Sinonasal Undifferentiated Pleomorphic Sarcoma in Five Patient Cases

Sung-Hee Kim; Min Joo Kim; Bong-Jae Lee; Ji Heui Kim

doi:10.18787/jr.2016.23.2.115

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Kim, Kim, Lee, and Kim: Sinonasal Undifferentiated Pleomorphic Sarcoma in Five Patient Cases

Case Report

J Rhinol 2016;23(2):115-118.

Published online: 10 January 2016

DOI: https://doi.org/10.18787/jr.2016.23.2.115

Sinonasal Undifferentiated Pleomorphic Sarcoma in Five Patient Cases

Sung-Hee Kim, MD, Min Joo Kim, MD, Bong-Jae Lee, MD, PhD, Ji Heui Kim, MD, PhD

Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Address for correspondence: Ji Heui Kim, MD, PhD, Department of Otolaryngology-Rhinology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3710, Fax: +82-2-489-2773, E-mail: jhkim0217@gmail.com

Received 9 April 2015 Revised 2 March 2016 Accepted 22 June 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Undifferentiated pleomorphic sarcoma (UPS) is a rare soft tissue sarcoma of the sinonasal area. Here, we present two primary cases of UPS and three post-irradiation sinonasal UPS cases. Imaging findings were misinterpreted by radiologists as representing other malignant tumors or recurrence of the primary tumor. Our cases indicate that post-irradiation UPS can originate within any part of the radiation field. Treatment outcomes of primary sinonasal UPS seem to be favorable if the tumor is treated ag-gressively, but the outcomes of post-irradiation sinonasal UPS may be poor if appropriate surgical margins cannot be obtained.

Keywords: Undifferentiated pleomorphic sarcoma, Paranasal sinus, Nasal cavity, Radiation.

References

1). Weiss SW, Enzinger FM. Malignant fibrous histiocytoma: an analysis of 200 cases. Cancer. 1978; 41:2250–66.

2). Barnes L, Kanbour A. Malignant fibrous histiocytoma of the head and neck. A report of 12 cases. Arch Otolaryngol Head Neck Surg. 1988; 114:1149–56.

3). Park SW, Kim HJ, Lee JH, Ko YH. Malignant fibrous histiocytoma of the head and neck: CT and MR imaging findings. AJNR Am J Neuroradiol. 2009; 30:71–6.

4). Wang CP, Chang YL, Ting LL, Yang TL, Ko JY, Lou PJ. Malignant fibrous histiocytoma of the sinonasal tract. Head & Neck. 2009; 31:85–93.

5). Sheppard DG, Libshitz HI. Postradiation sarcomas: a review of the clinical and imaging features in 63 cases. Clinical Radiology. 2001; 56:22–9.

6). Arlen M, Higinbotham NL, Huvos AG, Marcove RC, Miller T, Shah IC. Radiation-induced sarcoma of bone. Cancer. 1971; 28:1087–99.

7). Goldblum JR, Folpe AL, Weiss SW. Undifferentiated Pleomorphic Sarcoma. Goldblum JR, editor. editor.Enzinger and Weiss's Soft Tissue Tumors. 6th ed.Philadelphia: Elsevier;2013. p. 421–40.

8). Guillou L, Folpe AL. Fibroblastic and Fibrohistiocytic Tumors. Folpe AL, editor. editor.Bone and Soft Tissue Pathology. Philadelphia: Saunders & Elsevier;2010. p. 43–96.

9). Agaimy A, Gaumann A, Schroeder J, Dietmaier W, Hartmann A, Hofstaedter F, et al. Primary and metastatic high-grade pleomorphic sarcoma/malignant fibrous histiocytoma of the gastrointestinal tract: an approach to the differential diagnosis in a series of five cases with emphasis on myofibroblastic differentiation. Virchows Arch. 2007; 451:949–57.

10). Shahoon H, Esmaeili M, Nematollahi M. Eight-year Follow-up of Malignant Fibrous Histiocytoma (Undifferentiated High-grade Pleomorphic Sarcoma) of the Maxilla: Case Report and Review of the Literature. J Dent Res Dent Clin Dent Prospects. 2009; 3:32–5.

11). Vuity D, Bogdan S, Csurgay K, Sapi Z. Malignant fibrous histiocy-toma/undifferentiated high-grade pleomorphic sarcoma of the maxillary sinus: report of a case and review of the literature. Pathol Oncol Res. 2013; 19:605–9.

12). Blitzer A, Lawson W, Zak FG, Biller HF, Soon ML. Clinical-pathological determinants in prognosis of fibrous histiocytomas of head and neck. Laryngoscope. 1981; 91:2053–70.

13). Weber RS, Benjamin RS, Peters LJ, Ro JY, Achon O, Goepfert H. Soft tissue sarcomas of the head and neck in adolescents and adults. Am J Surg. 1986; 152:386–92.

14). Rodrigo JP1. Fernández JA, Suárez C, Gómez J, Llorente JL, Herrero A. Malignant fibrous histiocytoma of the nasal cavity and paranasal sinuses. Am J Rhinol. 2000; 14:427–31.

15). Park SW, Kim HJ, Lee JH, Ko YH. Malignant fibrous histiocytoma of the head and neck: CT and MR imaging findings. AJNR Am J Neuroradiol. 2009; 30:71–6.

16). Bentz BG, Singh B, Woodruff J, Brennan M, Shah JP, Kraus D. Head and neck soft tissue sarcomas: a multivariate analysis of outcomes. Ann Surg Oncol. 2004; 11:619–28.

17). Jang TY, Kim CH, Kim YM, Chu YC. Two cases of malignant fibrous histiocytoma in the nasal cavity and paranasal sinus. J Rhinol. 1998; 5:72–5.

18). Seo BS, Choi SJ, Jang YJ, Chung YS, Lee BJ. Recurrence patterns of the maxillary sinus cancer after total maxillectomy. J Rhinol. 2008; 15:39–43.

19). Hsu HC, Huang EY, Wang CJ. Treatment results and prognostic factors in patients with malignant fibrous histiocytoma. Acta Oncol. 2004; 43:530–5.

20). Le Doussal V, Coindre JM, Leroux A, Hacene K, Terrier P, Bui NB, et al. Prognostic factors for patients with localized primary malignant fibrous histiocytoma: a multicenter study of 216 patients with multivariate analysis. Cancer. 1996; 77:1823–30.

Fig. 1.

A bulky soft tissue mass in the right maxillary sinus with destruction of the maxillary walls and extension to the buccal space in gadolinium-enhanced T1-weighted MR image of primary UPS.

Fig. 2.

Heterogeneously enhancing large mass with bony destruction of the maxillary walls and nasal cavity in CT scan (A) and MR image (B) of post-irradiated UPS.

Fig. 3.

Histopathology of radiation-induced undifferentiated pleomorphic sarcoma. The tumor consists of mixed spindle cells and roundedcells arranged in a stori-form pattern. A: Hematoxylin-eo-sin (×400). B: Negative staining for cytokeratin by immunohistochemistry (×400).

Table 1.

Clinical features of the current series of undifferentiated pleomorphic sarcoma of the sinonasal tract

No.	Sex/age (years)	Primary/ PIUPS	Primary tumor	Location	T stage	Treatment	Outcome
1	M/41	Primary		ES and MS	T2	S+ RT	NED
2	F/58	Primary		MS	T2	S+ RT	DOD
3	M/30	PIUPS	Olfactory neuroblastoma	ES	T1	S	NED
4	F/47	PIUPS	Undifferentiated carcinoma of the nasopharynx	Nasopharynx	T2	S+ CT	DOD
5	F/49	PIUPS	SCC of MS	MS and NC	T2	RT	AWD

PIUPS: post-irradiated undifferentiated pleomorphic sarcoma, F: female, M: male, SCC: squamous cell carcinoma, MS: maxillary sinus, NC: nasal cavity, S: surgery, RT: radiation therapy, CT: chemotherapy, AWD: alive with disease, NED: no evidence of disease, DOD: dead of disease

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