1/18. Sinonasal teratocarcinosarcoma: ultrastructural and immunohistochemical evidence of neuroectodermal origin.The authors report a case of sinonasal teratocarcinosarcoma in a 37-year-old man, which was located in the anterior skull base and extended to the right nasal cavity and paranasal sinuses. The tumor was surgically resected twice, but it could not be removed completely. Microscopically, it was mainly composed of primitive cell nests within a moderately cellular stroma. The components of squamous cell epithelia with focal teratoid appearance and adenocarcinomatous differentiation were observed. There were many rhabdomyoblasts scattered in the nests and stroma. Ultrastructurally, the primitive cells had many neural processes with parallel microtubules, resembling olfactory neuroblastoma. Rhabdomyoblasts showed various degrees of skeletal muscle differentiation. Some of the stromal spindle cells had actin filaments with dense patches and dense core granules. Immunohistochemically, the primitive cells were positive for epithelial markers, neuron-specific enolase, synaptophysin, and myogenic regulatory proteins. The rhabdomyoblasts showed immunoreactivity for myoid markers, cytokeratin, epithelial membrane antigen, and synaptophysin. Most of the stromal spindle cells were positive for smooth muscle actin, neuron-specific enolase and synaptophysin. The immunohistochemical and ultrastructural findings suggest that primitive cells had the most primitive phenotype of placodes, and support the possibility that sinonasal teratocarcinosarcoma is essentially a neuroectodermal tumor with divergent differentiation.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/18. Biologic characteristics of paragangliomas of the nasal cavity and paranasal sinuses.Paragangliomas of the nasal cavity and paranasal sinuses are extremely rare. This study was conducted to investigate the biologic characteristics of these lesions on different molecular levels and to estimate their biologic behavior. Operative specimens of three patients who underwent surgery for a paraganglioma of the nasal cavity (one case) or paranasal sinuses (two cases) were investigated by routine histology, quantitative dna analysis, and immunohistochemical assessment of proliferation markers (i.e., proliferating cell nuclear antigen, PCNA; Ki67-MIB-1), the expression of cell-surface antigens, which reflect the tumor-stroma interaction (i.e., CD 44 v0.4/5 and 6, CD 54, CD 106), oncogene products (nm-23; p53), and bcl-2 as a marker of apoptosis. Histologically, two tumors were paragangliomas of the adenomatous subtype, one lesion was classified as angiomatous. According to dna analysis, aneuploid cells were detected in all tumors. Two of three paragangliomas were classified as a dna type III pattern, implying a high percentage of aneuploid cells and an aggressive behavior. Immunohistochemically, paragangliomas of the nasal cavity showed increased scores for both proliferation markers tested, indicating a rapid growth pattern. According to the expression of cell-surface markers and oncogene products, these tumors displayed an aggressive behavior and an infiltrating growth pattern. The highest value for the parameters of quantitative dna analysis and highest proliferation scores were found in a tumor of a patient who developed multiple tumor recurrences after radical excision of the lesion with clear margins, and finally died of disease. In conclusion, paragangliomas of the nasal cavity and paranasal sinuses examined in this study should be regarded as suspicious concerning their biologic and clinical behavior. Radical excision, and in cases with highly aggressive biology, postoperative radiation therapy are recommended. Tumor biologic examinations can help to recognize high-risk patients for developing recurrences and possibly lesions with a malignant behavior and to enhance our understanding of the biology of these extremely rare tumors of the nasal cavity and paranasal sinuses.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/18. Sinonasal undifferentiated carcinoma with orbital invasion: report of three cases.PURPOSE: To report three patients with sinonasal undifferentiated carcinoma (SNUC) that invaded the orbit. methods: Retrospective small case series. The clinical, radiographic, and pathologic features of three patients with SNUC were reviewed. RESULTS: Three patients with SNUC that invaded the orbit were evaluated. A biopsy was performed on the tumors, which were composed of small, hyperchromatic cells with numerous mitoses and areas of necrosis. Immunohistochemical staining was positive for cytokeratins AE1.3, epithelial membrane antigen, and neuron-specific enolase in all three tumors. Electron microscopic examination showed absence of neurosecretory granules and presence of basement membrane production. Two patients were treated with surgical resection and postoperative chemotherapy and/or radiation. One patient was treated with preoperative radiation and chemotherapy. CONCLUSIONS: Sinonasal undifferentiated carcinoma is a high-grade tumor that arises in the nasal and paranasal sinuses and may invade the orbit. SNUC should be distinguished from other small, round, blue cell tumors, in particular, esthesioneuroblastoma.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
4/18. Osteocartilaginous differentiation of mucosal melanoma in the sinonasal cavity.We present a very rare case of mucosal melanoma with osteocartilaginous differentiation (MMOD). This is the first report of MMOD originating in the sinonasal cavity. Preoperative diagnosis of this tumor from specimens resected for biopsy alone is very difficult, because it has 2 histopathologic components: a primary melanoma site and the part of the melanoma with osteocartilaginous differentiation. The immunohistochemical technique is useful in histopathologic diagnosis of this tumor. Malignant melanoma usually shows reactivity with MelanA (melanoma tumor antigen) and S-100 proteins. We diagnosed this case as MMOD because both regions in this tumor were stained with MelanA and S-100 proteins. magnetic resonance imaging provides the best clinical ability to detect malignant melanoma in the sinonasal region. In this case, the melanotic melanoma site in the posterior ethmoid sinus appeared hyperintense to gray matter on T1-weighted image magnetic resonance imaging. Thus, it would have been possible to diagnose this case as MMOD before operation, even though we could not obtain a biopsy specimen from the posterior ethmoid sinus lesion.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
5/18. Schwannoma of the sinonasal tract: a clinicopathologic and immunohistochemical study of 5 cases.CONTEXT: Peripheral nerve sheath tumors are soft tissue neoplasms rarely encountered in the nasal cavity and paranasal sinuses. OBJECTIVE: To describe the clinicopathologic and immunohistochemical features of a series of schwannomas of the sinonasal tract. DESIGN: Surgical pathology files were searched for the diagnosis "sinonasal schwannoma." All histologic documents and clinical data were reviewed. immunohistochemistry was performed on paraffin-embedded tissue with antibodies to S100 protein, epithelial membrane antigen, CD34, and MIB-1. RESULSTS: Five cases of sinonasal schwannoma were retrieved; patients included 3 women and 2 men, aged 20 to 56 years. Three cases were located in the ethmoid sinus. Clinical symptoms were nonspecific (nasal obstruction, epistaxis, and anosmia). All tumors were treated with conservative surgical resection. Pathologic examination showed a spindle cell proliferation without encapsulation in all cases. No cytologic atypia was seen, and the mitotic activity was low (<3 mitotic figures/10 high-power fields). immunohistochemistry showed diffuse positivity with S100 protein and negativity with CD34 and epithelial membrane antigen. MIB-1 staining was low (1%-5% of tumor cell nuclei stained). During the follow-up (median, 6 years), no recurrence or metastasis was observed. CONCLUSIONS: Schwannoma is a very unusual tumor of the sinonasal tract and is associated with nonspecific symptoms. Histologically, sinonasal schwannomas differ from schwannomas of other locations by their lack of a peripheral capsule and possible ulceration of the epithelial covering. Sinonasal schwannomas are treated with conservative surgical resection and have an excellent prognosis.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
6/18. Prostatic metastases in the nose and paranasal sinuses.Prostatic metastases in the nose and paranasal sinuses are rare. Seven cases have previously been reported in the world literature. We describe the clinical presentation of a patient with prostatic metastases and the use of prostate specific antigen in confirming the diagnosis. We also review the literature about metastases involving the nose and paranasal sinuses.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/18. T-cell sinonasal lymphoma presenting as acute orbit with extraocular muscle infiltration.We describe a rare case of sinonasal T-cell lymphoma in an 11-year-old boy who presented with a right acute orbit characterized by proptosis, eyelid edema and erythema, limitation of eye movements, and excruciating pain on the right side of his face. Orbital computed tomography showed progressive right extraocular muscle enlargement. One biopsy specimen showed extensive tissue necrosis and an infiltrate of atypical cells with pleomorphic nuclei within the walls of blood vessels. Immunohistochemical studies demonstrated that these cells were positive for leucocyte common antigen (CD45), CD3 cytoplasmic, CD45RO, and terminal deoxynucleotidyl transferase and negative for CD20, CD57, CD56, CD99 and Epstein-Barr virus. Chemotherapy for T-cell non-Hodgkin lymphoma was initiated, but the patient's status deteriorated and the child died of respiratory insufficiency, sepsis, and central nervous system infection.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
8/18. Metastasis of prostatic adenocarcinoma to the sphenoid sinus.The presentation, diagnosis, and management of prostatic adenocarcinoma metastatic to the sphenoid sinus are reviewed. We present a case report with a review of the literature. A 67-year-old man with a history of prostatic adenocarcinoma presented with gradual left visual loss. magnetic resonance imaging revealed a lesion of the left orbital apex with extension into the ipsilateral sphenoid sinus. Operative biopsy of the lesion was significant for adenocarcinoma of the prostate. When an otolaryngologist encounters a mass in the sphenoid sinus, he or she needs to consider a diverse differential diagnosis. In evaluating possible causes, a history of malignancies should be elicited. Furthermore, the pathophysiology and potential routes of metastatic disease should be assessed for these primary neoplasms. Having a high level of suspicion for metastatic disease from specific primary sites will help guide the pathological evaluation. As in this clinical scenario of a patient with a history of prostatic adenocarcinoma, appropriate analysis would entail sending specimens for immunohistochemical staining, such as prostate-specific antigen and prostate-specific acid phosphatase. Correct diagnosis is crucial, as these patients may achieve remission and prolonged survival with irradiation and/or hormonal therapy.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
9/18. Immunohistochemical differential diagnosis of granulocytic sarcomas and malignant lymphomas on formalin-fixed material.A panel of monoclonal antibodies (anti-CD45 [common leukocyte antigen], Ki-B3, L26, MT1, UCHL1, anti-CD15 [X-hapten], anti-neutrophil granule protein elastase [NP57]), anti-lysozyme, and the naphthol-ASD-chloroacetate reaction were applied to two cases of granulocytic sarcoma (GS) for evaluation of their utility in differentiating GS from malignant lymphoma. Lysozyme and naphthol-ASD-chloroacetate esterase were found to be the most reliable markers for detection of the myeloid nature of the tumour cells. GS infiltrated solely the mucosa of the nasal cavity in one case, while in the other it involved both the nasal cavity and maxillary sinus with simultaneous eruptions on the skin of the trunk. In both cases, peripheral blood and bone marrow findings were inconspicuous at the time of diagnosis of GS.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/18. Unusual sinonasal small-cell neoplasms following radiotherapy for bilateral retinoblastomas.Two patients developed sinonasal small-cell neoplasms that arose 22 years and 37 years, respectively, following radiotherapy for bilateral retinoblastomas. The tumors were composed of small cells with scant cytoplasm and had a few scattered Homer-Wright rosettes. Immunohistochemically, one tumor was positive for keratin (CAM 5.2 and AE1/AE3), epithelial membrane antigen, and neuron-specific enolase. The other neoplasm was immunoreactive for keratin (CAM 5.2 only) and neuron-specific enolase; it also had focal immunopositivity for S-100 protein, desmin, and muscle-specific actin. Both were negative for CEA, vimentin, melanocyte-specific antigen (HMB45), chromogranin a, synaptophysin, Leu-7, 200 kd neurofilament, and retinal S-antigen. Despite aggressive multimodal therapy, the patients died of metastatic tumor 7 months and 10 months following their initial diagnosis, respectively. Although osteosarcoma is the most frequent second cancer following bilateral retinoblastomas, some patients develop clinically aggressive sinonasal small-cell tumors that are difficult to place into conventional classifications. Both of our cases showed evidence of multidirectional differentiation; one tumor labeled with epithelial and neural markers, and the other expressed epithelial, neural, and myogenous antigens.- - - - - - - - - - ranking = 4keywords = antigen (Clic here for more details about this article) |
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