Leiomyosarcoma is a malignant smooth-muscle tumour that has a predilection for the gastrointestinal and female genital tract. It is locally fast-spreading and highly aggressive, and the prognosis is poor. We report a rare case of leiomyosarcoma of the maxilla in a patient who sought treatment for maxillary swelling, nasal obstruction with no epistaxis, orbital involvement or cervical lymph node metastasis. The patient underwent subtotal maxillectomy followed by radiotherapy. At present, he is symptom free with no recurrence and under regular follow up.
Mucosal malignant melanoma (MMM) is an aggressive tumour occurring in the upper respiratory tract. It is rare compared to malignant melanoma of the skin. We report a case of a 53-year-old man with left paranasal swelling. A biopsy showed high-grade spindle cell tumour. Subsequently a subtotal maxillectomy was performed. Histopathological examination revealed a hypercellular tumour composed of mixed spindle and epitheloid cells with very occasional intracytoplasmic melanin pigment. The malignant cells were immunopositive for vimentin, S-100 protein and HMB-45. It was diagnosed as mucosal malignant melanoma (MMM). This article illustrates a rare case of MMM where the diagnosis may be missed or delayed without proper histopathological examination that include meticulous search for melanin pigment and appropriate immunohistochemical stains to confirm the diagnosis. Malignant melanoma can mimic many other types of high-grade malignancy and should be considered as a differential diagnosis in many of these instances.
We reported a patient with an extensive benign sinonasal squamous papilloma in the right nasal cavity with involvement of right sphenoid, ethmoid, maxillary sinuses and intracranial extension. This tumour is rare with very few reported cases in the literature of such extensive in nature. The tumour is excised completely with combined endoscopic transnasal and transcranial approaches. The patient remains disease free at a year interval of follow-up.
Malignant melanocytic melanoma is a rare sinonasal malignancy. We present a case report of an elderly lady who presented with epistaxis and intranasal polyps. Computed tomography revealed soft tissue mass in the oropharynx, nasopharynx, left ethmoid and entire maxillary sinus. The mass was removed via endoscopic medial maxillectomy. Histopathology examination revealed sinonasal melanocytic malignant melanoma. At present 17 months postoperatively she is symptom free with no recurrence and under regular follow up.
Carcinosarcoma is a highly aggressive and infiltrative tumor. A finding of this tumor in a paranasal sinus is exceedingly rare. We describe the case of a 61-year-old man who presented with a mass on the left side of his face. The mass was excised via a total maxillectomy with a modified radical neck dissection. Histologic analysis identified a mixture of carcinomatous and sarcomatous components. Within 1 month of surgery, the patient developed a sternal metastasis, and he died within a short period of time. The aggressive nature of this tumor and its metastases demand early diagnosis and prompt treatment.
Extramedullary plasmacytoma is a rare malignant plasma cell tumour. We report an extremely aggressive case of extramedullary plasmacytoma of the right maxillary sinus, which had metastasised to the brain and rib. A 56-year-old man presented with recurrent epistaxis and acute anaemia. Nasendoscopy revealed a medialised medial wall of the right maxilla and a mass occupying the whole nasopharynx. Magnetic resonance imaging revealed a right maxillary tumour with extension to the ipsilateral nasal cavity, nasopharynx, right sphenoid and ethmoidal sinuses. There was an extra-axial brain metastasis. There were metastases to the right parietal region and left eighth rib. Histopathology examination of the maxillary mass revealed abundant plasma cells with kappa-chain restriction. He was planned for four cycles of chemotherapy. Unfortunately, in view of the advanced stage of disease, he succumbed to his disease during the first cycle of chemotherapy.
A retrospective data of 29 patients who underwent various types of maxillectomy from January 1998 till January 2004 in UKM hospital were reviewed. There were 21 males (72%) and 8 females (28%) with mean age of 42 years. Malays were the majority of patients 17 (59%), Chinese 11 (38%) and Indian 1 (3%). Seventeen patients (59%) presented with malignant tumours while 12 patients (41%) with benign tumours. Inverted papilloma (50%) was the commonest benign tumour and squamous cell carcinoma (36%) was the commonest malignancy. Medial maxillectomy was performed in ten patients (35%), total maxillectomy in seven patients (24%), three patients (10%) had near total, three patients (10%) had partial maxillectomy and six patients (21%) underwent inferior maxillectomy.
Inverted papilloma is a rare, benign tumour representing only 0.5 to 4 per cent of all sinonasal neoplasms; its involvement of the middle ear is extremely rare. We present a case of multicentric inverted papilloma in the sinonasal region and middle ear in a 54-year-old man. The patient later developed neck metastasis secondary to malignant transformation of the inverted papilloma in the middle ear.
A method is described for the fabrication of a closed hollow bulb obturator prosthesis using a hard thermoforming splint material and heat-cured acrylic resin. The technique allowed the thickness of the thermoformed bulb to be optimized for weight reduction, while the autopolymerized seal area was covered in heat-cured acrylic resin, thus eliminating potential leakage and discoloration. This technique permits the obturator prosthesis to be processed to completion from the wax trial denture without additional laboratory investing, flasking, and processing.
A 72-year-old man was referred from the surgery department for rehabilitation following surgical resection of Basaloid carcinoma. The first surgical intervention involved the anterior palatal region and was restored with a simple obturator. Two years later further surgery was undertaken to excise a recurrent tumor in the nose and part of the cheek. This resulted in an exposed nasal cavity and maxillary sinus. In addition, there was a small oral aperture composed of thin tissue that stretched to its maximum due to scar formation. The defect was restored with a full thickness skin flap but it subsequently broke down leaving the midface exposed with limited mouth opening due to tissue contraction and scar formation after the flap operation. The defect was rehabilitated with Co-Cr obturator intraorally and a silicone nose retained to the naso-palatal extension of the obturator by a magnet extraorally. This resulted in practically good retention, placement, and adaptation of the two parts of the prosthesis.