Abstract
A recurrent mass in the nose can pose diagnostic and therapeutic challenges. Even more so, if it exhibits rapid growth, displays unusual clinical features, is a rare histopathological diagnosis or if the patient is unavailable for regular follow-up. We present a case of a middle-aged retrovirus-positive man who underwent surgical removal of a recurrent nasal mass. Histopathology revealed a diagnosis of low-grade fibromyxoid sarcoma, a rare entity in the sinonasal tract. Immunohistochemistry plays a crucial role in clinching the diagnosis, especially for lesions with fibrous and myxoid components. Early and complete surgical resection diminishes the likelihood of recurrence and metastasis.
Highlights
INTRODUCTIONExamination revealed a polypoidal mass arising from the left lateral nasal wall, completely occluding the left nasal cavity (Fig. 1)
With a clinical suspicion of inverted papilloma, left endoscopic medial maxillectomy was performed with complete clearance
Histopathology was suggestive of spindle cell neoplasm; immunohistochemistry (IHC) showed focally positive smooth muscle actin (SMA), diffusely positive cytokeratin, 8% Ki-67, negative CD34, human melanoma black 45, S-100, anaplastic lymphoma receptor tyrosine kinase and desmin, suggestive of pseudosarcomatous myofibroblastic proliferation
Summary
Examination revealed a polypoidal mass arising from the left lateral nasal wall, completely occluding the left nasal cavity (Fig. 1). The patient was informed about the condition and advised of periodic follow-up and the need for revision surgery in the event of recurrence. He visited the hospital only two months later; the swelling had returned and repeat CECT (Fig. 2) revealed erosion of the posterior maxillary wall. The patient was referred to a higher centre for mucin-4 (MUC-4) marker and molecular testing, as they were not offered at our hospital His relatives confirmed that he had not considered any further management and had expired about six months after maxillectomy
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