A rare presentation of Sinonasal Undifferentiated Carcinoma with brain metastasis and para-aortic mass

Sinonasal Undifferentiated carcinoma (SNUC) comprises 3% of the head and neck tumors, including metastatic neoplasms. Herein we report the case of a 60-year-old male who was brought dead to our institute with previous records of a contrast-enhanced CT scan of the brain and MRI with evidence of tumor in the maxillary sinus with intracranial extensions. The histopathological examination of the mass in the maxillary sinus proved to be SNUC with metastases to the brain, lungs, and around the aorta. These tumors are undifferentiated and are distinct from other poorly differentiated tumors in deriving their origin from the Schneiderian epithelium. The aggressive nature of the tumor renders the prognosis quite dismal. SNUCs need to be early recognized and distinguished from other poorly differentiated carcinomas with the help of immunohistochemistry.

Hemangioma cavernoso gigante de seno maxilar: reporte de un caso y revisión de la literatura / Giant cavernous hemangioma of the maxillary sinus: case report and literature review

Los hemangiomas son neoplasias vasculares benignas que se presentan de preferencia en la región cervicofacial, siendo raros en las fosas nasales y excepcionales en los senos paranasales, con pocos casos reportados. Se presenta un paciente de sexo masculino y 33 años de edad, que consultó por obstrucción nasal, aumento de volumen maxilar y exoftalmo izquierdo de 2 años de evolución. La tomografía computada con contraste mostraba una masa hipodensa con realce anular del contraste en maxilar izquierdo, con extensión a la cavidad nasal, con destrucción del piso de la órbita y la pared anterior del seno maxilar. Se tomó biopsia que se informó como hemangioma cavernoso, por lo que fue manejado con embolización y escleroterapia arterial supraselectiva previa a la resección. Se realizó una maxilectomía subtotal por abordaje de Weber-Ferguson, sin recidiva al seguimiento a 15 meses. Además se comparan los hallazgos y el manejo de nuestro paciente con revisiones extranjeras.

Hemangiomas are benign vascular neoplasms that occur preferentially in the head and neck, being uncommon in the nasal cavities and exceptionally rare in the paranasal sinuses, with very few cases reported. We present the case of a 33 year old male, that consulted for nasal obstruction, maxillary enlargement and left exophthalmos of 2 years of evolution. Contrast enhanced computed tomography showed a hypódense mass with a ring enhanced lesion in the left maxilla, extending to the nasal cavity, with orbital floor and anterior wall of the maxillary sinus destruction. A biopsy sample was informed as cavernous hemangioma. Accordingly, it was treated by supraselective arterial embolization and sclerotherapy previous to surgical resection. A subtotal maxillectomy was performed following the Weber-Ferguson approach, with no recidives after a 15 month follow-up. In addition, we compare our findings and patient management with those reviewed in the literature.

Malignant peripheral nerve sheath tumour: an elusive diagnosis.

Malignant peripheral nerve sheath tumour (MPNST) also termed as spindle cell malignancy of the peripheral nerve Schwann cells or neurogenic sarcoma, represents approximately 10% of all soft tissue sarcomas. This tumour is usually found in the lower extremities and only 10-12% of all lesions occur in the head and neck region, which makes it a rare entity. The diagnosis of MPNST has been described as one of the most difficult and elusive diagnosis in the soft tissue diseases because of its non-specific presentation both clinically and histopathologically. This was overcome by the use of immunohistochemistry. A case of MPNST of the left maxillary antrum in a 45 -year -old male patient is reported.

Oncocytoma of maxillary sinus--a rare presentation.

A case of Oncocytoma of maxillary sinus in a 73 years old female is reported along with a brief review of literature. To the best of our knowledge this extremely rare tumor is the first of its kind reported in Nepal. Literature review has revealed only four such cases originating from maxillary sinus.

Pattern of local relapse of maxillary sinus carcinoma.

Maxillary sinus carcinoma (MSC) is a rare disease with a variety of treatment options. The present study was undertaken to review the outcome of patients with treated MSC in order to clarify the factors related to local recurrence by analyzing CT findings. The study group comprised of 47 cases, 40 males and 7 females with a median age of 61 years (range, 40- 84 years) treated between 1988 to 1996 at the department of radiotherapy. CT was taken with a slice thickness of 5 mm and contrast material was routinely used. The mean follow-up period for the group was 45.0 months (range, 3-125 months). The treatment policy was either preoperative radiotherapy of 40Gy/16fr followed by maxillectomy or radical radiotherapy of 65Gy/26fr with partial maxillectomy during the course of radiotherapy. By using CT-simulation, wedge pair techniques were used in most patients with Cobalt or 6MV X-ray machines as treatment sources. Tumor extension was categorized into the following anatomical sites: orbital contents, other paranasal sinuses, posterior wall of the maxillary sinus, pterygoid plate/muscle, nasopharynx, infra-temporal fossa, base of the skull, anterior wall of the maxillary sinus, subcutaneous tissue, cheek mucosa, hard palate and alveolar bone. Local control was computed by using the Kaplan-Meier method and p value was measured by using Chi-squared test. The 5-year overall local control rates for all patients were 56%. The local recurrence was found in 19 of 47 patients (40.4%). Tumors extending to pterygoid plates (n=13) and pterygoid muscles (n=10) showed higher rate of local recurrences as compared to those without extensions (9/13 [69%] vs 10/34 [29%], p<0.02 and 7/10 [70%] vs 12/37 [32%], p<0.05, respectively). Extensions to nasopharynx (6/9, 66%) and base of skull (4/6, 66%) also showed higher rates of recurrence; however, those were not statistically significant. More than 80% of the relapse became manifest within 12 months of diagnosis and isolated local failure was the most common pattern. This analysis indicates that tumor extension to pterygoid plate/muscles, results in higher rates of recurrences. This may due to the difficult surgical accessibility of the tumor. During radiotherapy planning, special emphasis should be given to this sites of tumor extension to avoid possible local recurrence.

Case reports of basaloid squamous cell carcinoma--an aggressive variant of squamous cell carcinoma.

Basaloid squamous cell carcinoma (BSCC) is a high grade variant of Squamous Cell Carcinoma with a predilection for the aero-digestive tract. The typical microscopic features of carcinoma with a basaloid pattern in intimate association with a squamous component helps in diagnosis of this tumour. There are few reports in the Indian literature and we report three cases, including one in the sinonasal region. This study discusses the differential diagnosis of BSCC, as recognition of this tumour may have therapeutic implications.

Unusual presentation of nasopharyngeal (juvenile) angiofibroma in a 45 year old female.

Juvenile nasopharyngeal angiofibroma is a rare tumour, comprising 0.05% of the head and neck tumours, histologically benign, locally invasive, and has a specific predilection for nasopharynx and adolescent males. This article presents an unusual case of nasopharyngeal angiofibroma in a 45-year-old female patient, manifesting as a destructive maxillary lesion and discusses the two most important factors regarding this tumour, the etio-pathogenesis and spread.

Cavernous hemangioma of the maxillary antrum

Hemangiomas of the maxillary antrum are rare lesions. The possibility of severe hemorrhage after surgical intervention makes these lesions potentially dangerous. Experience in successful treatment of a patient with hemangioma [peripheral, cavernous type] of the maxillary antrum prompts the report of the case and a review of the medical literature. The clinicopathological aspects and mode of treatment are also discussed

Schwannoma do seio maxilar: relato de caso / Schwannoma of maxillary sinus: a case report

Os autores relatam um caso de Schwannoma do seio maxilar e fazem uma pequena revisäo da literatura, abordando alguns aspectos conceituais, bem como a incidência, sintomatologia, dificuldades de diagnóstico, tratamento e prognóstico desta neoplasia

Cholesteatoma of the maxillary antrum

A rare case of cholesteatoma of the maxillary antrum with review of literature is reported. It's clinical course and management is discussed briefly