An Aggressive Sinonasal Mass

INTRODUCTION: Sinonasal teratocarcinosarcoma (SNTCS) is an extremely rare aggressive malignant tumor arising in the sinonasal tract, often confused with other sinonasal tumors. It is more common in adult males. These tumors are often difficult to diagnose because of their diverse histology. CASE REPORT: We are presenting a case of right sided SNTCS in a 38-year-old male patient. The patient had a history of right sided nasal obstruction associated with recurrent episodes of epistaxis for last 3 months. On examination, a solid mass was noted in the right nasal cavity that was greyish black in colour, irregularly shaped, brittle, exhibits localized surface necrosis and bleeds easily on touch. Microscopic examination revealed an admixture of carcinomatous (glands, non keratinized squamous epithelia), sarcomatous (atypical spindle cells, smooth muscle), primitive neuroectodermal and teratoid elements (immature squamous and clear cell nests). CONCLUSION: SNTCSs are highly aggressive tumors with poor prognosis. Majority of the patients do not survive beyond 3 years. Complete excision and extensive sampling are necessary for their diagnosis. However, because of their aggressive nature, aggressive treatment approach of surgery with adjuvant chemo-radiation is more beneficial than surgical excision alone. Keywords: adeno-squamous carcinoma, epistaxis, immunohistochemistry, olfactory neuroblastoma, paranasal sinus, sinonasal mass, teratocarcinosarcoma