Eosinophilic angiocentric fibrosis of the sinonasal tract

Eosinophilic angiocentric fibrosis (EAF) is an uncommon inflammatory fibrosing lesion of the upper respiratory tract and orbit that occurs mainly in young to middle-aged women. The etiology of EAF is unknown. To our knowledge, approximately 28 cases have been previously reported in the English literature. We report here 3 additional cases of EAF of the sinonasal tract; 2 in women aged 19 and 31 years, and 1 in a man aged 49 years. The 19-year-old woman is the youngest patient with EAF ever described. The patients presented with a nasal cavity mass, face pain, or nasal obstructive symptoms of long duration.     

Primary sinonasal ameloblastoma

A case of primary ameloblastoma of the right sinonasal tract in a 66-year-old man is reported. The tumour presented as a radiographically solid mass filling the right nasal cavity and sinuses and without continuity with maxillary alveola. After radical surgery plus postoperative radiotherapy, the patient has pursued a non-aggressive clinical course after nine months of follow-up. The paper reviews the clinico-pathological features of this rare tumour and supports the theory of its sinonasal epithelium origin.     

True hemangiopericytoma of the nasal cavity

Two cases of nasal tumors with pericytic myoid differentiation are reported. The tumors occurred in a 77-year-old woman and a 60-year-old man as polypoid lesions covered by normal mucosa. Histologically, the tumors were composed of uniform short spindle or stellate cells with indistinct cell borders arranged in narrow and short fascicles. Numerous blood vessels of various sizes were common in both cases. The tumor cells of both cases stained intensely with anti-vimentin and anti-actin antibodies, but not with anti-desmin, CD34, or anti-high-molecular-weight caldesmon antibodies. Ultrastructural examination revealed well-developed actin thin filaments with dense bodies, subplasmalemmal plaques, intercellular junctions, and irregular discontinuous basement membranes. These histopathologic features suggest true pericytic differentiation of the tumors (true hemangiopericytoma), unlike soft tissue-type hemangiopericytoma. Generally, sinonasal hemangiopericytomas are subdivided into soft tissue-type hemangiopericytomas and true hemangiopericytomas identical to the cases presented here. Soft tissue-type hemangiopericytomas are frequently highly aggressive, whereas true hemangiopericytomas show localized benign behavior. Sinonasal true hemangiopericytomas should be strictly differentiated from soft tissue-type hemangiopericytomas.     

Sinonasal glomangiopericytoma: case report with emphasis on the differential diagnosis

Glomangiopericytoma (sinonasal-type hemangiopericytoma) is an uncommon sinonasal neoplasm with a perivascular myoid phenotype. This tumor differs from conventional soft tissue hemangiopericytoma in location, biologic behavior, and histologic features. The proposed cell of origin is a modified perivascular glomuslike myoid cell. Glomangiopericytoma is an indolent tumor that tends to arise in the sinonasal tract of older adults and has a low malignant potential with excellent prognosis after surgical resection. Histologically, this lesion is composed of a diffuse, subepithelial proliferation of bland, uniform, closely packed spindled cells growing in a variety of patterns. A distinctive vascular network composed of variably sized vascular channels, the smaller of which demonstrate perivascular hyalinization, is often present. We report the case of a 48-year-old woman with epistaxis and nasal obstruction who was diagnosed with glomangiopericytoma and discuss the histologic differential diagnosis.     

Follicular ameloblastoma presenting as a sinonasal tumor

A case of follicular ameloblastoma of the left maxilla in a 74-year-old man is reported. The tumor was presented as a radiographically solid mass filling the left sinonasal cavity and invaded maxillary alveola. After radical surgery, the patient has pursued a non-aggressive clinical course after 4 years of follow-up. The radiopathological features of this tumor were reviewed and the possibility of its sinonasal epithelium origin was discussed.     

Alveolar soft part sarcoma of the paranasal sinuses masquerading as a giant invasive pituitary adenoma

Alveolar soft part sarcoma (ASPS) is a relatively rare tumor that mostly presents as a slow growing mass in the deep soft tissue of the extremities. A substantial number of cases in children occur in the head and neck region; however, in any age group, it is very rarely reported in the sinonasal region. We report a case of ASPS of the paranasal sinuses with sellar extension in a 25-year-old man that masqueraded as a giant invasive pituitary adenoma. This is only the fifth case of sinonasal ASPS in literature. The clinical and radiological diagnoses were misleading, but an extensive pathology workup including electron microscopy helped reach an accurate diagnosis in this unusual case.     

Sinonasal tract eosinophilic angiocentric fibrosis. A report of three cases

Eosinophilic angiocentric fibrosis (EAF) is a rare submucosal fibrosis without a well-developed differential diagnosis. Three cases of sinonasal tract EAF were identified in 2 women and 1 man, aged 49, 64, and 28 years, respectively. The patients experienced a nasal cavity mass, maxillary pain, or nasal obstructive symptoms of long duration. The process involved the nasal septum (n = 2), nasal cavity (n = 1), and/or the maxillary sinus (n = 1). There was no evidence for Wegener granulomatosis, Churg-Strauss syndrome, Kimura disease, granuloma faciale, or erythema elevatum diutinum. Histologically, the lesions demonstrated a characteristic perivascular "onion-skin" fibrosis and a full spectrum of inflammatory cells, although eosinophils predominated. Necrosis and foreign body-type giant cells were not identified. Surgical excision was used for all patients, who are all alive but with disease at last follow-up. Sinonasal tract EAF is a unique fibroproliferative disorder that does not seem to have systemic associations with known diseases. The characteristic histomorphologic features permit accurate diagnosis.     

Fine‐needle aspiration of alveolar soft part sarcoma: Histologic correlation and aberrant CD68 expression

Alveolar soft part sarcoma is a rare highly malignant neoplasm of the soft tissue and usually occurs in the lower extremities of children and young adults. We report two cases of alveolar soft part sarcoma: a 24‐year‐old Latino man with a 10‐ cm neck mass and a 56‐year‐old Latino woman with a recurring thigh mass. Fine‐needle aspiration and a core biopsy were performed on both, which was followed by tumor resection on the man. The smears displayed numerous loosely cohesive or single large cells with abundant granular cytoplasm, round nuclei, vesicular chromatin, and occasional prominent nucleoli. Periodic and Schiff (PAS)‐positive, diastase‐resistant rhomboid, or needle‐shaped crystals were present. Both tumors had diffuse and strong nuclear TFE3 expression and aberrant cytoplasmic CD68 expression. Fluorescence in situ hybridization analysis was performed in the first case, which detected a characteristic translocation t(X;17)(p11;q25). The diagnosis of alveolar soft part sarcoma was rendered in both cases. Herein, we present the cytology, histology, immunohistochemistry, and molecular findings and discuss the differential diagnosis.     

Renal botryomycosis

A case of visceral botryomycosis which arose in the left kidney of a 60-year-old woman is reported. This is the fifth reported case of renal botryomycosis which, in this patient, was mistaken clinically for a renal carcinoma. The lesion was composed of confluent abscesses containing 'sulphur granule-like' lesions in which irregularly lobed aggregates of Gram-negative organisms surrounded by an eosinophilic capsule were noted. Awareness of this unusual lesion is important because of its histopathological similarity to actinomycosis.     

Primary sinonasal choriocarcinoma

Primary choriocarcinoma of sinonasal tract has not been previously documented. The aim of the study was to report, for the first time, 2 cases of primary sinonasal choriocarcinoma. The differential diagnosis is discussed and also the theories concerning the histogenesis of this neoplasm are briefly reviewed. Two male patients of 44 and 49 years of age complained of epistaxis and nasal obstruction of 2-week duration. Computerized axial tomographic scan of the head revealed an opacity of the left nasal cavity in one patient and a destructive lesion of the maxillary sinus in the other. Histopathologically, the lesions disclosed a dual cell population composed of cytotrophoblastic cells with uniform, round nuclei, clear cytoplasm, admixed with large multinucleated syncytiotrophoblastic cells, with bizarre nuclei, and abundant eosinophilic cytoplasm. Immunohistochemically, the tumors were notable for strong keratin and β-chorionic gonadotrophin (HCG) positivity. The serum levels of HCG were 13 000 and 779 mIU/mL, respectively. One patient treated with maxillectomy, postoperative radiotherapy, and 5 courses of VIP chemotherapy (cisplatinum, etoposide, ifosfomide) died with brain metastases 10 months after diagnosis. The other patient received 4 courses of etoposide, and he is alive without tumor, 10 months after diagnosis. The serum levels of HCG are still negative. The present cases demonstrated the widespread distribution of germ cell tumors in the human body and lead to further support of the existence of primary choriocarcinomas in the sinonasal tract. Correct identification of this neoplasm is therefore important for institution of specific therapy.     

Eosinophilic angiocentric fibrosis: an unusual entity of the sinonasal tract

We present the case of a 45-year-old man who presented with medication-resistant chronic bilateral nasal obstruction. The patient had no known history of allergy or any other disease. Nasal septoplasty was performed to relieve his symptoms. Histologically, thick collagen bundles were seen, characteristically whorling around vessels in a fibrotic stroma. Inflammatory cells, rich in eosinophils, were scattered throughout the lesion. No granulomas, necrosis, or vessel destruction were present. A diagnosis of eosinophilic angiocentric fibrosis was made. This neoplasm, which has very characteristic histologic features, is a rare entity of the sinonasal tract.     

Pulmonary adenofibroma: report of two cases of an unusual type of hamartomatous lesion of the lung

We report two cases of a primary lung tumour characterized by complex gland-like spaces lined by simple cuboidal to columnar epithelium surrounded by a hyalinized spindle-cell fibroblastic proliferation reminiscent of adenofibromas of the female genital tract. The lesions occurred in a 54-year-old woman and a 56-year-old man. The tumours presented clinically as 1–2 cm, solitary 'coin' lesions and were discovered incidentally on routine chest X-rays. Both lesions were treated by lobectomy. One patient is alive and well with no evidence of disease after 8 years; the other died of myocardial infarction 5 years following resection of his tumour without evidence of recurrence. We interpret these lesions as benign hamartomatous growths; their main importance lies in distinguishing them histologically from other types of pulmonary hamartomas, pulmonary blastomas, intrapulmonary solitary fibrous tumours, and metastases from soft tissue and visceral sarcomas.     

Colonic adenocarcinoma metastasizing as a germ cell neoplasm: a case report and review of the literature

Mixed tumors of the gastrointestinal tract, including both adenocarcinoma and germ cell neoplasm, have been reported infrequently. In the colon, only 9 cases, to our knowledge, have been described in the English-language literature. This is the case of a 29-year-old man with an unsuspected mixed colonic neoplasm that metastasized as the germ cell component.     

Fibrous histiocytoma of the nasal cavity and maxillary sinus

Two cases of fibrous histiocytoma were presented; Case 1: a 46-year-old man with a tumor filling the left nasal cavity and maxillary sinus, and Case 2: an 80-year-old man with a tumor of the right maxillary sinus destroying its surrounding wall. Histologically, the former was dominated by storiform pattern and onion-like structures, and the latter by osteoclast-like multinucleated giant cells. After radical surgery, Case 1 was free of recurrence for more than one year, and Case 2 showed recurrence although still maintaining fairly good health. A total of 29 cases hitherto reported arising in the nasal, paranasal and nasopharyngeal regions were reviewed, pitfall of differential diagnoses was commented especially in our two cases, criteria of malignancy were discussed, and the necessity of repeated samplings was emphasized because of paucity and unfamiliarity of fibrous histiocytoma arising, in particular, from the upper respiratory tract.     

FIBROUS HISTIOCYTOMA OF THE NASAL CAVITY AND MAXILLARY SINUS

Two cases of fibrous histiocytoma were presented; Case 1: a 46-year-old man with a tumor filling the left nasal cavity and maxillary sinus, and Case 2: an 80-year-old man with a tumor of the right maxillary sinus destroying its surrounding wall. Histologically, the former was dominated by storiform pattern and onion-like structures, and the latter by osteoclast-like multinucleated giant cells. After radical surgery, Case 1 was free of recurrence for more than one year, and Case 2 showed recurrence although still maintaining fairly good health. A total of 29 cases hitherto reported arising in the nasal, paranasal and nasopharyngeal regions were reviewed, pitfall of differential diagnoses was commented especially in our two cases, criteria of malignancy were discussed, and the necessity of repeated samplings was emphasized because of paucity and unfamiliarity of fibrous histiocytoma arising, in particular, from the upper respiratory tract.     

Hidradenoma papilliferum of nasal skin

Pathologic examination of an excisional biopsy specimen of a subepidermal nodule from the nasal tip of a 37-year-old black man demonstrated papillae covered by eosinophilic columnar epithelial cells, suggesting cylindric cell papilloma or well-differentiated papillary adenocarcinoma of nasal mucosa. The patient did not submit to further investigation of the sinonasal tract but sought attention 15 months later because of local recurrence of the lesion. A protuberant, 3-cm, cystic nodule of the subcutis over the left nasal ala and tip was excised completely and found to have characteristics of hidradenoma papilliferum, an apocrine gland neoplasm most commonly occurring in the anogenital skin of white women. This case demonstrates how easily an apocrine neoplasm arising near a mucocutaneous junction can be confused with a mucosal tumor, potentially leading to inappropriate treatment.     

Ectopic primary olfactory neuroblastoma of the maxillary sinus

Olfactory neuroblastoma (ONB) is a rare malignant tumor. Although the vast majority of cases arise in the nasal cavity, ONB is rarely reported in ectopic locations. We report a case of ONB in the maxillary sinus. A 63-year-old woman presented with left-sided nasal obstruction and epistaxis. Magnetic resonance imaging showed a nonenhancing left maxillary sinus tumor. Histologic sections showed ONB, Hyams grade IV, invading bone, skeletal muscle, and adjacent fibroadipose tissue. It is essential to be accurate when diagnosing sinonasal tumors because the differential diagnosis is broad, and one must consider the possibility of ectopic ONB, although it is rare. The behavior of ONB and other neuroendocrine tumors of the sinonasal region is quite different, and there are varied approaches to treatment. Therefore, an accurate diagnosis as well as correct grade and stage must be assigned.     

Ovarian cavernous hemangioma

Vascular tumors of the female genital tract are rare, especially those of the ovary. Most cases are small lesions that are discovered incidentally. We describe a 68-year-old woman with a benign hemangioma that presented clinically as a very large ovarian mass.     

Primary non-Hodgkin's lymphoma of the nose and paranasal sinuses: a case report

Non Hodgkin's Lymphomas of the sinonasal tract are uncommon neoplasms that can be morphologically difficult to distinguish from destructive non-neoplastic process or other malignant neoplasm in this site. Non-Hodgkin's Lymphomas of the sinonasal tract are heterogeneous diseases that can be clinically aggressive. Immunophenotypic pattern of Non-Hodgkin's Lymphomas shows marked variations. We are reporting a case of B-Cell type of Non-Hodgkin's Lymphoma of the nasal cavity and paranasal sinus with complete clinicopathological and immunohistochemical study as it is rare in Indian literature and review of the literature is done.     

Three cases of malignant neoplasm,pneumonitis, and pancytopenia during treatment with low-dose methotrexate

Summary A 77-year-old man with chronic obstructive pulmonary disease was treated with low-dose methotrexate (7.5–15 mg per week). After 15 months a diagnosis of urothelial carcinoma of the bladder was made; after a further 6 months pneumonitis and pancytopenia developed. The patient died due to massive pulmonary hemorrhage. A malignant teratoma was diagnosed in a 65-year-old asthmatic man 16 months after initiation of methotrexate therapy (15 mg per week). The patient died 4 months later due to fulminant progression of the neoplasm. A third malignant neoplasm (dermal squamous cell carcinoma) was seen in a 64-year-old woman with rheumatoid arthritis after 13 months treatment with 7.5 mg methotrexate per week. These three cases, while obviously not proving a causal relationship between long-term treatment with low-dose methotrexate and development of malignant neoplasm, do call for stringent treatment criteria, close surveillance, and prospective studies.Abbreviation: NSAIDs= nonsteroidal anti-inflammatory drugs