[Synovial sarcoma of the nasal cavity. A case report]

Nasal spindle cell sarcoma: A case report

BACKGROUND

Synovial sarcoma is a mesenchymal high grade tumor. It is found in soft tissue mostly lower extremities. It is rarely found in the head and neck area with paraspinal neck accounting for the most common location. In rare occasions, it can be found in nasal cavity.

CASE PRESENTATION

A 46-year-old female patient presented with recurrent epistaxis for 7 months. A 0-degree rigid scope examination revealed a left nasal cavity mass. A non-contrasted CT scan of the paranasal sinus showed heterogeneous and hypodense lesion in the left nasal cavity. Functional endoscopic sinus surgery was performed and multiple nasal-mass biopsies were taken which showed high grade spindle cell sarcoma favoring synovial type. Further workup and management were done from MRI, cranial tumor resection with skull base reconstruction to adjuvant radiotherapy. Patient has regular follow up with involved specialties and thus far is doing well.

CONCLUSION

Spindle cell synovial sarcoma is a rare lesion found in soft tissue. It is unusual to be found in nasal cavity. Thus crucial attention to the clinical, radiographical and histopathological manifestation should be taken for more accurate diagnosis and further appropriate management.

Treatment, outcomes, and demographics in sinonasal sarcoma: a systematic review of the literature

Background

Sarcomas comprise a diverse group of soft tissue mesenchymal malignancies. The sinuses and nasal region are a relatively rare site of sarcomas.

Methods

Retrospective review of the literature on sinonasal sarcomas from 1987-2017. Data were analyzed for demographics, treatment type, stage, and histopathologic type. Kaplan-Meier analysis was used to assess and compare survival.

Results

A total of 198 cases of sinonasal sarcoma were identified and analyzed. The median age at diagnosis was 39 years. Overall 5-, 10-, and 20-year survival was 61.3%, 58.9%, and 49.1%, respectively, and disease-free 5-, 10-, and 20-year survival was 53.2%, 49.1%, and 38.3%, respectively. Lymph node metastasis was present at diagnosis in 3.0% of cases, and distant metastasis was present in 3.5% of cases. On univariate analysis T stage, overall stage, treatment type, histopathologic subtype, and presence of distant metastasis significantly affected survival. On multivariate analysis overall stage alone significantly predicted overall survival. Open vs. endoscopic surgery, total radiation dose, and presence of neck metastasis did not significantly affect survival. Combined modality treatment was associated with higher survival rates than single modality therapy.

Conclusions

Sinonasal sarcoma is a relatively rare malignancy. Lower T and overall stage, lack of distant metastasis, and multimodality therapy were associated with improved survival. Certain histopathologic subtypes were associated with poorer survival.

Electronic supplementary material

The online version of this article (10.1186/s12901-018-0052-5) contains supplementary material, which is available to authorized users.