# Sinonasal NUT-Midline Carcinoma – A Multimodality Approach to Diagnosis, Staging and Post-Surgical Restaging

## TL;DR

This paper presents a rare case of sinonasal NUT midline carcinoma diagnosed and staged using advanced imaging and molecular techniques.

## Contribution

The paper highlights a multimodal diagnostic approach for a rare and aggressive cancer with potential for misdiagnosis.

## Key findings

- NUT midline carcinoma was accurately diagnosed using CT and confirmed with molecular analysis.
- PET/CT and MRI were effective for staging and post-surgical restaging of the tumor.
- The case underscores the importance of integrating imaging and molecular diagnostics for accurate identification.

## Abstract

Nuclear protein testis (NUT) midline carcinoma is a rare malignancy involving predominantly the midline structures of the body. It is characterized by its genotypic feature of BRD4-NUT translocation, which is in contrast with other malignant processes that are usually categorized based on their histologic/phenotypic features. As these tumors may vary in their histologic presentation, they can be misdiagnosed as poorly differentiated carcinomas. Moreover, they are often very aggressive and associated with high mortality. Therefore, it is extremely important to diagnose them early using computed tomography (CT) and magnetic resonance imaging (MRI) and perform staging and restaging using 18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG PET/CT), in addition to accurately identifying them at a microscopic and molecular level. We report a unique case of a sinonasal NUT midline carcinoma that was diagnosed with CT, staged with PET/CT, and restaged using PET/CT and MRI.