Sinonasal teratocarcinosarcoma of the ethmoid and paranasal sinus: A rare neoplasm
A 60-year-old man presented with occasional bleeding from nose and nasal obstruction for last two months. He also had generalized weakness and episodic headache. His hemoglobin level was 11.7 gm/dl at the time of presentation. Other routine hematological and biochemical investigations were normal. X ray of paranasal sinus showed a mass in the posterior nasal cavity. A computed tomography (CT) scan revealed a solid tumor with isodensity. The mass was in the posterior nasal cavity and nasopharyngeal wall extending into left ethmoidal sinus []. Diagnostic imaging suspected of sinonasal malignancies such as poorly differentiated carcinoma, adenocarcinoma, and malignant lymphoma.\nThe patient was operated with all antiseptic measures under general anesthesia during Caldwell-Luc operation. Cheek was retracted and an incision was made above the canine teeth in the buccogingival sulcus. It was about 3-5 cm long and was placed high enough to prevent damage to the dental roots. A part of the anterior wall of left antrum was removed with a chisel and hammer to make an opening allowing an access into the antral cavity. The mass was removed with Luc's forceps. An intranasal antrostomy was done. The wound was sutured with absorbable catgut suture. The specimen was sent for biopsy. Multiple gray-white tissue bits, largest measuring 3.5 × 3 × 2.5 cm received grossly for histopathological examination. Microscopically, the tumor mass showed variegated histologic architecture. Benign and malignant components of epithelial and mesenchymal tissues were detected. The epithelial portion of the tumor was composed of benign and malignant squamous epithelium, glandular structure, and primitive neuroectodermal/blastemal cells [ and ]. Clear cell squamous epithelia were present in the epithelial component of the neoplasm. Teratoid components included this "fetal appearing" clear cell squamous epithelium and primitive neuroectodermal/blastemal cells. In the mesenchymal components; spindle cell sarcoma was noted []. Many mitoses including atypical cells were detected. MIB1 (Ki 67) positivity was detected in 25% of the mesenchymal components and 37% of the epithelial components of the malignant tumor, whereas the clear cell epithelia revealed MIB1 (Ki67) positivity in 5% of cells. Patient was treated with radiotherapy (60 Gy) followed by surgery. A whole body CT scan was done at six months interval to detect any recurrence or metastasis. Follow-up examination for two years after combined surgery and radiotherapy has shown no evidence of recurrence or metastasis.