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Endgames Spot Diagnosis

Unilateral bloodstained nasal discharge

BMJ 2020; 368 doi: (Published 26 March 2020) Cite this as: BMJ 2020;368:m9
  1. Zhenxiao Huang, consultant otolaryngologist,
  2. Qian Huang, consultant rhinologist
  1. Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Qian Huang qian_ner{at}

A man in his 40s presented with six months of bloodstained nasal discharge from his right nostril. Nasal endoscopy showed purulent bloodstained nasal discharge in the right nasal cavity and a mass with an irregular friable appearance in the right middle meatus of the right nasal cavity; the appearance of the septum and left nasal cavity was normal. He underwent a non-contrast computed tomography scan of his sinuses (fig 1).

Fig 1

Computed tomography scan of the sinuses shown in the coronal plane

Biopsy showed cytoplasmic keratinisation, intercellular bridges, and keratin pearls.

What is the most likely diagnosis?


Sinonasal squamous cell …

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