According to Il Mattino, the Scotland international remains a long way from agreeing fresh terms, and Napoli have no intention of allowing his current contract, which expires in 2028, to run down without clarity over his future.
The most striking element of the report is the suggestion that the club could be open to a sale in the upcoming winter window if no progress is made on an extension before then.
At the heart of the impasse is a significant gap over wages. McTominay is said to be seeking a salary increase to around €6.5m net per season, a figure that has made an agreement difficult to reach so far.
Sporting director Giovanni Manna has publicly acknowledged the difficulty of the negotiations, even as he maintains that extending the midfielder's contract remains a priority for the club.
No further meetings between Napoli and McTominay's representatives are currently scheduled. The club's position, however, appears clear: they want to avoid reaching the final year of his deal without having resolved his future one way or another.
Should an extension not materialise, a sale in the summer of 2027 would become a realistic scenario, though an earlier departure in January has not been ruled out either, particularly if substantial offers arrive once the player has fully recovered from a recent heart procedure.
McTominay underwent an ablation to resolve a benign arrhythmia, choosing to have the operation carried out in England, close to his home in Manchester, so he could recover surrounded by family.
Manna has said the midfielder faces around five weeks of rest and rehabilitation before returning to full training, with a strict no-contact period built into his recovery protocol, meaning his effective return is unlikely before the international break has passed.
The uncertainty over his contract comes despite McTominay's central role in Napoli's title-winning campaign last season, in which he established himself as one of the most influential midfielders in Serie A following his €30.5m move from Manchester United.
With his medical situation now the immediate priority, the question of his long-term future is likely to remain unresolved for some time yet, leaving supporters facing the prospect of losing one of their most important players within the next 12 months if talks do not soon find fresh momentum.