Low-grade fibromyxoid sarcoma of the maxillary sinus

A Retrospective Analysis of Clinicopathological Features in 117 Isolated Maxillary Sinus Pathologies in a Tertiary Care Hospital

Diagnosis of maxillary sinus pathologies is challenging. Herewith we describe the clinicopathological features in isolated maxillary sinus lesions in tertiary care hospital in Goa, India. The retrospective study included patients treated between 2017 and 2022, of all age groups and gender, who underwent either a biopsy or surgery, providing a histopathological diagnosis. Of the 117 pathologies, 88 (75.2%) were non-neoplastic. The overall frequency of pathologies were polyp in 40.2%, fungal lesions (18.8%), malignancy (13.7%), chronic rhinosinusitis (11.9%) and inverted papilloma (10.3%). There were 71 men (60.7%) and 46 women (39.3%). There were 10 patients (8.5%) below 20 years of age, of which 8 patients (80%) had non-neoplastic pathology. Common comorbidities were diabetes and hypertension, while symptoms were nasal blockage (75.2%), nasal discharge (47%) and ocular redness (16.2%). Each pathology was evaluated for demography, side of lesion, comorbidity, and symptoms. Most isolated maxillary sinus pathologies were benign lesions. However, a strong clinical suspicion and histopathological confirmation is needed for all lesions in all age groups due to a risk of malignancy.

Low-Grade Fibromyxoid Sarcomas with the Maxillary Sinus Localization: A Case Report and Review of the Literature

A low-grade fibromyxoid sarcoma (LGFMS) is an extremely rare tumor first described by Evans in 1987. LGFMS is a type of soft tissue sarcoma characterized by a deceptively benign histological appearance but completely malignant behavior. LGFMS is usually seen in the deep soft tissues of the extremities and trunk. We have examined many reviews, case reports and case series previously published in PubMed and Google Scholar. To date, only five cases have been reported in the maxilla. LGFMS generally affects young adults, but it can also be seen in children and older adults. A radical surgical approach is the most recommended treatment option. LGFMS has a very low mitotic activity; therefore, it is considered that neither chemotherapy nor radiotherapy has a significant effect on long-term LGFMS prognosis. However, to date, there has been no study suggesting any protocol for the follow-up of patients with LGFMS. In this report, we present a case with LGFMS located in the maxillary sinus, in which despite radiotherapy following extensive surgical excision, the tumor recurred in a short period of three months and reached its former size.

Low-grade fibromyxoid sarcoma in the middle ear as a rare location: a case report

BACKGROUND

Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue tumor with a misleadingly bland histological appearance and fully malignant behavior, typically occurring in the deep soft tissues of the proximal extremities or trunk of young adults. However, no cases of primary middle ear LGFMS have been reported previously. LGFMS is characterized by high rates of local recurrence and metastatic spread, which should be attached of great importance to clinical diagnosis and treatment.

CASE DESCRIPTION

Herein, we report an unusual case of LGFMS occurring primarily in the middle ear of a 12-year-old boy, who presented with aural fullness and gradually progressive hearing loss in the left ear for 6 months, without other related symptoms and family history. Preoperative imaging examination suggested that the lesions were located in the tympanic cavity, tympanic antrum, and mastoid portion, with equisignal or hypointense on T1 weighted image (T1WI), apparent hyperintense on T2 weighted image (T2WI), and slight enhancement on T1WI following administration of gadolinium. A decision was made to perform mastoidectomy, as the lesion was limited to the middle ear and did not invade the facial nerve canal or the inner ear. During the surgery, the mass exhibited a hard texture and smooth surface that was approximately 1.0 cm × 1.5 cm in size, not easy to bleed, and non-adherent to surrounding tissues. After consultation, a diagnosis of LGFMS was made by postoperative pathology. The patient showed an excellent recovery from surgery without any complications. At present, the patient has been followed up for 24 months, and no local recurrence or distant metastasis has been observed.

CONCLUSIONS

The primary LGFMS in the middle ear is very rare, and the clinical manifestations and related examinations lack specificity, so a clinical diagnosis of LGFMS is very difficult, and the final diagnosis is mainly determined by pathological diagnosis. Due to its malignant behavior, clinical diagnosis and treatment should be vigilant against it. Treatment of LGFMS mainly requires extensive resection combined with radiotherapy and chemotherapy if necessary, and long-term follow-up is essential. Reporting and identification of this rare case are imperative to improving our understanding of LGFMS and reducing misdiagnosis.

Head and Neck Low-Grade Fibromyxoid Sarcoma: A Clinicopathologic Study of 15 Cases

Low-grade fibromyxoid sarcoma (LGFMS) is an uncommon mesenchymal tumor usually arising in the lower extremities and trunk. Only rare examples in the head and neck region have been reported. Fifteen cases of head and neck LGFMS were retrieved. MUC4 was performed on all cases. Results for smooth muscle actins, β-catenin, desmin, S100 protein, Epithelial membrane antigen (EMA) and STAT6 immunohistochemistry, as well as FUS rearrangement status, were recorded when available. Sites included neck (8), supraclavicular region (4) and orbit (1), parapharyngeal space (1) and lower lip (1). The age of the patients ranged from 3 to 97 years (median, 26 years). Tumors displayed classical morphologic features of LGFMS, as described. All cases (15/15) were positive for MUC4, and all cases tested (4/4) harbored FUS rearrangement. Variable positivity for EMA was identified in one case. Follow-up was available in 11 patients, ranging from 2 to 240 months (mean 71.4 months; median, 44 months). Three tumors recurred locally; none metastasized. In conclusion, although distinctly uncommon, LGFMS may arise in the head and neck region and should be distinguished from other more common spindle cell tumors in these locations. The morphologic, immunohistochemical and molecular genetic features of head/neck LGFMS are identical to those occurring elsewhere. The long-term metastatic risk of LGFMS in these locations remains to be fully elucidated.

The role of endoscopic medial maxillectomy in sinus disease

PURPOSE OF REVIEW

The endoscopic medial maxillectomy (EMM) has remained a relevant procedure for certain sinus diseases and at the same time reemerged as a salvage technique or even as a primary procedure for other diseases. Several mucosal-sparing techniques have also been described and the outcome of the surgeries is available for review.

RECENT FINDINGS

Modifications of the EMM technique in the last two decades, aimed at mucosal preservation of the inferior turbinate, nasolacrimal duct, and medial maxillary wall have been successful in addressing a multitude of diseases. There are also evidences to support adjunct procedures/methods to improve access, healing, and to address associated dysfunction such as impaired mucociliary clearance. Tailored approaches have shown favourable outcomes with a low rate of adverse effects.

SUMMARY

The EMM is appropriate for selected indications, in particular lesions causing medial wall destruction or extensive tumour involving the anterior wall or the prelacrimal recess. As for other maxillary sinus diseases including those identified to a limited site, a modified EMM is a reasonable consideration. The choice is appropriate provided instrument access, visualization, the ability for complete resection, postoperative care, and the requirement for surveillance is not compromised. A tailored approach with or without adjunct procedures is recommended.