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Gross J, Fritchie K. Soft Tissue Special Issue: Biphenotypic Sinonasal Sarcoma: A Review with Emphasis on Differential Diagnosis. Head Neck Pathol 2020; 14:33-42. [PMID: 31950469 PMCID: PMC7021886 DOI: 10.1007/s12105-019-01092-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/26/2019] [Indexed: 02/07/2023]
Abstract
Biphenotypic sinonasal sarcoma is an anatomically restricted low-grade malignant neoplasm with dual neural and myogenic differentiation composed of a monotonous population of spindled cells with herringbone/fascicular architecture. These tumors demonstrate a unique immunoprofile with relatively consistent S100-protein and actin expression in conjunction with more variable desmin, myogenin and myoD1 staining. SOX10 is uniformly negative. Genetically, the majority of tumors harbor PAX3-MAML3 fusions, with alternate PAX3 partners including FOXO1, NCOA1, NCOA2 and WWTR1. Although the differential diagnosis of BSNS is broad, careful morphologic inspection together with targeted ancillary studies is often sufficient to arrive at the correct diagnosis. As these tumors have significant local recurrence rates but lack metastatic potential, awareness and accurate diagnosis of this rare and newly described neoplasm is critical for appropriate management.
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Affiliation(s)
- John Gross
- Anatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Karen Fritchie
- Anatomic Pathology – Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
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Vengaloor Thomas T, Abraham A, Bhanat E, Al Hmada Y, Albert A, Vijayakumar S, Stinger SP, Packianathan S. Malignant peripheral nerve sheath tumor of nasal cavity and paranasal sinus with 13 years of follow-up-A case report and review of literature. Clin Case Rep 2019; 7:2194-2201. [PMID: 31788278 PMCID: PMC6878039 DOI: 10.1002/ccr3.2465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/09/2019] [Accepted: 09/01/2019] [Indexed: 12/11/2022] Open
Abstract
Although extremely rare, sarcomas including malignant peripheral nerve sheath tumors should be considered in the differential diagnosis of sino-nasal tract lesions. Long-term cure is possible through definitive operative management followed by adjuvant therapy.
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Affiliation(s)
- Toms Vengaloor Thomas
- Department of Radiation OncologyUniversity of Mississippi Medical CenterJacksonMississippi
| | - Anu Abraham
- Department of PathologyUniversity of Mississippi Medical CenterJacksonMississippi
| | - Eldrin Bhanat
- Department of Radiation OncologyUniversity of Mississippi Medical CenterJacksonMississippi
| | - Youssef Al Hmada
- Department of PathologyUniversity of Mississippi Medical CenterJacksonMississippi
| | - Ashley Albert
- Department of Radiation OncologyUniversity of Mississippi Medical CenterJacksonMississippi
| | - Srinivasan Vijayakumar
- Department of Radiation OncologyUniversity of Mississippi Medical CenterJacksonMississippi
| | - Scott P. Stinger
- Department of Otolaryngology and Communicative SciencesUniversity of Mississippi Medical CenterJacksonMississippi
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Dean KE, Shatzkes D, Phillips CD. Imaging Review of New and Emerging Sinonasal Tumors and Tumor-Like Entities from the Fourth Edition of the World Health Organization Classification of Head and Neck Tumors. AJNR Am J Neuroradiol 2019; 40:584-590. [PMID: 30765377 DOI: 10.3174/ajnr.a5978] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022]
Abstract
The sinonasal tract is an environment diverse with neoplasia. Given the continued discovery of entities generally specific to the sinonasal tract, the fourth edition of the World Health Organization Classification of Head and Neck Tumors was released in 2017. It describes 3 new, well-defined entities and several less-defined, emerging entities. The new entities are seromucinous hamartomas, nuclear protein in testis carcinomas, and biphenotypic sinonasal sarcomas. Emerging entities include human papillomavirus-related sinonasal carcinomas, SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1-deficient sinonasal carcinomas, renal cell-like adenocarcinomas, and chondromesenchymal hamartomas. The literature thus far largely focuses on the pathology of these entities. Our goal in this report was to familiarize radiologists with these new diagnoses and to provide available information regarding their imaging appearances.
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Affiliation(s)
- K E Dean
- From the Department of Radiology (K.E.D., C.D.P.), NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - D Shatzkes
- Department of Radiology (D.S.), Lenox Hill Hospital, Northwell Health, New York, New York
| | - C D Phillips
- From the Department of Radiology (K.E.D., C.D.P.), NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York
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Carter CS, East EG, McHugh JB. Biphenotypic Sinonasal Sarcoma: A Review and Update. Arch Pathol Lab Med 2018; 142:1196-1201. [DOI: 10.5858/arpa.2018-0207-ra] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Biphenotypic sinonasal sarcoma (BSNS) is a rare, slow-growing soft tissue sarcoma of the sinonasal tract, typically presenting with nonspecific obstructive nasal symptoms. Although recurrences are common, no metastases have been reported, and only 1 patient has died of disease thus far. It characteristically demonstrates rearrangements of PAX3 with multiple fusion partners, the most common of which is MAML3.
Objectives.—
To highlight the most important diagnostic features, including morphologic, immunohistochemical, and molecular findings, and to provide comparisons to other entities in the differential diagnosis. We also aim to provide a summary of the clinical features and outcomes in cases reported to date.
Data Sources.—
Recently published literature encompassing BSNS and its synonym, low-grade sinonasal sarcoma with neural and myogenic differentiation.
Conclusions.—
BSNS is a sinonasal tumor that is important to recognize because its biologic behavior differs from most of the entities in the differential diagnosis. The diagnosis can typically be rendered through a combination of morphology, immunohistochemical stains, and ancillary testing for characteristic PAX3 rearrangements.
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New tumor entities in the 4th edition of the World Health Organization classification of head and neck tumors: Nasal cavity, paranasal sinuses and skull base. Virchows Arch 2017; 472:315-330. [DOI: 10.1007/s00428-017-2116-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
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Abstract
The nasal cavity and paranasal sinuses occupy the top of the upper respiratory tract and form pneumatic spaces connected with the atmosphere. They are located immediately beneath the base of the cranium, where crucial vital structures are harbored. From this region, very much exposed to airborne agents, arise some of the more complex and rare benign and malignant lesions seen in humans, whose difficulties in interpretation make this remarkable territory one of the most challenging in the practice of surgical pathology. Contents of this chapter cover inflammations and infections, polyps and pseudotumors, fungal and midfacial destructive granulomatous lesions, as well as benign, borderline, and malignant neoplasms. Among the neoplasms, emphasis is made on those entities characteristic or even unique for the sinonasal region, such as Schneiderian papillomas, glomangiopericytoma, intestinal- and non-intestinal-type adenocarcinomas, olfactory neuroblastoma, nasal-type NK-/T-cell lymphoma, and teratocarcinosarcoma. Moreover, recently recognized entities involving this territory, i.e., HPV-related non-keratinizing carcinoma, NUT carcinoma, and SMARCB1-deficient basaloid carcinoma, are also discussed in the light of their specific molecular findings. Furthermore, the text is accompanied by numerous classical and recent references, several tables, and 100 illustrations.
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Affiliation(s)
- Antonio Cardesa
- University of Barcelona, Anatomic Pathology Hospital Clínic University of Barcelona, Barcelona, Spain
| | - Pieter J. Slootweg
- Radboud Univ Nijmegen Medical Center, Pathology Radboud Univ Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Nina Gale
- University of Ljubljana,, Institute of Pathology, Faculty of Medic University of Ljubljana,, Ljublijana, Slovenia
| | - Alessandro Franchi
- University of Florence, Dept of Surg & Translational Medicine University of Florence, Florence, Italy
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Second primary malignant peripheral nerve sheath tumor of the paranasal sinuses after nasopharynx carcinoma. J Craniofac Surg 2015; 25:2074-6. [PMID: 25304136 DOI: 10.1097/scs.0000000000000912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Malignant peripheral nerve sheath tumors are uncommon neoplasms that arise out of Schwann cells from the peripheral nerves, which rarely occur in the paranasal sinuses and nasal cavity. Especially with the increasing long-term survival of patients with nasopharynx carcinoma, second primary cancers can be diagnosed. Second primary cancers are not uncommon in patients with the prior radiation therapy. However, malignant peripheral nerve sheath tumor in the head and neck region after radiation is an exceedingly rare condition. We report the first case of malignant peripheral nerve sheath tumor of the paranasal sinuses as a second primary malignancy in a patient treated with radiation therapy for nasopharyngeal carcinoma 10 years ago.
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Das SR, Dash S, Pradhan B, Chandra Sahu M, Padhy RN. Malignant peripheral nerve sheath tumour of nose and paranasal sinuses with orbital extension. J Taibah Univ Med Sci 2015. [DOI: 10.1016/j.jtumed.2014.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Azani AB, Bishop JA, Thompson LDR. Sinonasal Tract Neurofibroma: A Clinicopathologic Series of 12 Cases with a Review of the Literature. Head Neck Pathol 2014; 9:323-33. [PMID: 25503638 PMCID: PMC4542792 DOI: 10.1007/s12105-014-0593-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/15/2014] [Indexed: 01/13/2023]
Abstract
Neurofibroma (NF), a benign peripheral nerve sheath tumor, is very uncommon in the sinonasal tract, with only a few reported cases in the English literature. Cases within the files of the authors' institutions confined to the sinonasal tract were compared to cases reported in the English literature (Medline 1966-2014). The 12 patients included 6 females and 6 males, aged 26-75 years (mean 46.2 years). The patients usually presented clinically with a mass lesion (n = 11), obstruction (n = 4) or pain (n = 3), with an average symptom duration of 42.9 months. Two patients had neurofibromatosis (NF1). Tumors involved the nasal cavity alone (n = 8), maxillary sinus alone (n = 2), or mixed sites (n = 2), with a range of 0.4-4.1 cm (mean 2.2 cm). The tumors were circumscribed, composed of spindled to wavy cells with curvilinear nuclei set in a background of collagenized stroma and mast cells. Nuclear palisading and perivascular hyalinization were not seen. Mitoses were scant. Pleomorphism, necrosis and increased cellularity were absent. By immunohistochemistry, the lesional cells were S100 protein, SOX10 and NFP positive, while CD34 highlighted the perineurium. INI1 was intact, with strong nuclear expression in all cases. All patients had surgical excision without recurrence (mean follow-up 8.6 years). The principle differential diagnoses include schwannoma, perineurioma, fibromatosis, and solitary fibrous tumor. NF of the sinonasal tract occurs in middle-aged patients without a gender predilection, usually with non-specific symptoms present for a long duration. Tumors are relatively large (mean 2.2), and usually affect one site only. Surgery is curative, with only 16.7 % NF1 associated. S100 protein, SOX10 and NFP highlight the Schwann cells, with CD34 highlighting the perineural fibroblasts.
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Affiliation(s)
- Ari B. Azani
- />Department of Pathology, Southern California Permanente Kaiser Medical Group, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
| | - Justin A. Bishop
- />Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD USA
| | - Lester D. R. Thompson
- />Department of Pathology, Southern California Permanente Kaiser Medical Group, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
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Malignant peripheral nerve sheath tumours of the infraorbital nerve: case report and literature review. The Journal of Laryngology & Otology 2009; 123:466-70. [DOI: 10.1017/s002221510800265x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We report a case of malignant peripheral nerve sheath tumour seen in our department.Method:We present case reports and a review of the world literature concerning malignant peripheral nerve sheath tumour.Results:A 38-year-old Caucasian woman was diagnosed with malignant peripheral nerve sheath tumour of the infraorbital nerve. She underwent a wide enbloc resection followed by a course of radiotherapy. A five-year post-operative magnetic resonance imaging scan revealed no evidence of recurrence.Conclusion:Malignant peripheral nerve sheath tumours are rare in the head and neck. An awareness of their occurrence is important for early diagnosis. Management involves: accurate histological diagnosis; radiological imaging to define tumour extent and plan resection; wide surgical excision with histologically negative margins; reconstruction of the tissue defect; and post-operative radiotherapy.
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Yildirim G, Gillenwater AM, Ordonez NG, Garden AS, El-Naggar AK. Concurrent epithelioid malignant peripheral nerve sheath tumor and papillary thyroid carcinoma in the treated field of Hodgkin's disease. Head Neck 2008; 30:675-9. [PMID: 17972308 DOI: 10.1002/hed.20706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Simultaneous malignancies in the field of radiation for Hodgkin's disease is an extremely rare event. A unique case of concurrent thyroid and neck mass in the postirradiation field of a young patient with Hodgkin's disease is presented. METHODS AND RESULTS Thyroidectomy and excision biopsy of the neck mass were performed. A 1.5-cm papillary thyroid carcinoma was identified in thyroidectomy and an initial diagnosis of undifferentiated malignant neoplasm was rendered on the neck mass biopsy. Subsequent surgical excision of the neck mass and immunohistochemical analysis revealed malignant peripheral nerve sheath tumor. CONCLUSION Concurrent malignancies in the field of treatment of Hodgkin's disease may occur. Rare malignancies including malignant peripheral nerve sheath tumor may be encountered along with the more common papillary thyroid carcinoma.
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Affiliation(s)
- Gokcen Yildirim
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Martin-Duverneuil N, Auriol M, Behin A, Bertrand JC, Chiras J. Facial malignant peripheral nerve sheath tumors. J Neuroradiol 2006; 33:237-49. [PMID: 17041528 DOI: 10.1016/s0150-9861(06)77269-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND/PURPOSE Malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms, only sporadically reported involving the maxillo-mandibular region (ten cases with CT or MR data). We present here five additional cases with CT and MR findings along with an extensive review of the literature. RESULTS Accurate diagnosis of MPNSTs is difficult because pathological like radiological criteria are often non specific. Radiological features display a large spectrum of abnormalities from a well-delineated heterogeneous appearance simulating benign schwannoma to extensive erosive patterns. Their development along the mandibular nerve, the absence of any target or central dot sign, their strong predominant peripheral enhancement must suggest the diagnosis of MPNSTs while irregular bone destruction or the detection of poorly defined margins with muscular infiltration are the most reliable criteria of malignancy. Unfortunately, MPNSTs also display a considerably varied histology. Careful clinical and radiological correlation should bring pathologists to examining large samples of the lesion to better evaluate the overall organisation of the lesion and detect some evocative criteria often only present in some areas of the sample as the peculiar curlicue or whorled arrangement of the spindle cells or the alternation of densely cellular fascicles with hypocellular, myxoid zones. Focal, limited immunostaining for S-100 protein is one of the most important additional criterion. CONCLUSION If accurate early diagnosis often remains difficult, careful correlation of clinical, pathological and radiological data should in most cases suggest a diagnosis of MPNSTs which display a poor prognosis and requires early and adapted treatment.
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Affiliation(s)
- N Martin-Duverneuil
- Service de Neuroradiologie, GH Pitié-Salpêtrière, 47 Bd de l'Hôpital, 75013 Paris.
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Ahsan F, Lee MK, Ah-See KW, Chapman AD. Malignant Peripheral Nerve Sheath Tumor of the Paranasal Sinuses. EAR, NOSE & THROAT JOURNAL 2004. [DOI: 10.1177/014556130408301015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Malignant peripheral nerve sheath tumors of the nose and paranasal sinuses are extremely uncommon. We report the case of a 65-year-old woman who presented with a rapid emergence of “nasal polyps” that completely obstructed her nasal passages. Six years earlier, she had been assessed elsewhere for nasal polyps. At presentation, the patient exhibited gross polyposis, with lesions protruding from both nostrils. Histology confirmed a diagnosis of a malignant peripheral nerve sheath tumor. This case demonstrates that symptoms of nasal obstruction are not always secondary to simple causes. We discuss the clinical picture of nasal and paranasal malignant peripheral nerve sheath tumor, its pathology, and its treatment.
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Affiliation(s)
- Farhan Ahsan
- Department of Otolaryngology—Head and Neck Surgery, Aberdeen Royal Infirmary, University of Aberdeen, Foresterhill, Aberdeen, Scotland
| | - Maggie K. Lee
- Department of Otolaryngology—Head and Neck Surgery, Aberdeen Royal Infirmary, University of Aberdeen, Foresterhill, Aberdeen, Scotland
| | - Kim W. Ah-See
- Department of Otolaryngology—Head and Neck Surgery, Aberdeen Royal Infirmary, University of Aberdeen, Foresterhill, Aberdeen, Scotland
| | - Andrea D. Chapman
- Department of Otolaryngology—Head and Neck Surgery, Aberdeen Royal Infirmary, University of Aberdeen, Foresterhill, Aberdeen, Scotland
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Maheshwari GK, Baboo HA, Gopal U, Baiar DB, Shah NM. Malignant schwannoma of the sinonasal tract. Indian J Otolaryngol Head Neck Surg 1999; 51:47-50. [PMID: 23119484 DOI: 10.1007/bf02996845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Malignant Schwannoma of the sinonasal tract is an extremely rare tumour. So far, only 19 cases have been reported in the literature. We report herein a case of malignant schwannoma involving nasal cavity, maxillary antrum and ethmoid sinus in a 60-year-old male patient. The patient was treated with surgery and post-operative radiotherapy. He currently remains free of the disease 15 months after the diagnosis and twelve months after completing therapy.
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Affiliation(s)
- G K Maheshwari
- Dept. of Radiation Oncology, The Gujarat Cancer and Research Institute NCH Campus, 380 016 Asarwa, Ahmedabad, India
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