Supplementary Material for: Dissenting an uncommon diagnosis at unusual origin: A case Report of Teratocarcinosarcoma of Sinonasal Cavity-A Rare Malignancy

Introduction: Teratocarcinosarcoma is an extremely rare and aggressive malignancy of the nasal cavity and paranasal sinuses, comprising epithelial, mesenchymal, and neuroectodermal components. Due to its aggressive behavior, early diagnosis and a multimodal treatment approach are essential for improving outcomes. Case Presentation: We report the case of a 55-year-old male who presented with bilateral nasal discharge, recurrent epistaxis, progressive nasal swelling, and left-sided epiphora over several months. Clinical examination revealed a grade III reddish, polypoidal mass with nasal obstruction and palpable cervical lymph nodes. Imaging showed a destructive mass involving the nasal cavity and adjacent sinuses. Histopathology and immunohistochemistry confirmed the diagnosis of teratocarcinosarcoma. Surgical resection via lateral rhinotomy and medial maxillectomy, followed by radiotherapy and chemotherapy, led to significant regression of the tumor. Conclusion: This case underscores the importance of timely diagnosis and a multidisciplinary treatment approach in managing aggressive sinonasal malignancies like teratocarcinosarcoma.