Two weeks after the operation, extensive granulation tissue was foundin the right nasal cavity and immediately removed. The patient was instructedto clean the nasal cavity daily with isotonic sodium chloride solution. Nineweeks after the operation, a 2 × 1-cm mass was noticed at the medialcanthal area (Figure 1). The dacryocystorhinostomysite was blocked. Computed tomography revealed a large mass in the lacrimalsac, extending from the medial orbit and the nasal cavity through the osteotomy(Figure 2). An incisional biopsyfrom the right nasal mass was performed, and a 3 × 5 × 2-mm specimenof firm, reddish tissue was submitted for histopathologic evaluation. Microscopicexamination revealed 2 large, well-defined, irregular round lobules surroundedby fibroinflammatory connective tissue. The tumor was composed of solid sheetsof large round and polygonal cells with hyperchromatic nuclei and prominentnucleoli (Figure 3). Many cellshad vacuolated cytoplasm and periodic acid-Schiff–positive cytoplasmicgranules. A central area of necrosis was present in one of the lobules (Figure 4). One mitotic figure was presentin 40 high-power fields. There was moderate polymorphonuclear infiltration.No vascular invasion was observed. Special stains for mucin were negative.Immunohistochemical staining showed a positive epithelial marker for cytokeratin(AE1/ AE3) (Figure 5), but negativemarkers for leukocyte common antigen (lymphoid), S100 protein (melanocytic),desmin (muscle), and neuron-specific enolase (neuroendocrine). The sectionstained for HMB45 had no tumor present. In situ hybridization for Epstein-Barrvirus–encoded RNAs was negative. The pathologic diagnosis of SNUC wasconfirmed through consultation with William R. Green, Eye Pathology Laboratory,Johns Hopkins Hospital (Baltimore, Md).