Management of Spindle Cell Carcinoma of the Maxillary Sinus: A Case Report and Literature Review

Abstract

Patient: Male, 52Final Diagnosis: Spindle-cell carcinoma of the maxillary sinusSymptoms: —Medication:—Clinical Procedure: Functional endoscopic sinus surgery • total maxillectomySpecialty: OtolaryngologyObjective:Rare diseaseBackground:Carcinosarcomas, also known as spindle cell carcinomas, are rare and highly aggressive tumors characterized by dual histologic differentiation of squamous cell and mesenchymal cell tumors. Occurrence of carcinosarcoma in maxillary sinus is very rare, with only 11 cases reported since 1957. The small number of reported cases creates an obstacle to the increased understanding of the behavior, prognosis, and therapeutic management of this tumor.Case Report:A 52-year-old man presented with a 2-month history of right nasal obstruction. Computed tomography (CT) and magnetic resonance imaging (MRI) showed opacified right frontal, sphenoid, ethmoid, and maxillary sinuses with soft tissue density and expansion of the mass with erosion of the right lateral maxillary wall. Functional endoscopic sinus surgery (FESS) was done and histopathology revealed multiple fragments of nasal mucosa lined by stratified hyperplastic squamous epithelium with an increased degree of dysplasia and pleomorphism and a second spindle cell high-grade neoplastic growth with bizarre giant cells and abnormal mitotic figures. Consistent with carcinosarcoma, immunohistochemistry showed strong positive staining for vimentin in the spindle cell component and strong positive staining for cytokeratin markers in the epithelial cell component. The patient underwent right total maxillectomy with postoperative chemoradiation therapy and survived for 1 year.Conclusions:Carcinosarcoma of the maxillary sinus is a rare disease with non-specific symptoms; it usually presents in the advance stage and is associated with poor patient prognosis. This case indicates that surgical intervention with postoperative chemoradiotherapy improves patient prognosis and should be considered as the standard therapeutic modality.

A Report of Spindle Cell Carcinoma in Maxillary Sinus: Diagnosis and Management

“…This explanation has been supported by ultrastructural and histpathologic examinations (9, 10). Nappi et al (11) There is a controversy about the management of spindle cell carcinoma due to the scarcity, difficulty of histological confirmation, and a shortage of literature about disease pathogenesis, outcome survey, and management guidelines (1,3,12).…”

“…Either radiotherapy or chemotherapy is an alternative option for inoperable patients or those with sinonasal tumors. Overall, the time of diagnosis and the site of lesion affect the outcome so that early stage diagnosis and extraoral lesion have been resulted in better outcomes (12)(13)(14)). Some studies reported the increased mortality rate in the tumors of the head and neck area as a result of lower resistance to tumor-spreading along tissue planes and extensive lymph drainage system with resultant lymphatic and distant metastases (3,4,13).…”

Two cases of spindle cell carcinoma with a histopathological review of biphasic tumours of head and neck

“…Adjuvant radiation and/or chemotherapy should be used in case of incomplete removal or positive surgical margins [12]. While other studies suggest that postoperative chemoradiation therapy improves patient prognosis and should be considered as the standard therapeutic modality [13].…”

Spindle Cell Carcinoma of the Maxilla: A Case Report of Rare Entity

“…Despite its rarity in the head and neck region, the most frequently involved site is the larynx, with reports of cases found in nasal cavity, hypopharynx, oral cavity, esophagus, trachea, maxilla and skin also present in the literature [6]. Spindle cell carcinoma arising in maxilla is much rarer occurrence in literature [7] with few cases reported since 1957 (Table 1).…”