Figure 1: Computed tomography scan of head and neck (A) Axial section showing a lobulated soft tissue mass lesion epicentered in left nasal cavity extending into left maxillary sinus with intra-orbial and anterior cranial fossa infiltration and (B) Coronal section showing enlarged left cervical and supraclavicular lymph-nodes

Figure 2: Biopsy from paranasal sinus mass (A) Showing abundant small blue cells with scattered rhabdomyoblasts (H & E 200 X). Immunohistochemistry (IHC) stained positive for (B) Desmin (400 X) and (C) Myogenin (400 X)

Figure 3: (A) Patient on presentation with left facial and neck swelling and (B) Patient after induction chemotherapy and radiotherapy with significant resolution of facial and neck swellings

Figure 4: The patient with loco-regional recurrence within 14 weeks post-surgery with swelling of left side face and proptosis

Figure 5: CT scan of the patient showing vertebral metastasis (yellow pointer)