear protein in testis, Recurrence, Magnetic resonance imaging, Treatment, X-ray computed tomography, Positron emission tomography, Case report

Core Tip: This case demonstrates the aggressive and recurrence-prone biological behavior of nuclear protein in testis midline carcinoma (NMC). A variety of methods can be used to diagnose NMC, including immunohistochemistry, karyotyping, fluorescence in situ hybridization, reverse transcription-polymerase chain reaction, and next-generation sequencing. The patient achieved some degree of remission after radiation therapy and after initial treatment with anti-angiogenic drugs and sonodynamic therapy (SDT), but cannot achieve long-term stability and eventually developed distant metastases, with an overall survival of only 17 mo. This case is the first attempt to apply heat therapy and SDT in the treatment of NMC. Computed tomography (CT), Magnetic resonance imaging, and positron emission tomography/CT imaging are essential for the staging, management, treatment response assessment and monitoring of NMC.