DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20171213

Sinonasal teratocarcinosarcoma: is minimally invasive resection followed by adjuvant histology directed chemo-radiation a better alternative to radical excision? Case report

N. Dhaneshwar Singh, Kanwar Sen, Arun Sharma, Meenakshi Bharadwaj

Abstract


Sinonasal teratocarcinosarcoma (SNTCS) is a rare higly malignant tumour occuring almost exclusively in the sinonasal tract. This aggressive tumour arising from the primitive embryonic or immature pluripotential cells of olfactory epithelium has high propencity for loco-regional recurrence and mortality. SNTCS generally presents with relatively benign symptoms like nasal obstruction and recurrent epistaxis in its early stage. In advance stage with orbital and intracranial spread other symptoms raising suspicion of malignancy, such as dysphagia, odynophagia, epiphora, vision loss, exophthalmos, anosmia, headache and altered sensorium appears. In view of its aggressive behaviour, radical excision with or without chemoradiation is advocated as the optimum treatment. Local recurrence of SNTCS after excision has been reported as high as 45% with a mean recurrence time of 21.3 months. Even though distant metastasis is rare, local recurrence frequently leads to treatment failure and subsequent death. Here we share our experience of SNTCS in a 23 year old male managed with endoscopic craniofacial resection followed by histocytology directed chemotherapy with external beam radiation. He remains disease free in last 3 years of follow up.

 


Keywords


Sinonasal teratocarcinosarcoma, Teratoid carcinosarcoma, Olfactory neuroblastoma, Nasal mass

Full Text:

PDF

References


Heffner DK, Hyams VJ. Teratocarcinosarcoma (malignant teratoma?) of the nasal cavity and paranasal sinuses. A clinicopathologic study of 20 cases. Cancer. 1984;53:2140-54.

Budrukkar A, Agarwal JP, Kane S, Siddha M, Laskar SG, Pai P, et al. Management and clinical outcome of sinonasalteratocarcinosarcoma: single institution experience. J LaryngolOtol. 2010;124:739-43.

Kane S V, Karpate AA, Bal M, Juvekar SL, Pai PS. Chemotherapy-induced neuronal maturation in sinonasalteratocarcinosarcoma—a unique observation. Head Neck Pathol. 2009;3:31-6.

Pai SA, Naresh KN, Masih K, Ramarao C, Borges AM, Path FRC. Teratocarcinosarcoma of the paranasal sinuses: a clinicopathologic and immunohistochemical study. Hum Pathol. 1998;29:718–22.

Smith SL, Hessel AC, Luna MA, Malpica A, Rosenthal DI, El-Naggar AK. Sinonasal teratocarc-inosarcoma of the head and neck: a report of 10 patients treated at a single institution and comparison with reported series. Arch Otolaryngol Head Neck Surg. 2008;134(6):592-5.

Zainul AS, Shabbir A, Montasir J, Iftikhar S. Sinonasal Teratocarcinosarcoma. J pak med assoc. 2012;62(6):633-5.

Wei S, Carroll W, Lazenby A, Bell W, Lopez R, Said-Al-Naief N. Sinonasal teratocarcinosarcoma: report of a case with review of the literature and treatment outcome. Ann Diagn Pathol. 2008;12:415-25.

Sharma HS, Abdullah JM, Othman NH, Muhamad M. Teratocarcinosarcoma of the nasal cavity and ethmoid. J Laryngol Otol. 1998;112:682-6.

Nitsche M, Hermann R, Christiansen H, Berger J, Pradier O. Rationale for individualized therapy in Sinonasal Teratocarcinosarcoma (SNTC): case report. Onkologie. 2005;28(12):653-6.