Collision Occurrence of Sinonasal Carcinosarcoma and Pituitary Adenoma: A Case Report and Literature Review.

Abstract BACKGROUND: Collision occurrences of sinonasal carcinosarcoma and pituitary adenoma are rarely reported. Sinonasal carcinosarcomas represent rare neoplasms with invasive characteristics and unfavorable prognoses.CASE DESCRIPTION: We present a rare case of a collision occurrence of sinonasal carcinosarcoma and pituitary adenoma in a 45‐year‐old male patient. MRI demonstrated a large mass involving the sellar region, nasal cavity, paranasal sinuses and anterior cranial base. Total surgical resection with a pure endoscopic expanded endonasal approach was performed successfully with neuronavigational assistance. Histopathologic results were a carcinosarcoma in the nasal cavity, paranasal sinuses, and anterior cranial base and a pituitary adenoma in the intrasellar zone. The Ki-67 index of the carcinosarcoma was high (more than 95%). Although the patient received chemotherapy, he died 6 months after surgery because of in situ recurrence and extensive metastatic growth.CONCLUSIONS: Collision occurrences of sinonasal carcinosarcoma and pituitary adenoma are rare events. Such tumor could be removed successfully by neuronavigational guidance with a pure endoscopic expanded endonasal approach. A contralateral nasal septum mucosa flap without tumor invasion can be used as a kind of skull base repair material. A high Ki-67 index may be a biomarker of rapid tumor progression and poor prognosis in such patients.

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Techniques of the Expanded Endonasal Approach to Lesions of the Anterior Cranial Base

Skull Base ◽

10.1055/s-2006-958366 ◽

2007 ◽

Vol 16 (S 1) ◽

Author(s):

Arlan Mintz ◽

Amin Kassam ◽

Carl Snyderman ◽

Ricardo Carrau ◽

Paul Gardner

Keyword(s):

Cranial Base ◽

Endonasal Approach ◽

Expanded Endonasal Approach ◽

Anterior Cranial Base

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Zones of Approach for Craniofacial Resection: Minimizing Facial Incisions for Resection of Anterior Cranial Base and Paranasal Sinus Tumors

Neurosurgery ◽

10.1227/01.neu.0000088802.58956.5a ◽

2003 ◽

Vol 53 (5) ◽

pp. 1126-1137 ◽

Cited By ~ 59

Author(s):

James K. Liu ◽

David Decker ◽

Steven D. Schaefer ◽

Augustine L. Moscatello ◽

Richard R. Orlandi ◽

...

Keyword(s):

Nasal Cavity ◽

Maxillary Sinus ◽

Paranasal Sinuses ◽

Tumor Resection ◽

Blind Spot ◽

Cranial Base ◽

Transsphenoidal Approach ◽

Surgical Approaches ◽

Extended Transsphenoidal Approach ◽

Anterior Cranial Base

Abstract OBJECTIVE Anterior cranial base tumors are surgically resected with combined craniofacial approaches that frequently involve disfiguring facial incisions and facial osteotomies. The authors outline three operative zones of the anterior cranial base and paranasal sinuses in which tumors can be resected with three standard surgical approaches that minimize transfacial incisions and extensive facial osteotomies. METHODS The zones were defined by performing dissections on 10 cadaveric heads and by evaluating radiographic images of patients with anterior cranial base tumors. The three approaches performed on each cadaver were transbasal, transmaxillary, and extended transsphenoidal. RESULTS Three zones of approach were defined for accessing tumors of the anterior cranial base, nasal cavity, and paranasal sinuses. Zone 1 is exposed by the transbasal approach, which is limited anteriorly by the supraorbital rim, posteriorly by the optic chiasm and clivus, inferiorly by the palate, and laterally by the medial orbital walls. This approach allows access to the entire anterior cranial base, nasal cavity, and the majority of maxillary sinuses. The limitation imposed by the orbits results in a blind spot in the superolateral extent of the maxillary sinus. Zone 2 is exposed by a sublabial maxillotomy approach and accesses the entire maxillary sinus, including the superolateral blind spot and the ipsilateral anterior cavernous sinus. However, access to the anterior cranial base is limited. Zone 3 is exposed by the transsphenoidal approach. This approach accesses the midline structures but is limited by the lateral nasal walls and intracavernous carotid arteries. An extended transsphenoidal approach allows further exposure to the anterior cranial base, clivus, or cavernous sinuses. The use of the endoscope facilitates tumor resection in the nasal cavity and paranasal sinuses. CONCLUSION The operative zones outlined offer minimally invasive craniofacial approaches to accessing lesions of the anterior cranial base and paranasal sinuses, obviating facial incisions and facial osteotomies. Case illustrations demonstrating the approach selection paradigm are presented.

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Zones of Exposure in Surgical Approaches to the Anterior Cranial Base and Paranasal Sinuses

Contemporary Neurosurgery ◽

10.1097/00029679-200312150-00001 ◽

2003 ◽

Vol 25 (25) ◽

pp. 1-11

Author(s):

William T. Couldwell ◽

James K. Liu ◽

Richard R. Orlandi ◽

Martin H. Weiss

Keyword(s):

Paranasal Sinuses ◽

Cranial Base ◽

Surgical Approaches ◽

Anterior Cranial Base

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Pituitary macroadenoma presenting as a nasal tumor: case report

Sao Paulo Medical Journal ◽

10.1590/1516-3180-2014-1326693 ◽

2014 ◽

Vol 132 (6) ◽

pp. 377-381 ◽

Cited By ~ 2

Author(s):

Nivaldo Adolfo Silva Junior ◽

Fabiano Reis ◽

Larissa Kaori Miura ◽

Guilherme Henrique Vieira ◽

Luciano Souza Queiroz ◽

...

Keyword(s):

Pituitary Adenoma ◽

Nasal Cavity ◽

Nasal Obstruction ◽

Sphenoid Sinus ◽

Sella Turcica ◽

Rare Condition ◽

Lower Surface ◽

Large Mass ◽

Histopathological Analysis ◽

Tumor Extension

CONTEXT: Pituitary macroadenomas are rare intracranial tumors. In a few cases, they may present aggressive behavior and invade the sphenoid sinus and nasal cavity, causing unusual symptoms. In this paper, we report an atypical case of pituitary adenoma presenting as a nasal mass.CASE REPORT: The patient was a 44-year-old woman who had had amenorrhea and galactorrhea for ten months, with associated nasal obstruction, macroglossia and acromegaly. Both growth hormone and prolactin levels were increased. Magnetic resonance imaging showed a large mass originating from the lower surface of the pituitary gland, associated with sella turcica erosion and tumor extension through the sphenoid sinus and nasal cavity. Histopathological analysis demonstrated a chromophobe pituitary adenoma with densely packed rounded epithelial cells, with some atypias and rare mitotic figures. There was no evidence of metastases.CONCLUSION: Macroadenoma invading the nasal cavity is a rare condition and few similar cases have been reported in the literature. This study contributes towards showing that tumor extension to the sphenoid sinus and nasopharynx needs to be considered and investigated in order to make an early diagnosis when atypical symptoms like nasal obstruction are present.

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Bicoronal Approach in the Treatment of Frontal Mucoceles and Tumors Involving Anterior Cranial Base, Nasal Fossae and Paranasal Sinuses

Skull Base Surgery ◽

10.1159/000429785 ◽

2015 ◽

pp. 117-118

Author(s):

A. Gandolfi ◽

C. Zini ◽

F. Piazza

Keyword(s):

Paranasal Sinuses ◽

Cranial Base ◽

Anterior Cranial Base

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Osteoblastoma of the nasal cavity invading the anterior skull base in a young child

Journal of Neurosurgery ◽

10.3171/jns.1997.87.4.0625 ◽

1997 ◽

Vol 87 (4) ◽

pp. 625-628 ◽

Cited By ~ 15

Author(s):

Keisuke Imai ◽

Kounosuke Tsujiguchi ◽

Chiaya Toda ◽

Ki-Chul Sung ◽

Sadao Tajima ◽

...

Keyword(s):

Nasal Cavity ◽

Nasal Bone ◽

Cranial Base ◽

Magnetic Resonance Images ◽

Content Type ◽

X Ray ◽

Anterior Cranial Base ◽

Radiological Images ◽

Benign Osteoblastoma ◽

Fine Print

✓ The benign osteoblastoma is rarely seen as a tumor of the facial bone in infancy or early childhood. Only five cases with nasal involvement have been reported in the literature. The authors present a case of osteoblastoma of the nasal cavity, the nasal bone, the ethmoid sinus, and the anterior cranial base. This 3-year-old girl presented with a tumor surrounding the left medial canthus. Imaging studies, including x-ray films, computerized tomography scans, magnetic resonance images, a 99mTc-scintigram, and angiograms, confirmed the location of the tumor. A biopsy specimen of tumor was obtained intranasally and the pathological diagnosis was an osteoblastic tumor suggestive of osteoblastoma. Although the tumor margin was well defined on the radiological images, it was difficult to determine the exact margin during the operation. Therefore, it is important to show how to excise the tumor completely under direct view. With the use of a “dismasking flap,” it was possible to resect the benign osteoblastoma completely from the nasal cavity, even though it extended into the orbit, the maxilla, and the anterior cranial base.

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