Paranasal sinus rhabdomyosarcoma: a rare tumor of poor prognosis

The magnetic resonance characteristics of sinonasal rhabdomyosarcoma in adults: analysis of 27 cases and comparison with pathological subtypes

BACKGROUND

Sinonasal rhabdomyosarcoma (RMS) in adults is extremely rare, and early diagnosis and treatment are crucial to improve the patient's prognosis. The purpose of this study was to evaluate the magnetic resonance imaging (MRI) findings of sinonasal RMS in adults and analyze the correlations between the imaging features and pathological subtypes.

METHODS

We reviewed 27 patients with pathologically proven RMS of the nasal cavity and paranasal sinuses, including embryonal RMS (ERMS) in 14 patients, alveolar RMS (ARMS) in seven patients, and mixed-type RMS in six patients. Conventional MRI was performed in all 27 patients, and high-resolution diffusion-weighted imaging was conducted in 25 patients. The tumor location, size, morphological features, signal intensity, texture, contrast enhancement characteristics, lymph node metastases, apparent diffusion coefficients (ADCs), and involvement of local soft tissues were independently assessed by two authors.

RESULTS

On MR imaging, sinonasal RMS appeared isointense on T1-weighted imaging in 21 cases (77.8%) and heterogeneously hyperintense on T2-weighted imaging in 18 patients (66.7%). After enhancement, the tumors were heterogeneously enhanced in 24 cases (88.9%). Botryoid enhancement with multiple small rings resembling bunches of grapes was found in 15 cases (55.6%). Mucosal invasion of the maxillary sinus was identified in 51.9% patients. Skull and orbit involvement were found in 55.6% and 81.5% patients, respectively. Lymph node metastasis was seen in 18 cases (66.7%). There were significant differences in botryoid enhancement (P = 0.044) and skull involvement (P = 0.044) among different histological subtypes. The mean ADC value of RMS was 0.73 ± 0.082 × 10^-3 mm²/s, and there was no significant difference among different histological subtypes.

CONCLUSIONS

Some characteristic MRI findings such as botryoid enhancement in the ethmoid sinus, involvement of the orbit and skull, and a lower ADC value can provide important clues for preoperative diagnosis of sinonasal RMS in adults. Further, botryoid enhancement was more common in ERMS, while skull involvement was more common in ARMS.

Adult embryonal rhabdomyosarcoma in the nasal cavity; a case report with a review of the literature

Introduction

Rhabdomyosarcoma (RMS) is a primitive malignant soft tissue tumor arising from premature mesenchymal cells. The current study presents a rare case of embryonal rhabdomyosarcoma in the nasal cavity of an adult patient.

Case presentation

An 18-year-old female presented with right nasal obstruction for five months. Examination showed a pale soft, painless mass in the right nasal cavity with attachment to the nasal septum at the osteocartilaginous junction. The patient was falsely suspected for bacterial infection, but later histological examination showed undifferentiated small round blue cell tumor with extensive necrosis. Immunohistochemistry confirmed the diagnosis of embryonal RMS. The patient was operated on for endoscopic sinus surgery to remove the mass with additional cleaning of surrounding sinuses.

Discussion

Embryonal RMS is a rare type of malignant tumor that mostly affects the head and neck area in children while usually occur in the extremities of adults. Encountering an adult ERMS of the nasal chambers represents a small portion of head and neck cases that lack specific presentations.

Conclusion

Adult embryonal RMS of the nasal cavity is exceedingly rare and presents a diagnostic and management challenge, with immunohistochemistry being the only definitive diagnostic method.

•

Embryonal rhabdomyosarcoma is a malignant soft tissue tumor of the pediatric population.

•

Specific presentation and symptoms regarding Embryonal rhabdomyosarcoma of the nasal cavity is lacking.

•

The recommended management is surgical excision with radiotherapy and chemotherapy.

•

This report presents a case of adult Embryonal rhabdomyosarcoma occurring in nasal cavity.

Treatment, outcomes, and demographics in sinonasal sarcoma: a systematic review of the literature

Background

Sarcomas comprise a diverse group of soft tissue mesenchymal malignancies. The sinuses and nasal region are a relatively rare site of sarcomas.

Methods

Retrospective review of the literature on sinonasal sarcomas from 1987-2017. Data were analyzed for demographics, treatment type, stage, and histopathologic type. Kaplan-Meier analysis was used to assess and compare survival.

Results

A total of 198 cases of sinonasal sarcoma were identified and analyzed. The median age at diagnosis was 39 years. Overall 5-, 10-, and 20-year survival was 61.3%, 58.9%, and 49.1%, respectively, and disease-free 5-, 10-, and 20-year survival was 53.2%, 49.1%, and 38.3%, respectively. Lymph node metastasis was present at diagnosis in 3.0% of cases, and distant metastasis was present in 3.5% of cases. On univariate analysis T stage, overall stage, treatment type, histopathologic subtype, and presence of distant metastasis significantly affected survival. On multivariate analysis overall stage alone significantly predicted overall survival. Open vs. endoscopic surgery, total radiation dose, and presence of neck metastasis did not significantly affect survival. Combined modality treatment was associated with higher survival rates than single modality therapy.

Conclusions

Sinonasal sarcoma is a relatively rare malignancy. Lower T and overall stage, lack of distant metastasis, and multimodality therapy were associated with improved survival. Certain histopathologic subtypes were associated with poorer survival.

Electronic supplementary material

The online version of this article (10.1186/s12901-018-0052-5) contains supplementary material, which is available to authorized users.

Malignant Lesions in the Dentomaxillofacial Complex

Malignancies in the maxillofacial region are rare but comprise a broad spectrum of lesions. Given the potential for malignancies to mimic dental/sinus/temporomandibular joint pathology or remain asymptomatic, the judicious radiologist will be familiar with the initial and unique malignant changes affecting the dentition, periodontium, and supporting osseous structures on conventional film, dental, and sinus imaging. This article is meant to serve as a complement to the many excellent texts dedicated to advanced imaging techniques for the staging of known malignancies. The lesions discussed are a representative sample of malignancies involving hard tissues of the maxillofacial complex but are far from complete.