When Two Lives Are at Stake: Sinonasal Adenoid Cystic Carcinoma During Pregnancy

Sinonasal malignancies during pregnancy present unique diagnostic and therapeutic challenges due to their rarity and nonspecific clinical presentation. This case describes a 28-year-old primigravida patient at 32 weeks of gestation, who presented with left-sided nasal obstruction, epistaxis, and facial swelling. Clinical evaluation, imaging, and histopathology confirmed adenoid cystic carcinoma of the left maxillary sinus. Given the advanced disease stage, a multidisciplinary team opted for conservative management until fetal viability was ensured. At 35 weeks and 3 days of gestation, the patient underwent an emergency cesarean section, delivering a healthy neonate. Postpartum, she underwent left total maxillectomy, followed by adjuvant radiotherapy and five cycles of intravenous cisplatin chemotherapy. Long-term follow-up demonstrated stable disease, with minor speech difficulties and adequate oral intake. This case highlights the importance of early recognition, individualized treatment strategies, and multidisciplinary collaboration in managing malignancies during pregnancy, while balancing maternal prognosis and fetal safety. Further research is needed to establish standardized treatment guidelines for rare malignancies in pregnancy.