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<p>Sinonasal adenocarcinomas (SNACs) are the second most common carcinoma category in the sinonasal tract after squamous cell carcinomas and include intestinal type adenocarcinoma, non-intestinal type adenocarcinomas and salivary-type adenocarcinomas. Improved morphologic and molecular characterization have established that most non-ITAC are phenotypically seromucinous with several provisional subtypes (<i>BRAF V600E</i>-mutated sinonasal ductal-like tumors, <i>MAPK/PI3-K</i> altered SNAC, <i>CTNNB1</i>-mutated sinonasal carcinoma, fusion-kinase associated SNAC e.g. <i>ETV6::NTRK3</i>, <i>FGFR-</i>rearranged biphasic SNAC). We report two biphasic/ bicellular (“oncocytic” and “basaloid”) SNACs, with multimodal omics characterization, to further underscore the biological complexity of these tumors. One oncocytic case showed <i>HRAS</i> and <i>AKT1</i> activating mutations; the other basaloid case had a <i>FGFR2::SORB3</i> fusion. Spatial transcriptomics revealed divergent intra- and inter-tumoral signatures emphasizing the transcriptomic heterogeneity within biphasic components.</p>

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Sinonasal biphasic seromucinous adenocarcinomas: a report of two morphologically distinct cases with multimodal omics characterization

  • 期刊论文

  • 发表日期：

    2026年5月4日

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  • Diana Bell,
  • Randal S. Weber,
  • Miao Zhang,
  • Michelle Afkhami,
  • Raja R. Seethala

摘要

Sinonasal adenocarcinomas (SNACs) are the second most common carcinoma category in the sinonasal tract after squamous cell carcinomas and include intestinal type adenocarcinoma, non-intestinal type adenocarcinomas and salivary-type adenocarcinomas. Improved morphologic and molecular characterization have established that most non-ITAC are phenotypically seromucinous with several provisional subtypes (BRAF V600E-mutated sinonasal ductal-like tumors, MAPK/PI3-K altered SNAC, CTNNB1-mutated sinonasal carcinoma, fusion-kinase associated SNAC e.g. ETV6::NTRK3, FGFR-rearranged biphasic SNAC). We report two biphasic/ bicellular (“oncocytic” and “basaloid”) SNACs, with multimodal omics characterization, to further underscore the biological complexity of these tumors. One oncocytic case showed HRAS and AKT1 activating mutations; the other basaloid case had a FGFR2::SORB3 fusion. Spatial transcriptomics revealed divergent intra- and inter-tumoral signatures emphasizing the transcriptomic heterogeneity within biphasic components.