Large Cell Poorly Differentiated Neuroendocrine Carcinoma of the Maxilla: An extremely Rare Tumor.

Neuroendocrine carcinomas are epithelial neoplasm with predominant neuroendocrine differentiation. Mostly they are found in gastrointestinal and respiratory system. In the nasal and paranasal sinus regions, squamous cell carcinoma is the most common tumor, followed by adenocarcinoma, malignant lymphoma, sinonasal undifferentiated carcinoma, and olfactory neuroblastoma. Large cell neuroendocrine carcinoma of head and neck region is extremely rare. Until now, very few cases of neuroendocrine tumors of paranasal sinuses have been documented. Compared to other organ systems, the neuroendocrine carcinoma involving sinuses are much more aggressive and with poor prognosis. The rarity of this carcinoma has restricted the understanding of its etiology and clinical outcome. We herein reporting a case of large cell poorly differentiated neuroendocrine tumor of maxilla with orbital extension with the purpose of analysis of the available information of this rare malignancy.

Extranodal Nasal NK/T-Cell Lymphoma: A Rare Oral Presentation and FASN, CD44 and GLUT-1 Expression

Extranodal natural killer (NK)/T-cell lymphoma is an aggressive malignant tumor with distinctive clinicopathological features, characterized by vascular invasion and destruction, prominent necrosis, cytotoxic lymphocyte phenotype and a strong association with Epstein-Barr virus. Here is reported an extranodal nasal NK/T-cell lymphoma case, involving the maxillary sinus, floor of the orbit, and interestingly extending to the oral cavity through the alveolar bone and buccal mucosa, preserving the palate, leading to a primary misdiagnosis of aggressive periodontal disease. Moreover, this work investigated for the first time the immunohistochemical expression of fatty acid synthase (FASN) and glucose transporter 1 (GLUT-1) proteins in this neoplasia. FASN showed strong cytoplasmatic expression in the neoplastic cells, whereas GLUT-1 and CD44 were negative. These findings suggest that the expression of FASN and the loss of CD44 might be involved in the pathogenesis of the extranodal nasal NK/T-cell lymphoma, and that GLUT-1 may not participate in the survival adaptation of the tumor cells to the hypoxic environment. Further studies with larger series are required to confirm these initial results.

O linfoma de células natural killers (NK)/T extranodal é um tumor maligno agressivo com características clinicopatológicas distintas, caracterizadas por invasão e destruição vasculares, necrose proeminente, fenótipo linfocítico citotóxico e uma forte associação com o vírus Epstein-Barr. Relatamos aqui um caso de linfoma de células NK/T nasal extranodal, envolvendo o seio maxilar, assoalho de órbita, e interessantemente estendendo-se para a cavidade oral através do osso alveolar e mucosa vestibular, preservando o palato, levando a um diagnóstico inicial equivocado de doença periodontal agressiva. Ainda, nós investigamos pela primeira vez a expressão imunoistoquímica das proteínas Fatty acid sinthase (FASN) e glucose transporter 1 (GLUT-1) nesta neoplasia. FASN revelou uma forte expressão citoplasmática nas células neoplásicas, enquanto GLUT-1 e CD44 foram negativas. Estes achados sugerem que a expressão de FASN e a perda de CD44 podem estar envolvidas na patogênese do linfoma de células NK/T nasal extranodal, e que GLUT-1 não deve participar da adaptação das células tumorais ao ambiente de hipóxia. Estudos adicionais com séries maiores são necessários para confirmar nossos resultados iniciais.

Myxoid type of malignant fibrous histiocytoma of the maxillary sinus: a case report

Myxofibrosarcoma was originally described as the myxoid variant of Malignant Fibrous Histiocytoma [MFH], a high-grade and aggressive sarcoma, which is very uncommon in the head and neck region, with about 100 cases reported up to now. MFH occurring in the maxillary sinus is so rare that only 23 cases have been reported. We hereby report a case of myxofibrosarcoma in the maxillary sinus. The case was a 54-year-old male with symptoms of toothache in the right posterior maxillary teeth, a swelling adjacent to maxillary molar region and symptoms of chronic maxillary sinusitis. In clinical examination, the teeth were sensitive to percussion and palpation, but no caries and restoration was detected on his molar teeth. He was suffering from local pain and tenderness over his midface and mild fever, fatigue and some nonspecific vague pain. CT scan showed a mass lesion involving right nasal cavity, maxillary and ethmoidal sinuses. A lowgrade malignancy arising from the right maxillary sinus was highly suspected. A surgery was done to remove the mass. The histological and immunohistochemical studies proved the diagnosis of myxoid variant of Malignant Fibrous Histiocytoma. Therefore radiotherapy and chemotherapy was started for the patient but six months later the symptoms returned and CT scan showed a right maxillary and ethmoidal mass that extended to base of the skull. Maxillectomy and ethmoidectomy were performed for the patient, but 2 months later he died because of the extension of the tumor, which confirmed the necessity of early diagnosis. Amplified radical surgery is the first choice of treatment. The second surgery has special value to the recurrent patients. Radiotherapy alone or chemotherapy alone is not effective to MFH of head and neck region

Carcinoid tumour of the maxillary sinus

Neuroendocrine carcinomas have been described in the larynx, lungs, middle ear and salivary glands. They represent a diverse spectrum of histological types with typical carcinoid at the benign end, atypical carcinoid in the middle, and small and large cell neuroendocrine carcinoma at full malignant. The purpose of this article is to describe and discuss the biologic behavior of a rare case of carcinoid tumour of the maxillary sinus. Many sinonasal neoplasms appear to be composed of small to medium sized cells that stain blue with conventional haematoxylin and eosin [H and E] stain. The category of round blue-cell tumour is quite large. Histological diagnosis using H and E alone pose a great challenge. The use of immunohistochemical or histochemical methods is an important tool that can be valuable in reaching the diagnosis as shown in the present case by grimelius histochemical method. In addition, the histological, radiological and clinical presentation of this tumour in the maxillary sinus denoted that the lesion had an aggressive biological behavior

Maxillary Sinus mucormycosis mimicking sinus malignancy

Mucormycosis is an opportunistic fulminant fungal infection in diabetic and immunocompromised patients. The infection is acquired in the nose and paranasal sinuses by the inhalation of the fungal spores. We report of a case of maxillary sinus mucormycosis in a 32-years-old non diabetic woman. She had right side facial pain, headache, unilateral right side nasal obstruction, and post nasal discharge [PND] for five years. Nasal endoscopy revealed pus and granulation tissue, and semi-black middle turbinate in right side nasal cavity. Computed tomography showed bone erosion and a large soft tissue mass similar to sinus carcinoma in maxillary sinus with extension into the ethmoidal sinus. She underwent functional Endoscopic sinus surgery. Macroscopically, the specimen consisted of multiple tissue fragment 0.8-1 cm. Microscopic findings included an inflammatory cells and deposited fungal elements [mucormycosis]. So in the paranasal sinus and nasal cavity mass, mucormycosis should be included in the differential diagnosis, especially in the non diabetic and young patients

Epistaxis and proptosis - unusual primary manifestations of metastatic renal cell carcinoma

Metastasis to the paranasal sinuses is rare presentation. We report a case of a patient with metastasis to the maxillary antrum from renal cell carcinoma

Odontogenic myxoma of the maxillary sinus in a Nigerian child - report of a case

A case of grossly disfiguring swelling of the right maxilla in a Nigerian girl with delayed presentation due to socio-economic factors is presented. A 15 year old girl presented with a right facial upper jaw swelling of six years duration. It was painless and progressive, with expansion into the right maxilla, zygoma and filling the maxillary antrum with an intra-oral extension and nasal obstruction. The CT scan revealed an expansive radiolucent mass of the right maxilla and the lesion was surgically excised completely via a right maxillectomy. The histolopathological features of the excised mass are consistent with fibrous dysplasia of the right maxilla which has undergone myxomatous degeneration. This case highlights the clinical, radiological and histological characteristics of this rare locally aggressive tumour that underwent myxomatous degeneration as a result of late presentation due to socio-ecnomic factors. More concerted efforts should be made to make the national health insurance scheme fully operational. This will make presentations at the hospitals not to be delayed thereby avoiding complications

Sinonasal verrucous carcinoma with oral invasion.

Verrucous carcinoma is a rare warty variant of squamous cell carcinoma, most often seen in the oral cavity and larynx. Its occurrence in the sinonasal tract is rare. This tumor constitutes approximately 1% of all sinonasal neoplasms. The clinical presentation and the histopathological features of verrucous carcinoma are a subject of continuous discussion amongst diagnosticians and pathologists. A case with oral and nasal presentation of this tumor is reported here.

A Hybrid Carcinoma of Epithelial-Myoepithelial Carcinoma and Adenoid Cystic Carcinoma in Maxillary Sinus

Hybrid carcinoma of the salivary gland is a very rare entity that has been described only in the parotid and palate. The occurrence of a hybrid carcinoma of maxillary sinus has not been reported. The diagnosis of hybrid carcinoma is important particularly when the components of tumor have different biologic behaviors. Diagnosis and treatment require a high index of suspicion, especially when the tumor is an epithelial-myoepithelial carcinoma, pathological effort to look for a more aggressive accompanying tumor, and proper oncologic treatment. We describe a case of 26-yrold woman with a hybrid carcinoma composed of epithelial-myoepithelial carcinoma with an adenoid cystic carcinoma component (cribriform pattern) in the right maxillary sinus with a brief review of the relevant literature.

Clear cell adenocarcinoma of the maxillary sinus: a case report.

A variety of salivary gland tumours histologically show the presence of clear cells. Clear cell adenocarcinoma of salivary glands (CCASG) is a distinct clinico-pathologic entity arising in the minor salivary glands of mainly the oral cavity in elderly women and having a low grade malignant potential. A case occurring in the maxillary sinus and extending to the nasal cavity is reported.

Linfomas extranodales de cabeza y cuello / Extranodal lymphoma of the head and neck

Antecedentes: Representan menos del 5 por ciento de todos los tumores malignos de cabeza y cuello y generalmente no son analizados en grandes series. Objetivo: Analizar la experiencia de 20 años en una sola institución sobre la base de una única clasificación y hallar variables pronósticas. Lugar de Aplicación: Hospital Público Municipal. Diseño: Retrospectivo. Población: 19 hombres y 17 mujeres con una edad media de 63,5 años: 64 por ciento en EI-II; 72 por ciento grado intermedio o alto. 44,4 por ciento localizados en el anillo de Waldeyer. El resto en tiroides, glándula salivales, cavidades oral y sinusonasal. Método: El tratamiento fue en base a quimio y/o radioterapia. La cirugía fue diagnóstica y constó de exéresis del órgano en 11 pacientes y biopsia en 25. Resultado: La tasa de recaída a 5 años fue 58,3 por ciento, la mortalidad global 55,5 por ciento y la específica 75 por ciento. El estadío actuó como factor pronóstico frente a la muerte y la recaída de la enfermedad. Conclusiones: El tratamiento es clínico. La cirugía debe limitarse al diagnóstico. El estadío fue la única variable pronóstica. La aparición de recaídas actúa como aceleradora de muerte. Las tasas de recaída y mortalidad a 5 años superan el 50 por ciento

Patrón de crecimiento y características imagenológicas de tumores malignos sinonasales / Growth pattern and imaging characteristics of malign synonasal neoplasms

Objetive: To describe the local and regional anatomical spread and growing pattern of the sinonasal malignant tumors based on pretreatment CT and MRI findings. Material, patients and methods: The current study was performed as a retrospective clinical series that includes 21 patients studied and treated in MD Anderson Cancer Center, Houston, Texas. Anatomical analisis was performed based in CT and MRI findings. Results: Here is described in detail the growing pattern of sinonasal malignancies and the corresponding secondarily affected structures. Conclusion: The sinonasal malignancies mainly affects elderly people, corresponding to carcinomas, arising frequently from the maxilary sinus that compromises the suprastructure and secondarily involves the pterigopalatine fossa, orbits and nasal cavity. Imaging based anatomical mapping of the tumoral spread leads the desition of resectability and focuses the attention in possible areas of recurrence

Osteomas of maxillary sinuses mimicking epidermoid cyst and sinusitis

Osteomas of maxillary sinuses mimicking epidermoid cyst and sinusitis

Actinomycosis mimicking carcinoma of the maxillary sinus.

Human actinomycosis may pose a diagnostic problem at times and is often mistaken for a neoplasm. A thirty-five year old male was clinically diagnosed as a case of carcinoma of the right maxillary sinus on the basis of history, clinical presentation and radiologic findings. Tissue biopsy was negative for malignancy on three consecutive occasions. Microscopic examination showed bits of granulation tissue and fragments of filamentous structures. On microbiological examination, Actinomyces israelii was isolated and fungus culture was negative. Long term Penicillin treatment caused disappearance of all signs and symptoms. The report highlights the importance of bearing in mind the fact that certain rare, chronic, suppurative granulomatous infections, like actinomycosis, may mimic malignancy.