CC BY 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0044-1792130
Case Report with Review of Literature

Carcinosarcoma Maxillary Sinus: A Rare Case Report with Review of Literature

1   Department of Medical Oncology, Government Medical College, Kozhikode, Kerala, India
,
Mohamed Jabir K.
1   Department of Medical Oncology, Government Medical College, Kozhikode, Kerala, India
,
Arathi Edayattil
1   Department of Medical Oncology, Government Medical College, Kozhikode, Kerala, India
,
Suprya N. K.
2   Department of Pathology, Government Medical College, Kozhikode, Kerala, India
,
Suma R.
3   Department of Otorhinolaryngology, Government Medical College, Kozhikode, Kerala, India
,
Amina Abdurahman
4   Department of Radiation Oncology, Government Medical College, Kozhikode, Kerala, India
› Author Affiliations
Funding None.

Abstract

Carcinosarcoma of maxillary sinus is an extremely rare type of cancer in the head and neck region. It is an aggressive tumor compared with other head and neck malignancies.

An 85-year-old male evaluated for left nasal obstruction, swelling at the root of the nose, and epistaxis. On evaluation with nasal endoscopy, computed tomography (CT) and magnetic resonance imaging showed an enhancing proliferative soft tissue mass, involving the left nasal cavity, with destruction of the left frontal bone, extending up to the medial wall of the orbit. Biopsy showed a biphasic tumor with malignant squamous and sarcomatoid areas. He underwent medial maxillectomy and histology report was consistent with carcinosarcoma, with positive margins. Repeat CT showed gross residual disease. The patient was treated with palliative radiotherapy in view of advanced age, multiple comorbidities, and poor performance status and poor general health. He tolerated the treatment well. Surgery with or without adjuvant radiation is the mainstay of treatment. There is no role of adjuvant chemotherapy as of now. Chemotherapy can be tried in neoadjuvant or palliative setting. Radiotherapy can be delivered for postsurgical palliation of local recurrence. Palliative radiotherapy can be offered when no other options are available or not tolerated, or to relieve symptoms, or to treat the metastases, or in case of recurrent disease. There is no evidence for role of immunotherapy or targeted agents in the neoadjuvant or adjuvant setting. Molecular studies may pave way to the future therapeutic options for this rare variant.

Declaration of Patient Consent

We have obtained written consent from the patient. The full statement is attached with the form submitted with the manuscript.




Publication History

Article published online:
05 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Ghosal R, Roychowdhury D, Chatterjee RP, Sultana M, Sinha S. Sarcomatoid carcinoma: a clinicopathological dichotomy. Cureus 2024; 16 (02) e53565
  • 2 Viswanathan S, Rahman K, Pallavi S. et al. Sarcomatoid (spindle cell) carcinoma of the head and neck mucosal region: a clinicopathologic review of 103 cases from a tertiary referral cancer centre. Head Neck Pathol 2010; 4 (04) 265-275
  • 3 Ansari-Lari MA, Hoque MO, Califano J, Westra WH. Immunohistochemical p53 expression patterns in sarcomatoid carcinomas of the upper respiratory tract. Am J Surg Pathol 2002; 26 (08) 1024-1031
  • 4 Chen HB, Gong XY, Li W. et al. Genomic landscape and tumor mutation burden analysis of Chinese patients with sarcomatoid carcinoma of the head and neck. Oral Oncol 2021; 121: 105436
  • 5 Zhang L, Chen L, Xiao M, Xie X, Wang F. Locally advanced undifferentiated sarcomatoid carcinoma of the right maxillary sinus with PDCD6-TERT fusion: a rare case report. Oral Oncol 2022; 124: 105466
  • 6 Ando M, Saito Y, Morikawa T. et al. Maxillary carcinosarcoma: Identification of a novel MET mutation in both carcinomatous and sarcomatous components through next generation sequencing. Head Neck 2015; 37 (12) E179-E185
  • 7 Jatin P Shah. Nasal cavity and paranasal sinuses. In: Shah JatinP, Patel SnehalG, Bhuvanesh Singh. eds. Jatin Shah's Head and Neck Surgery and Oncology 5th ed. Edinburgh Elsevier; 2019: 115-156
  • 8 Frank SJ, Ahamad A, Perez CA. Cancer of the nasal cavity and paranasal sinuses. In: Perez and Brady's Principles and Practice of Radiation Oncology. Lippincott Williams & Wilkins (LWW), Philadelphia:: Wolters Kluwer;; 2018: 936-955
  • 9 Hanna EY, Cardenas AD, DeMonte F. et al. Induction chemotherapy for advanced squamous cell carcinoma of the paranasal sinuses. Arch Otolaryngol Head Neck Surg 2011; 137 (01) 78-81
  • 10 Huey RW, Makawita S, Xiao L. et al. Sarcomatoid carcinoma presenting as cancers of unknown primary: a clinicopathological portrait. BMC Cancer 2019; 19 (01) 965
  • 11 Noronha V, Patil VM, Joshi A. et al. Induction chemotherapy in technically unresectable locally advanced carcinoma of maxillary sinus. Chemother Res Pract 2014; 2014: 487872
  • 12 Burtness B, Harrington KJ, Greil R. et al; KEYNOTE-048 Investigators. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. Lancet 2019; 394 (10212): 1915-1928
  • 13 Ferris RL, Blumenschein Jr G, Fayette J. et al. Nivolumab for recurrent squamous-cell carcinoma of the head and neck. N Engl J Med 2016; 375 (19) 1856-1867
  • 14 Vermorken JB, Mesia R, Rivera F. et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 2008; 359 (11) 1116-1127
  • 15 Liu X, Jia Y, Stoopler MB. et al. Next-generation sequencing of pulmonary sarcomatoid carcinoma reveals high frequency of actionable MET gene mutations. J Clin Oncol 2016; 34 (08) 794-802
  • 16 Lu H, Yang S, Zhu H. et al. Targeted next generation sequencing identified clinically actionable mutations in patients with esophageal sarcomatoid carcinoma. BMC Cancer 2018; 18 (01) 251
  • 17 Jiang T, Jia Q, Fang W. et al. Pan-cancer analysis identifies TERT alterations as predictive biomarkers for immune checkpoint inhibitors treatment. Clin Transl Med 2020; 10 (02) e109
  • 18 Kim SM, Kim MJ, Jung HA. et al. Presence of anaplastic lymphoma kinase translocation in sarcomatoid carcinoma of head and neck and treatment effect of crizotinib: A case series. Head Neck 2015; 37 (05) E66-E69
  • 19 ClinicalTrials.gov. clinicaltrials.gov. Accessed July 4, 2024 at: https://clinicaltrials.gov/study/NCT01524926
  • 20 Arumugam T, Ramachandran V, Fournier KF. et al. Epithelial to mesenchymal transition contributes to drug resistance in pancreatic cancer. Cancer Res 2009; 69 (14) 5820-5828
  • 21 Zhang W, Feng M, Zheng G. et al. Chemoresistance to 5-fluorouracil induces epithelial-mesenchymal transition via up-regulation of Snail in MCF7 human breast cancer cells. Biochem Biophys Res Commun 2012; 417 (02) 679-685
  • 22 Davis FM, Stewart TA, Thompson EW, Monteith GR. Targeting EMT in cancer: opportunities for pharmacological intervention. Trends Pharmacol Sci 2014; 35 (09) 479-488
  • 23 Furuta Y, Nojima T, Terakura N, Fukuda S, Inuyama Y. A rare case of carcinosarcoma of the maxillary sinus with osteosarcomatous differentiation. Auris Nasus Larynx 2001; 28: S127-S129
  • 24 Howard SN, Bond WR, Hong IS, Foss RD. Right maxillary sinus sarcomatoid carcinoma (sarcomatoid/spindle cell carcinoma). Otolaryngol Head Neck Surg 2007; 137 (02) 355-357
  • 25 Moon JK, Kim AY, Chang DS, Park KY. Carcinosarcoma of the maxillary sinus. Clin Exp Otorhinolaryngol 2013; 6 (02) 114-116
  • 26 Alem HB, AlNoury MK. Management of spindle cell carcinoma of the maxillary sinus: a case report and literature review. Am J Case Rep 2014; 15: 454-458
  • 27 Cheong JP, Rahayu S, Halim A, Khir A, Noorafidah D. Report of a rare case of carcinosarcoma of the maxillary sinus with sternal metastasis. Ear Nose Throat J 2014; 93 (06) E1-E4
  • 28 Li J, Wang S, Tang X, Que L, Han W, Yu B. Primary maxillary sinus carcinosarcoma with multidisciplinary management: a case report with 4 years follow-up and literature review. BMC Oral Health 2023; 23 (01) 96
  • 29 Patel TD, Vázquez A, Plitt MA, Baredes S, Eloy JA. A case-control analysis of survival outcomes in sinonasal carcinosarcoma. Am J Otolaryngol 2015; 36 (02) 200-204
  • 30 Sanabre AA, Gonzalez-Lagunas J, Redecilla PH, Martin GR. Carcinosarcoma of the maxillary sinus: a case report. J Oral Maxillofac Surg 1998; 56 (12) 1456-1460