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Sommer F. Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base. Laryngorhinootologie 2021; 100:S1-S44. [PMID: 34352902 PMCID: PMC8354577 DOI: 10.1055/a-1331-2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.
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Affiliation(s)
- Fabian Sommer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinik Ulm
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Chapurin N, Totten DJ, Morse JC, Khurram MS, Louis PC, Sinard RJ, Chowdhury NI. Treatment of Sinonasal Teratocarcinosarcoma: A Systematic Review and Survival Analysis. Am J Rhinol Allergy 2020; 35:132-141. [PMID: 32954838 DOI: 10.1177/1945892420959585] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sinonasal teratocarcinosarcoma (SNTCS) is a rare malignancy of the anterior skull base with only 127 cases described in the English literature. Given the rarity of this tumor, new cases and analysis of published reports may assist in future management of SNTCS. OBJECTIVES 1) Describe findings from a systematic review of all available literature for malignant SNTCS including the clinical presentation, treatment modalities and outcomes. 2) Present two new cases of this rare anterior skull base tumor. 3) Compare treatment outcomes with respect to recurrence and mortality. METHODS A systematic review of all English literature available in 2 comprehensive databases was conducted by two independent reviewers using PRISMA guidelines. 85 publications were identified. Each case was reviewed for demographics, treatment and survival, and aggregate treatment outcomes were compared using Kaplan-Meier analysis. RESULTS A total of 64 articles meeting inclusion criteria were reported in the literature between 1977-2018. This represented a total of 127 patients, with a strong male predominance (83%) and mean age of 50 years (range 10-82). Mean follow-up was 21 months. Recurrence rate was 38%, with mean survival at 2 years of 55%. Almost all patients underwent surgery as a primary treatment modality (90%). The majority of cases were treated with multimodal therapy, with 55% receiving surgery and radiation and 20% receiving surgery with adjuvant chemoradiation. Kaplan-Meier analysis demonstrated a significant survival advantage for patients treated with combined therapy compared to surgery alone (p < 0.001) but did not show differences in recurrence (p = 0.085). CONCLUSION Two-year survival rates for SNTCS are 55%. Multimodality treatment outcomes appear to be superior to surgery alone based on the published data of this rare skull base tumor, although heterogeneity of treatment methods and reporting bias limits the generalizability of these findings.
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Affiliation(s)
- Nikita Chapurin
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Justin C Morse
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohammad S Khurram
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter C Louis
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert J Sinard
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Naweed I Chowdhury
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
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Management of sinonasal teratocarcinosarcoma: a systematic review. Am J Otolaryngol 2014; 35:5-11. [PMID: 23731851 DOI: 10.1016/j.amjoto.2013.04.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 04/26/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE Sinonasal teratocarcinosarcoma (SNTCS) is a rare and highly malignant neoplasm that often involves the anterior skull base. This study reviews the published literature related to SNTCS. Clinical presentation, demographics, radiographic diagnosis, pathology, treatment, and management outcomes of this uncommon disease are reported. METHODS A systematic review in the published English literature was conducted. A MEDLINE/PubMed search and bibliographic examination of articles pertaining to SNTCS were performed. Each case was analyzed for patient demographics, clinical presentation, tumor location, diagnosis, treatment, and survival outcome. RESULTS A total of 49 journal articles were included. Individual patient data were reported in 86 cases. The average age of the patients was 54.5 years (range, 0.1 to 85 years), with a strong male predilection (7:1). Average follow-up was found to be 38.9 months (range, 2 to 372 months). The most common treatment method was surgery with radiation therapy, utilized in 59.3% of patients. Out of 71 cases with reported outcome and follow-up, there were 21 cases of recurrence, 8 cases with metastasis, and 6 cases reporting both recurrence and metastasis. Forty-two out of 71 (59.2%) patients survived at the time of follow-up. CONCLUSIONS This study describes the largest pool of SNTCS patients to date. SNTCS is a rare and aggressive malignant skull base tumor with a poor prognosis with frequent recurrence and metastasis. Although a variety of treatment paradigms have been reported in the literature, radical surgical resection followed by radiation therapy appears to be the most commonly used treatment option.
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Abstract
Sinonasal teratocarcinosarcoma is an extremely rare and aggressive neoplasm with <100 cases described in the literature and only 3 reported pediatric cases. We describe a 15-year-old male with a case of sinonasal teratocarcinosarcoma with extension to the cribriform plate. He presented with epistaxis, nasal obstruction, and frontal headaches and was treated with resection and postoperative chemoradiation. He is currently doing well without evidence of recurrence 45 months after therapy.
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Yang S, Sun R, Liang J, Zhou Z, Zhou J, Rui J. Sinonasal teratocarcinosarcoma: a clinical and pathological analysis. Int J Surg Pathol 2012; 21:37-43. [PMID: 22923779 DOI: 10.1177/1066896912457202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of this study was to assess the pathological and differential diagnoses of sinonasal teratocarcinosarcoma (SNTCS) in order to ultimately improve the diagnosis and treatment of this rare disease. Data from 2 cases of sinonasal teratocarcinosarcoma from the Wuxi People's Hospital (China) were analyzed. The clinical presentation for these patients consisted of nasal obstruction, epistaxis, and headache. On further physical examination, the presence of a polypoid mass was identified and, despite surgery and radiotherapy, both cases experienced recurrence. Histologically, the tumors showed a heterogeneous mixture of components from the 3 germ layers, primitive neuroepithelial elements, diagnostic immature squamous cell nests (clear cell nests), and various epithelial and mesenchymal components. Staining of the different germ layers corresponded with the appropriate immune markers. In case 1, the postradiotherapy resection specimen was completely dominated by a mature teratoma, with a complete absence of the corresponding adenocarcinoma and fibrosarcoma components. To date, this is the first study describing this composition within an SNTCS recurrent tumor. In summary, SNTCS is a rare tumor characterized by the presence of benign and malignant epithelial, mesenchymal, and dysembryomal components. Owing to its heterogeneous histologic appearance, adequate sampling and recognition of all SNTCS components are needed for future diagnosis. Currently, surgical removal, postoperative radiotherapy, and a histology-specific multidrug chemotherapy appear to be the best therapeutic approach. Future individualized therapy may also hold promise.
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Affiliation(s)
- Shudong Yang
- Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu, People's Republic of China.
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Mohanty S, Somu L, Gopinath M. Sino nasal teratocarcinosarcoma-an interesting clinical entity. Indian J Surg 2012; 75:141-2. [PMID: 24426542 DOI: 10.1007/s12262-012-0510-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 04/25/2012] [Indexed: 11/30/2022] Open
Abstract
Sinonasal teratocarcinoma is a rare tumour of the paranasal sinuses. It was earlier termed as teratoid carcinosarcoma or teratocarcinoma. It is a highly aggressive tumour with a 5 year survival rate of 45 %. Here we report a case of sinonasal teratocarcinoma who was managed excision of tumour by lateral rhinotomy approach followed by radiotheraphy.
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Affiliation(s)
- Sanjeev Mohanty
- Department of ENT, Head and Neck Surgery, SRMC & RI, Chennai, India
| | - L Somu
- Department of ENT, Head and Neck Surgery, SRMC & RI, Chennai, India
| | - M Gopinath
- Department of ENT, Head and Neck Surgery, SRMC & RI, Chennai, India
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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. Ann Diagn Pathol 2007; 12:415-25. [PMID: 18995206 DOI: 10.1016/j.anndiagpath.2007.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Shi Wei
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35242, USA
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Oka K, Kanayama R, Fukunaga M, Fukazawa M, Okamoto A, Oikawa T, Hakozaki H. Nasal teratocarcinosarcoma - a case report. Pathol Res Pract 2007; 203:549-53. [PMID: 17583442 DOI: 10.1016/j.prp.2007.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Revised: 02/05/2007] [Accepted: 03/19/2007] [Indexed: 11/15/2022]
Abstract
A 79-year-old man noticed nasal obstruction and bleeding caused by a pedunculated tumor in the left nasal cavity. The tumor revealed a malignant neoplasm predominantly composed of immature neuroepithelial cells with rosettes and palisading patterns, rhabdomyoblastic cells with positivity for desmin and cross-striations, and immature mucin-producing glandular cells. Small amounts of mature chondroid tissue and neurofibrillary matrix were also present. Therefore, the tumor was diagnosed as nasal teratocarcinosarcoma.
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Affiliation(s)
- Kuniyuki Oka
- Department of Pathology, Mito Saiseikai General Hospital, 3-3-10 Futabadai, Mito, Ibaraki 311-4198, Japan.
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Krishna Kumar K, Sundararajan I, Rangachari V, Sumathi V. Sinonasal teratocarcinosarcoma-A case report. Indian J Otolaryngol Head Neck Surg 2007; 59:148-50. [PMID: 23120415 PMCID: PMC3451798 DOI: 10.1007/s12070-007-0043-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sinonasal teratocarcinosarcoma is a very rare tumor of ambiguous origin. Detailed examination of the biopsy material is essential for diagnosis. It is a very aggressive tumor with a five-year survival rate of 45%. Surgery with radiotherapy has been shown to be effective. We report a case of a 38-year old Indian gentleman with left nasoethmoidal mass eroding the cribriform plate with intracranial extension. Subtotal endoscopic excision of the mass revealed features of a sinonasal teratocarcinosarcoma. Immunohistochemistry confirmed the same. The patient was subsequently treated with radiotherapy. The clinical features, histopathological and immunohistochemistry findings and management of sinonasal teratocarcinosarcoma are discussed.
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Affiliation(s)
- K. Krishna Kumar
- Department of Otorhinolaryngology, Sundaram Medical Foundation, IV Avenue, Shanthi Colony, Anna Nagar, Chennai, India 600 040
| | - Indu Sundararajan
- Department of Otorhinolaryngology, Sundaram Medical Foundation, IV Avenue, Shanthi Colony, Anna Nagar, Chennai, India 600 040
| | - Vijay Rangachari
- Department of Otorhinolaryngology, Sundaram Medical Foundation, IV Avenue, Shanthi Colony, Anna Nagar, Chennai, India 600 040
| | - V. Sumathi
- Department of Otorhinolaryngology, Sundaram Medical Foundation, IV Avenue, Shanthi Colony, Anna Nagar, Chennai, India 600 040
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Carrizo F, Pineda-Daboin K, Neto AG, Luna MA. Pharyngeal teratocarcinosarcoma: review of the literature and report of two cases. Ann Diagn Pathol 2006; 10:339-42. [PMID: 17126251 DOI: 10.1016/j.anndiagpath.2006.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Teratocarcinosarcomas are rare malignant neoplasms histologically characterized by the presence of benign and malignant epithelial and mesenchymal elements. They are seen almost exclusively in the sinonasal tract of men. We report two cases of teratocarcinosarcomas involving the posterior pharyngeal wall in a 55-year-old male and 60-year-old men. The tumors consisted of epithelial components including squamous, neuroendocrine, and glandular structures; neuroepithelium, and mesenchymal components with prominent rhabdomyoblastic, osteoblastic and chondroid differentiation. Immunohistochemical studies demonstrated markers characteristic of each component. The tumors were resected, and the patients received postoperative radiation therapy. One patient is alive with recurrent tumor 33 months after treatment and the other died 26 months after radiation therapy with distant metastasis.
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Affiliation(s)
- Fernando Carrizo
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Takasaki K, Sakihama N, Takahashi H. A case with sinonasal teratocarcinosarcoma in the nasal cavity and ethmoid sinus. Eur Arch Otorhinolaryngol 2006; 263:586-91. [PMID: 16534629 DOI: 10.1007/s00405-006-0014-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 09/15/2005] [Indexed: 10/24/2022]
Abstract
Sinonasal teratocarcinosarcoma (SNTCS) is a rare and aggressive malignant neoplasm histologically characterized by the combination of one or more epithelial elements and mesenchymal components. We report a 61-year-old man with SNTCS involving left nasal cavity and ethmoid sinus. He complained of left epistaxis for 1 week. Computed tomography and magnetic resonance imaging revealed a soft tissue filling the left middle meatus and ethmoid sinus, and effusion in the left sphenoid sinus but no invasion to the orbit or skull base. Tumor was completely removed with lateral rhinotomy, and post-operative radiation therapy (Liniac 60 Gy) was performed. Follow-up examination for 3 years and 5 months after the radiation therapy has shown no evidence of recurrence or metastasis. This report describes his clinical course, etiology, diagnosis and management of SNTCS with a review of literature.
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Affiliation(s)
- Kenji Takasaki
- Division of Otorhinolaryngology, Department of Translational Medical Science, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, 852-8501, Nagasaki, Japan.
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Nitsche M, Hermann RM, Christiansen H, Berger J, Pradier O. Rationale for individualized therapy in Sinonasal Teratocarcinosarcoma (SNTC): case report. Oncol Res Treat 2005; 28:653-6. [PMID: 16330889 DOI: 10.1159/000089146] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sinonasal Teratocarcinosarcoma (SNTC) is a very unusual and aggressive neoplasm characterized by the combination of malignant teratoma and carcinosarcoma features. We present the first case of malignant SNTC treated with individualized multimodal therapy including a histology-specific chemotherapy. CASE REPORT A 31-year-old man presented with an obstruction of the right pansinus. Histology showed an SNTC with major parts of small cell, poorly differentiated carcinoma and a small proportion of highly differentiated embryonal rhabdomyosarcoma. An operation was performed followed by intraoperative application of a 5-FU ointment. Adjuvant chemotherapy with cisplatin, etoposid and ifosfamid were given in regard to the major components of this heterogeneous tumor. Radiotherapy up to 59.4 Gy was applied. CONCLUSION 36 months after the end of therapy, there is no sign of tumor recurrence or metastasis in our patient. We suggest that surgery, radiotherapy and a histology-specific multidrug chemotherapy seems to be a therapeutic approach that is appropriate for this heterogeneous tumor.
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Affiliation(s)
- Mirko Nitsche
- Department of Radiotherapy, University of Göttingen, Germany.
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Abstract
Sinonasal teratocarcinosarcoma (SNTCS) is a distinctly rare tumor characterized by a variegated histologic architecture of epithelial and mesenchymal components. By reported accounts, SNTCS is a highly malignant tumor displaying rapid, aggressive growth. Prognosis is poor: less than 45% of all patients survive past 5 years. Combination surgery and radiotherapy currently appear to be the most effective treatment. This report presents a 76-year-old African American man with a SNTCS in the right nasal cavity and paranasal sinuses. The patient was treated with combination surgical excision and postoperative radiation therapy. The clinical and pathologic features and clinical course will be discussed.
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Affiliation(s)
- K Kenneth Chao
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio and Cancer Therapy and Research Center, San Antonio, Texas 78229, USA
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