Sinonasal teratocarcinosarcoma: report of a case with review of literature and treatment outcome
Shi Wei, William Carroll, Audrey Lazenby, Walter Bell, Robert Lopez, Nasser Said-Al-Naief
Sinonasal teratocarcinosarcoma is a highly malignant, polymorphous neoplasm that combines features of carcinosarcoma and teratoma. We describe the clinicopathologic features and management of a well-documented example of this unique entity that involved a 41-year-old Hispanic man. The patient presented with a history of multiple episodes of epistaxis, nasal obstruction and frontal headaches. Computerized tomography scans and magnetic resonance imaging revealed a large mass filling the left nasal cavity and extending to the cribriform plate with involvement of the ethmoid sinuses, lamina papyracea, and orbit. The patient underwent a complex procedure for a T3N0 tumor. Histologic examination revealed a heterogeneous admixture of epithelial, mesenchymal, and neuroepithelial elements. The mesenchymal components consist of fibrous stroma and myxomatous areas, labeled with calponin and smooth muscle actin. The epithelial components vary from clear cells, nonkeratinizing epithelium to glandular pattern, and keratin containing cysts. Immature neuroepithelium and olfactory neuroblastomalike tissue are highlighted with neuroendocrine markers. Postoperatively, the patient had a rapid local recurrence of the tumor and underwent reexcision, and was treated with radiotherapy and chemotherapy. Twelve months after his primary resection, computerized tomography scans revealed an intrathoracic tumor with dominant mass in the left hilum and metastases to the mediastinum, left pleural space, and both lungs. The histologic nature of his chest mass remains undetermined. Among 54 cases of reported sinonasal teratocarcinosarcoma, 67% of patients with initial single surgical resection and 80% of patients primarily treated with radiotherapy had recurrence, or metastatsis, or unresponsiveness to treatment. The high rate of local recurrence and metastasis is indicative of its highly aggressive biologic behavior. Almost half of the patients died of tumor within 3 years of diagnosis, despite aggressive therapy. Seventy percent of the patients who survived more than 1 year had the initial therapeutic regiments of combined surgery and adjuvant therapies, suggesting that aggressive therapeutic approaches may improve the treatment outcome.
Annals of Diagnostic Pathology
https://doi.org/10.1016/j.anndiagpath.2007.05.003
Head and neck pathology
Sinonasal pathology
Teratocarcinosarcoma
10.1016/j.anndiagpath.2007.05.003
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Malignant Teratocarcinosarcoma Medicine & Life Sciences 100%
Recurrence Medicine & Life Sciences 12%
Ethmoid Bone Medicine & Life Sciences 10%
calponin Medicine & Life Sciences 10%
Ethmoid Sinus Medicine & Life Sciences 10%
Radiotherapy Medicine & Life Sciences 9%
Tomography Medicine & Life Sciences 9%
Wei, S., Carroll, W., Lazenby, A., Bell, W., Lopez, R., & Said-Al-Naief, N. (2008). Sinonasal teratocarcinosarcoma: report of a case with review of literature and treatment outcome. Annals of Diagnostic Pathology, 12(6), 415-425. https://doi.org/10.1016/j.anndiagpath.2007.05.003
Sinonasal teratocarcinosarcoma : report of a case with review of literature and treatment outcome. / Wei, Shi; Carroll, William; Lazenby, Audrey; Bell, Walter; Lopez, Robert; Said-Al-Naief, Nasser.
In: Annals of Diagnostic Pathology, Vol. 12, No. 6, 12.2008, p. 415-425.
Wei, S, Carroll, W, Lazenby, A, Bell, W, Lopez, R & Said-Al-Naief, N 2008, 'Sinonasal teratocarcinosarcoma: report of a case with review of literature and treatment outcome', Annals of Diagnostic Pathology, vol. 12, no. 6, pp. 415-425. https://doi.org/10.1016/j.anndiagpath.2007.05.003
Wei S, Carroll W, Lazenby A, Bell W, Lopez R, Said-Al-Naief N. Sinonasal teratocarcinosarcoma: report of a case with review of literature and treatment outcome. Annals of Diagnostic Pathology. 2008 Dec;12(6):415-425. https://doi.org/10.1016/j.anndiagpath.2007.05.003
Wei, Shi ; Carroll, William ; Lazenby, Audrey ; Bell, Walter ; Lopez, Robert ; Said-Al-Naief, Nasser. / Sinonasal teratocarcinosarcoma : report of a case with review of literature and treatment outcome. In: Annals of Diagnostic Pathology. 2008 ; Vol. 12, No. 6. pp. 415-425.
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title = "Sinonasal teratocarcinosarcoma: report of a case with review of literature and treatment outcome",
abstract = "Sinonasal teratocarcinosarcoma is a highly malignant, polymorphous neoplasm that combines features of carcinosarcoma and teratoma. We describe the clinicopathologic features and management of a well-documented example of this unique entity that involved a 41-year-old Hispanic man. The patient presented with a history of multiple episodes of epistaxis, nasal obstruction and frontal headaches. Computerized tomography scans and magnetic resonance imaging revealed a large mass filling the left nasal cavity and extending to the cribriform plate with involvement of the ethmoid sinuses, lamina papyracea, and orbit. The patient underwent a complex procedure for a T3N0 tumor. Histologic examination revealed a heterogeneous admixture of epithelial, mesenchymal, and neuroepithelial elements. The mesenchymal components consist of fibrous stroma and myxomatous areas, labeled with calponin and smooth muscle actin. The epithelial components vary from clear cells, nonkeratinizing epithelium to glandular pattern, and keratin containing cysts. Immature neuroepithelium and olfactory neuroblastomalike tissue are highlighted with neuroendocrine markers. Postoperatively, the patient had a rapid local recurrence of the tumor and underwent reexcision, and was treated with radiotherapy and chemotherapy. Twelve months after his primary resection, computerized tomography scans revealed an intrathoracic tumor with dominant mass in the left hilum and metastases to the mediastinum, left pleural space, and both lungs. The histologic nature of his chest mass remains undetermined. Among 54 cases of reported sinonasal teratocarcinosarcoma, 67% of patients with initial single surgical resection and 80% of patients primarily treated with radiotherapy had recurrence, or metastatsis, or unresponsiveness to treatment. The high rate of local recurrence and metastasis is indicative of its highly aggressive biologic behavior. Almost half of the patients died of tumor within 3 years of diagnosis, despite aggressive therapy. Seventy percent of the patients who survived more than 1 year had the initial therapeutic regiments of combined surgery and adjuvant therapies, suggesting that aggressive therapeutic approaches may improve the treatment outcome.",
keywords = "Head and neck pathology, Sinonasal pathology, Teratocarcinosarcoma",
author = "Shi Wei and William Carroll and Audrey Lazenby and Walter Bell and Robert Lopez and Nasser Said-Al-Naief",
doi = "10.1016/j.anndiagpath.2007.05.003",
journal = "Annals of Diagnostic Pathology",
publisher = "W.B. Saunders Ltd",
T1 - Sinonasal teratocarcinosarcoma
T2 - report of a case with review of literature and treatment outcome
AU - Wei, Shi
AU - Carroll, William
AU - Lazenby, Audrey
AU - Bell, Walter
AU - Lopez, Robert
AU - Said-Al-Naief, Nasser
N2 - Sinonasal teratocarcinosarcoma is a highly malignant, polymorphous neoplasm that combines features of carcinosarcoma and teratoma. We describe the clinicopathologic features and management of a well-documented example of this unique entity that involved a 41-year-old Hispanic man. The patient presented with a history of multiple episodes of epistaxis, nasal obstruction and frontal headaches. Computerized tomography scans and magnetic resonance imaging revealed a large mass filling the left nasal cavity and extending to the cribriform plate with involvement of the ethmoid sinuses, lamina papyracea, and orbit. The patient underwent a complex procedure for a T3N0 tumor. Histologic examination revealed a heterogeneous admixture of epithelial, mesenchymal, and neuroepithelial elements. The mesenchymal components consist of fibrous stroma and myxomatous areas, labeled with calponin and smooth muscle actin. The epithelial components vary from clear cells, nonkeratinizing epithelium to glandular pattern, and keratin containing cysts. Immature neuroepithelium and olfactory neuroblastomalike tissue are highlighted with neuroendocrine markers. Postoperatively, the patient had a rapid local recurrence of the tumor and underwent reexcision, and was treated with radiotherapy and chemotherapy. Twelve months after his primary resection, computerized tomography scans revealed an intrathoracic tumor with dominant mass in the left hilum and metastases to the mediastinum, left pleural space, and both lungs. The histologic nature of his chest mass remains undetermined. Among 54 cases of reported sinonasal teratocarcinosarcoma, 67% of patients with initial single surgical resection and 80% of patients primarily treated with radiotherapy had recurrence, or metastatsis, or unresponsiveness to treatment. The high rate of local recurrence and metastasis is indicative of its highly aggressive biologic behavior. Almost half of the patients died of tumor within 3 years of diagnosis, despite aggressive therapy. Seventy percent of the patients who survived more than 1 year had the initial therapeutic regiments of combined surgery and adjuvant therapies, suggesting that aggressive therapeutic approaches may improve the treatment outcome.
AB - Sinonasal teratocarcinosarcoma is a highly malignant, polymorphous neoplasm that combines features of carcinosarcoma and teratoma. We describe the clinicopathologic features and management of a well-documented example of this unique entity that involved a 41-year-old Hispanic man. The patient presented with a history of multiple episodes of epistaxis, nasal obstruction and frontal headaches. Computerized tomography scans and magnetic resonance imaging revealed a large mass filling the left nasal cavity and extending to the cribriform plate with involvement of the ethmoid sinuses, lamina papyracea, and orbit. The patient underwent a complex procedure for a T3N0 tumor. Histologic examination revealed a heterogeneous admixture of epithelial, mesenchymal, and neuroepithelial elements. The mesenchymal components consist of fibrous stroma and myxomatous areas, labeled with calponin and smooth muscle actin. The epithelial components vary from clear cells, nonkeratinizing epithelium to glandular pattern, and keratin containing cysts. Immature neuroepithelium and olfactory neuroblastomalike tissue are highlighted with neuroendocrine markers. Postoperatively, the patient had a rapid local recurrence of the tumor and underwent reexcision, and was treated with radiotherapy and chemotherapy. Twelve months after his primary resection, computerized tomography scans revealed an intrathoracic tumor with dominant mass in the left hilum and metastases to the mediastinum, left pleural space, and both lungs. The histologic nature of his chest mass remains undetermined. Among 54 cases of reported sinonasal teratocarcinosarcoma, 67% of patients with initial single surgical resection and 80% of patients primarily treated with radiotherapy had recurrence, or metastatsis, or unresponsiveness to treatment. The high rate of local recurrence and metastasis is indicative of its highly aggressive biologic behavior. Almost half of the patients died of tumor within 3 years of diagnosis, despite aggressive therapy. Seventy percent of the patients who survived more than 1 year had the initial therapeutic regiments of combined surgery and adjuvant therapies, suggesting that aggressive therapeutic approaches may improve the treatment outcome.
KW - Head and neck pathology
KW - Sinonasal pathology
KW - Teratocarcinosarcoma
U2 - 10.1016/j.anndiagpath.2007.05.003
DO - 10.1016/j.anndiagpath.2007.05.003
JO - Annals of Diagnostic Pathology
JF - Annals of Diagnostic Pathology