Sinonasal Teratoid Carcinosarcoma

This is from a 76-year-old male with a fungating maxillary antral mass that extends into the nasal cavity. Sinonasal teratoid carcinosarcoma was first described in 1984 and since then 60 cases have been reported. I have had the opportunity to encounter four cases locally, the first one in 1995, another in 2003 and two cases in 2006. There is a male predominance among cases and age has ranged from 18 to 79 years. The usual symptoms reported are epistaxis and nasal obstruction while the most common physical examination finding is that of a nasal cavity mass. A closer look shows a mass at the ethmoid sinus or maxillary antrum with secondary involvement of adjacent sinuses and soft tissue. The tumor is highly malignant rapidly invading adjacent soft tissues and bone and giving rise to regional node and distant metastases. The reported average survival is 1.7 years after diagnosis, with less than 3% surviving beyond three years. Radical surgery, radiotherapy and chemotherapy have all been used with limited success. Histologic sections show a confusing array of teratomatous, sarcomatous and carcinomatous elements represented here by immature squamous and cartilaginous islands, atypical fibrosarcoma-like spindle cell stroma and infiltrating atypical adenocarcinomatous glands.