Biphenotypic sinonasal sarcoma

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Biphenotypic sinonasal sarcoma
Other namesBSNS, LGSSNMF (archaic name)
Biphenotypic Sinonasal Sarcoma LDRT 12256.tif
A high-power view of a hematoxylin- and eosin-stained slide showing respiratory epithelial inclusions within a spindled cell neoplasm showing characteristics of a biphenotypic sinonasal sarcoma
Specialty Oncology, ENT surgery
Symptoms Various upper respiratory symptoms such as difficulty breathing
Usual onsetAges 24-85 (Average of 52 years)
Diagnostic method Biopsy
Differential diagnosis Synovial sarcoma, fibrosarcoma, and other related sarcomas of the ENT
TreatmentSurgery with radiation
Prognosis Good
FrequencyVery Rare
Deaths0

Biphenotypic sinonasal sarcoma is a newly recognized, very rare, low-grade malignant tumor of the nasal cavity, which was formerly probably included in fibrosarcoma and synovial sarcoma cases. It was incorporated into the fourth edition of the World Health Organization Classification of Head and Neck Tumours, published in 2017. [1]

Contents

Classification

Abbreviations:

Definitions:

Signs and symptoms

The tumor often affects multiple sites within the upper aerodigestive tract, frequently showing extension into the orbit (25%) or through the cribriform plate (11%) of the ethmoid sinus into the skull base. The patient presents with nonspecific findings, including difficulty breathing, facial pressure, congestion, pain, and mild epiphora. Often, concurrent benign sinonasal tract inflammatory polyps are seen.

Diagnosis

Microscopic

Hematoxylin and eosin stained image of a biphenotypic sinonasal sarcoma Biphenotypic Sinonasal Sarcoma LDRT 12255.tif
Hematoxylin and eosin stained image of a biphenotypic sinonasal sarcoma

Ancillary tests

Differential diagnoses

Epidemiology

As it is newly described, this tumor is probably under-reported, though it is considered to be very rare. Patients present over a wide age range (24–85 years), with a mean age of 52 years. More females are diagnosed than males (2:1).

Management

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References

  1. Phillips, C. D.; Shatzkes, D.; Dean, K. E. (2019-02-14). "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". American Journal of Neuroradiology. 40 (4): 584–590. doi: 10.3174/ajnr.A5978 . ISSN   0195-6108. PMC   7048508 . PMID   30765377.
  2. 1 2 Lewis JT, Oliveira AM, Nascimento AG, Schembri-Wismayer D, Moore EA, Olsen KD, Garcia JG, Lonzo ML, Lewis JE (April 2012). "Low-grade sinonasal sarcoma with neural and myogenic features: a clinicopathologic analysis of 28 cases". Am J Surg Pathol. 36 (4): 517–25. doi:10.1097/PAS.0b013e3182426886. PMID   22301502. S2CID   22479682.
  3. Wang X, Bledsoe KL, Graham RP, Asmann YW, Viswanatha DS, Lewis JE, Lewis JT, Chou MM, Yaszemski MJ, Jen J, Westendorf JJ, Oliveira AM (July 2014). "Recurrent PAX3-MAML3 fusion in biphenotypic sinonasal sarcoma". Nat Genet. 46 (7): 666–8. doi:10.1038/ng.2989. PMC   4236026 . PMID   24859338.