Teratocarcinosarcoma: A rare malignant tumor of sinonasal tract

Abstract

Sinonasal teratocarcinosarcoma is an extremely rare malignant tumor arising in the sinonasal tract, having combined histological features of teratoma and carcinosarcoma. Here, we are presenting a case of sinonasal teratocarcinosarcoma in a 44 year‑old male patient. 44 year old male presented to us with complains of nasal obstruction and intermittent epistaxis since 1 month. On examination polypoidal mass was noted in left nasal cavity which bleeds on touch. On MRI, well defined heterogeneously enhancing lesion completely filling the left nasal cavity was noted. Histopathological examination of resected specimen revealed, malignant epithelial components being adenocarcinoma and squamous cell carcinoma, mesenchymal component composed of spindle cells, along with primitive mesenchymal and blastemal components. Immunohistochemistry showed epithelial and stromal markers positive for Cytokeratin and Vimentin respectively. Sinonasal teratocarcinosarcoma (TCS) is a rare and aggressive malignant neoplasm characterized by the combination of malignant teratoma and carcinosarcoma. Most common presentation being nasal obstruction and epistaxis with male preponderance. The tumor shows heterogeneous morphology with varying proportions of benign and malignant epithelial, mesenchymal, and blastemal components. Less than 100 cases have been reported in literature. Teratocarcinosarcoma is a rare aggressive sinonasal tumor. Total excision of the tumor and aggressive sampling for histopathological examination is necessary to avoid misdiagnosis of olfactory neuroblastoma and carcinosarcoma.