Recurrent Sinonasal Teratocarcinosarcoma Treated with Surgery and Post-operative Intensity Modulated Radiotherapy (IMRT): A Case Report

Background: With only about a hundred published cases at this time, sinonasal teratocarcinosarcoma is a rare disease managed definitively with surgery and adjuvant radiotherapy with concurrent chemotherapy. With no level I evidence, this management has been based on previous case reports, series and systematic reviews. At this time, there is no guideline on how to manage recurrent disease due to limited published cases, and decision on how to treat is extrapolated from management of paranasal carcinomas in general. This study reports a case of a 64 year-old male diagnosed with sinonasal teratocarcinosarcoma who presented with recurrence to neck after 30 months post surgery and adjuvant radiotherapy. Case Presentation: Patient initially presented with nasal obstruction and epistaxis. Rhinoscopy showed a mass on right nasal cavity that revealed teratocarcinosarcoma on biopsy. Computed tomography (CT) scan showed mass on the sinonasal region. Patient underwent craniofacial resection followed by adjuvant radiotherapy to primary site via intensity modulated radiotherapy (IMRT). On follow-up at 30 months, the patient presented with biopsy proven recurrent disease in the neck. Radical neck dissection was done followed by adjuvant chemoradiation Results: Patient is currently undergoing follow-up and surveillance with MRI. Two years on followup, patient presented with asymptomatic temporal lobe necrosis that was managed conservatively with watchful observation. Patient is asymptomatic and disease free for 8 years now. Conclusion: Surgical resection with adjuvant radiotherapy with or without chemotherapy for presence of adverse risk features is reasonable treatment for recurrent sinonasal teratocarcinosarcoma. JC Kennetth M. Jacinto* and Michael Benedict A. Mejia Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines JC Kennetth M. Jacinto, et al., Annals of Medical Case Reports Radiation Oncology Remedy Publications LLC., | http://medcaserep.com/ 2017 | Volume 1 | Article 1017 2 Philippines and even in South East Asia.