Figure 1 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
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Axial section of computed tomography demonstrates a massive tumor occupying the left nasal cavity and maxillary sinus and destroying the nasal bones including bowing of the nasal septum on the affected side.
Source publication
Patient: Male, 72-year-old
Final Diagnosis: Sarcomatoid carcinoma arising from inverted papilloma
Symptoms: Nasal mass • nasal obstruction
Medication: —
Clinical Procedure: Excsion
Specialty: Pathology
Objective
Challenging differential diagnosis
Background
Carcinosarcoma of the sinonasal tract is an extremely rare malignant neoplasm; it is often...
Context in source publication
Citations
... 3 Sinonasal carcinosarcomas typically have a rapid growth, extensive local destruction and high recurrence rate. 4,5 Sinonasal carcinosarcomas are most commonly diagnosed in elderly individuals and are slightly more common in men than women. 6 The exact cause of sinonasal carcinosarcoma is not yet known, but it is believed to be associated with exposure to certain environmental toxins such as wood dust, leather dust and textile fibers. ...
Carcinosarcoma is an extremely rare neoplasm in the nasal cavity and in the paranasal sinus, with rapid growth and extensive local destruction. We report a case of a 61-year-old man with progressive left-side nasal obstruction and epiphora for six months. Imaging showed a massive mass lesion, mainly located in the left nasal cavity and ethmoid sinus, with no intracranial or orbital extension. Biopsy of the nasal mass revealed a poorly-differentiated squamous cell carcinoma associated with sarcomatous elements. Patient underwent an endoscopic transnasal resection. Definitive histopathologic analysis revealed a carcinosarcoma. Postoperative radiotherapy was, then, performed. After five years of follow-up, there is no evidence of tumor recurrence. This report highlights that even though despite the lack of optimal treatment protocol, long term disease control can be achieved through endoscopic transnasal resection complemented with radiotherapy.
... Histologically, carcinosarcoma has been classified as part of the sarcomatoid carcinoma spectrum, most of which occur in elderly patients (sixth to seventh decade) with a slight male predominance. Other risk factors include a history of smoking tobacco, alcohol consumption, and radiation exposure [1]. In the head and neck region, carcinosarcomas are most commonly found in the oral cavity (63.0%), larynx (17.5%), oropharynx/hypopharynx (11.7%), and esophagus (2.8%) [2]. ...
We report a case of a 62-year-old man with epistaxis and right-sided nasal obstruction. Nasal endoscopy revealed an exophytic mass arising from the anterior septum that extended posteriorly to the osteo-meatal complex. Excision with endoscopic sinus surgery was performed. Carcinosarcoma was diagnosed based on histopathology and immunohistochemical studies. The patient declined surgery and opted for chemoradiation therapy for the residual tumor. Six weeks after completion of the treatment, clinical resolution of the right nasal mass was noted. Carcinosarcomas are rare and rapidly growing tumors that have a high recurrence rate and are associated with poor patient prognosis. This report emphasizes the need for patients with prolonged nasal obstruction and epistaxis to consult otolaryngologists and undergo nasal endoscopy for definitive diagnosis and appropriate treatment.
Background
Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represents a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology‐based topics spanning the field.
Methods
In accordance with prior ICAR documents, ICSNT assigned each topic as an Evidence‐Based Review with Recommendations, Evidence‐Based Review, and Literature Review based on level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses format, and completed sections underwent a thorough and iterative consensus‐building process. The final document underwent rigorous synthesis and review prior to publication.
Results
The ICNST document consists of 4 major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology‐based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention.
Conclusion
As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.
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Objectives
Sarcomatoid carcinoma (SC) is rare in the sinonasal cavity with poor prognosis. This study aimed to summarize the clinical characteristics, treatment and prognosis of patients with sinonasal SC from a single tertiary medical center.
Methods
Retrospective review of the clinical data of seven patients diagnosed with sinonasal SC from May 1988 to February 2021.
Results
Seven patients with SC in nasal cavity and paranasal sinus, including six males and one female, aged 34-77 years (mean, 58.3 years), were included in this case series. The common presenting symptoms included epistaxis and nasal obstruction. The tumor usually occurred in nasal cavity, maxillary sinus and ethmoid sinus. Most patients were diagnosed at advanced stages with the involvement of orbit and skull base. Open and endoscopic surgery were performed in five and two patients, respectively. The follow-up period ranged from 3 to 26 months. Four patients died of disease within one year, though two received adjuvant chemotherapy and one received radiotherapy. Two patients survived without recurrence at the end of follow-up, both of them underwent adjuvant radiotherapy. One patient received palliative re-irradiation due to local recurrence of the tumor three months after the surgery, however, this patient was lost to follow-up.
Conclusions
Sinonasal SC is a rare entity with an aggressive behavior and poor prognosis. Early diagnosis and multimodality treatment are recommended to improve the survival.
