Yolk sac tumors (YSTs), which are also called endodermal sinus tumors, are malignant tumors of germ cell origin. These tumors usually occur in the gonads, but 20% of cases have been reported at extragonadal sites. The head and neck is a rarely affected region that accounts for just 1% of all malignant tumors of germ cell origin. In addition, YSTs arise mostly in childhood. We present a rare pathologically pure case of primary adult YST in the sinonasal area. A 45-year-old male patient presented with a rapidly growing mass in the nasal cavity, which caused nasal obstruction and bloody post-nasal drip. The histopathologic features indicated pure YST, and immunohistochemical analysis revealed positive reactivity for Sal-like protein 4 and alpha-fetoprotein. Herein, we discuss the clinical, radiologic, and histologic features of this YST and review other cases of sinonasal YST in adults.
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International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors Edward C. Kuan, Eric W. Wang, Nithin D. Adappa, Daniel M. Beswick, Nyall R. London, Shirley Y. Su, Marilene B. Wang, Waleed M. Abuzeid, Borislav Alexiev, Jeremiah A. Alt, Paolo Antognoni, Michelle Alonso‐Basanta, Pete S. Batra, Mihir Bhayani, Diana Bell, International Forum of Allergy & Rhinology.2024; 14(2): 149. CrossRef
Yolk sac tumor of postpubertal-type does not exhibit immunohistochemical loss of SMARCB1/INI1 and SMARCA4/BRG1…but choriocarcinoma? Costantino Ricci, Francesca Ambrosi, Tania Franceschini, Francesca Giunchi, Eugenia Franchini, Francesco Massari, Veronica Mollica, Federico Mineo Bianchi, Maurizio Colecchia, Andres Martin Acosta, Michelangelo Fiorentino Pathology - Research and Practice.2023; 241: 154269. CrossRef
Pure yolk sac tumor primarily in the nasal cavity: A case report Zijun Liu, Baohong Wen, Yan Zhang Asian Journal of Surgery.2023; 46(10): 4712. CrossRef
A case of Yolk sac tumor arising from paranasal sinus Kaori Shinomura, Munehito Moriyama, Keigo Fujita, Takashi Hirano, Masashi Suzuki JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY.2023; 33(1): 41. CrossRef
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Herein we describe two cases of nasal glomus tumor.
Histological findings were typical, save for one which was quite large (3.1 cm in its greatest dimension) with an invasive growth pattern and increased ki-67 labeling index (up to 10%). These features raised a red flag of similarity to a recently described "invasive glomus tumor of nasal cavity", suggesting a more aggressive form of glomus tumor.
However, objective criteria for this possibility is lacking at present and more similar case studies are needed to establish a truly aggressive form of glomus tumor.
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Nasal Septum Glomus Tumor: A Rare Cause of Unilateral Nasal Obstruction Adamantios Kilmpasanis, Zoi Apazidi-Kesoglou, Alexandros Poutoglidis, Sotiria Sotiroudi, Konstantinos Vlachtsis, Nikolaos Tsetsos Ear, Nose & Throat Journal.2023; 102(6): 402. CrossRef
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A case of malignant glomus tumor (glomangiosarcoma) of the nasal cavity Omar A Alhroub, Shimaa A Mahameed, Mohammad O Abdelhafez, Asil Alhroub, Hani Hour, Nabil Hasasna, Nazmi Kamal Journal of Surgical Case Reports.2022;[Epub] CrossRef
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BACKGROUND Metastases to the sinonasal tract are rare but occur for many malignancies. The demographics of sinonasal metastases in Korea aren't well known. METHODS Nine cases of metastases to the sinonasal tract identified at Asan Medical Center from January, 1995 to December, 2007 were reviewed. RESULTS Metastatic carcinomas accounted for 2.4% of sinonasal malignancies and 4.7% of carcinomas. Six kinds of cancer metastasized to the sinonasal tract. They included hepatocellular carcinomas (nasal cavity and maxillary sinus), colonic adenocarcinomas (sphenoid sinus and maxillary sinus), clear cell renal cell carcinoma (nasal cavity), pulmonary small cell carcinoma (nasal cavity), follicular carcinoma of thyroid (sphenoid sinus), and breast ductal carcinoma (maxillary sinus). Primary sites had been known in 7 cases, but follicular carcinoma and one adenocarcinoma were diagnosed after sinus metastases.
Histologically, they had ill-defined borders and involved both mucosae and bones. Microscopic findings were not different from those for the primary tumors. CONCLUSIONS The pattern of sinonasal metastases in Korea are different from western data regarding incidence, site, and type, with hepatocellular carcinoma and the nasal cavity being the most common type and site, respectively. Awareness of the possibility of metastases and their pattern is encouraged when examining sinonasal tumors.
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Metastatic Carcinomas to the Oral Cavity and Oropharynx Su-Jin Shin, Jong-Lyel Roh, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon Kim, Sung Bae Kim, Sang-wook Lee, Kyung-Ja Cho Korean Journal of Pathology.2012; 46(3): 266. CrossRef
Encephalocele and nasal glioma are rare, benign congenital neuroectodennal tumors which result from a failure of embryologic sepearation of neuroectodermal and ectodemlal tissues. Nasal glioma should be differentiated from a true glioma, and from a primary encephalocele, which is a herniation of the cranial contents through a bony defect in the skull. For this reason, nasal cerebral heterotopia is a preferred term. We report an unusual case of a nasal mass that was histologically indistinguishable from nasal cerebral heterotopia but proved to be connected to the skull base by fibrotic cord. The patient was a 2 year old girl who had had a slow growing palpable mass in the left epicanthal area for three months.
Heterotopic brain tissue is a developmental anomaly of neurogenic origin with no malignant potential, and is usually present around the nose of children and infants. So it has been called nasal glioma. But, even more rarely, heterotopic glial tissue may be found in various sites other than nasal cavity, such as the ethmoidal sinus, palate, tonsillar area, pharynx, ear, subcutaneous tissue, lung, and female genital tract. We experienced a more unusual case of a polypoid heterotopic brain tissue in the soft palate in a 3-year-old boy. The mass was microscopically reminiscent of "gliosis" of the central nervous system and interestingly contained choroid plexus focally. The glial nature of the lesion was confirmed by glial fibrillary acidic protein immunostain.
Nasal chondromesenchymal hamartoma is a distinctive mixed mesenchymal lesion of sinonasal region with a complex histologic appearance and benign clinical course and clinicopathologically similar to those of the mesenchymal hamartoma of the chest wall of infancy. We report a case of nasal chondromesenchymal hamartoma occurred in the right nasal cavity in a 3-month-old female. She was admitted with a history of profuse nasal bleeding and obstruction. CT revealed complex solid and cystic mass, measuring 3.5x2.5x2.5 cm in dimensions which filled the right nasal cavity and extended into ethmoid sinus and cribriform plate.
The received piecemeal fragments of tissue were brown tan-colored firm semitranslucent tissue with a cartilaginous appearance. Microscopically, the basic morphologic elements were irregular islands of hyaline cartilage and myxoid to spindle cell stroma with various cellularity.
Non-salivary type adenocarcinoma of the sinonasal tract is a rare entity and includes low grade and high grade adenocarcinomas, which show somewhat different clinical and histological features. We report a case of non-salivary type adenocarcinoma occurring in a 55-year-old man. Computed tomography showed a soft tissue mass in right nasal cavity and ethmoid sinus, which extended to the nasopharynx. Removed mass showed both high grade and low grade adenocarcinomatous areas, which have different histology from usual salivary type tumor. The high grade area mimicked intestinal adenocarcinoma and low grade area was similer to adenoma because of very well differentiated tumor glands.
The acinic cell carcinoma (ACC) is very rare in the nasal cavity. A 57-year-old woman suffered from nasal obstruction, postnasal dripping, and hyposmia for 2 months.
Rhinoscopic examination revealed a huge polypoid mass in the right inferior and anterior nasal fossa of the nasal cavity and the mass was resected.
The tumor showed the classic acinar and trabecular features of ACC on light microscopic examination. The finely granular cytoplasmic granules stained with periodic acid-schiff (PAS) and diastase digested-PAS, but not with alcian blue at pH 2.5 and mucicarmine. On ultrastructural examination, tumor cells contained numerous secretory granules diagnostic of ACC.
Sinonasal undifferentiated carcinoma(SNUC) is a distinct, relatively rare neoplasm arising in the nasal cavity and paranasal sinuses composed of undifferentiated epithelial cells and clinically characterized by a fulminant course. We report a case of SNUC in a 56-year old man who have had bilateral neck masses since one month ago before coming to our hospital. The paranasal computed tomography showed soft mass density in the left maxillary sinus and the nasal cavity with bone destruction in the anterior medial and the inferior maxillary sinus wall. This mass was extruded into the left orbital wall. Biopsy of the nasal mass and fine needle aspiration(FNA) of the neck mass were done. FNA revealed medium-sized neoplastic cells forming clusters or individually dispersed. Nuclei were round to oval, slightly to moderately pleomorphic, and hyperchromatic. Chromatin was finely granular, but occasionally was coarsely granular.
Nucleoli varied from large to inconspicuous and the cytoplasm was scanty.
We report a case of a 38-year-old male with extranodal NK/T-cell lymphoma, nasal type, showing unusual clinical and pathological features. The patient was admitted for soft tissue swelling and tenderness in both legs. The patient had been treated intermittently 8 months prior for repeated muco-cutaneous ulcers. A muscle biopsy showed medium-sized atypical lymphoid cells with bizarre nuclei and plump cytoplasm, infiltrating to the skeletal muscle fibers with angiocentricity. The immunoresults were Ki-1+, CD56+, cytoplasmic CD3+, with EBV-in situ hybridization +. The patient rapidly deteriorated and died of sepsis and respiratory failure shortly after initiation of low-dose chemotherapy. A careful review of previous biopsies revealed scarce atypical lymphoid cells around vessels with similar immunoprofiles without the presence of Ki-1 positive cells.
This case emphasizes that an extranodal NK/T-cell lymphoma may have a dermatomyositis-like diffuse presentation. Ki-1 co-expression can be an unexpected event in a process of the disease course; however, this should be validated with future studies.
Juvenile xanthogranuloma (JXG) is a benign and self-limiting non-Langerhans-cell histiocytosis that generally occurs during infancy and childhood. It develops frequently in the head and neck but is very rare in the nasal cavity. To date, only five cases of JXG in the nasal cavity have been reported. Here, we report the second case of JXG in the nasal cavity in Korea. A 19-year-old male patient presented with a protruding 1.1 cm mass in the left nasal vestibule.
Histologically, a dense dermal infiltrate of histiocytes with Touton giant cells was observed. Immunohistochemically, the histiocytes tested positive for CD68 and the S-100 protein but negative for CD1a. This shows that a S-100-positive histiocytic lesion dose not exclude a diagnosis of JXG.
Nasal angiomyolipomas are exceedingly rare and usually present as small tumors in middle-aged or old men. Their histology is similar to that of the renal counterpart, but they differ in the absence of epithelioid cells, the lack of HMB-45 immunoexpression and no association with tuberous sclerosis. A case of angiomyolipoma occurring in the right nasal cavity was presented in a 44-year-old male patient.
The mass was removed by an endoscopic approach. A well-circumscribed, 1.3 cm-sized, ovoid mass was composed of yellowish gray, solid, soft tissue. Histologically, it consisted of bundles of smooth muscles, mature fat cells and thick-walled blood vessels. Nests of seromucous glands were admixed within the mass. Neither epithelioid nor pleomorphic cells were found, and HMB-45-positive cells were not detected. No recurrence has been detected for 2 months after the operation.
Angioleiomyoma of the sinonasal area is an extremely rare benign neoplasm. To the best of our knowledge, only 26 cases have been described. Here, we report a case of angioleiomyoma arising in the nasal cavity of a 60-year-old woman. Microscopically, the tumor consisted of proliferating smooth muscle cells punctuated with thick-walled vessels with slit-like lumina. The tumor was negative for estrogen and progesterone receptor by immunohistochemical study.
Further studies are needed to clarify whether the growth of this tumor is sex steroid-dependent.
Primary extracranial and extraspinal meningiomas are rare. Case s involving the orbit, skin, nasal cavity, paranasal sinuses, oral cavity and parotid gland have been reported.
The histogenesis of primary extracranial meningioma is still nucertain, but it has been thought that this tumor originates from arachnoid cell rests in displaced during embryonal development. The authors observed a case of primary meningioma of the nasal cavity and paranasal sinuses occurring in a thirty-eight year old male patient in Feb.
1989. He suffered from bulging in the medio-superior portion of left orbit for 15 years, and left nasal obstruction and headache for 5 years, A head CT scan revealed numberous polypoid masses filling the left frontal sinus left ethmoidal sinus, left maxillary sinus and left nasal cavity.
During the operation, a connection to the dura was not found. Microscopically, there were discrete lobules or netst of meningothelial cells, beneath the nasal mucosa. They showed an occasional whorling pattern and psammoma bodies.
Therefore, this case was diagnosed as primary meningioma, meningotheliomatous type involving the left nasal cavity and paranasal sinuses.