Adenoid cystic carcinoma (ACC) is the most common malignant tumor of the minor salivary glands. The sinonasal tract is a common site of ACC occurrence, second only to the oral cavity. Of all cases of sinonasal ACC, a minority (22 to 35%) arise in the nasal cavity. Three histologic patterns of ACC have been described: cribriform, tubular, and solid. Compared with the cribriform and tubular forms, predominantly solid-type ACCs have been associated with higher rates of perineural invasion, higher S-phase fractions, and a higher incidence of aneuploidy. The histologic differentiation of solid-pattern ACC from other sinonasal malignancies typically requires the identification of one or both of the other ACC patterns in the same specimen. We present the case of a 39-year-old man with solid-pattern ACC arising in the nasal cavity. The tumor was resected endoscopically. We also discuss the relevant literature regarding the histologic diagnosis, prognosis, and treatment options for solid-pattern ACC.