Carcinosarcoma Maxillary Sinus: A Rare Case Report with Review of Literature

Carcinosarcoma of maxillary sinus is an extremely rare type of cancer in the head and neck region. It is an aggressive tumor compared with other head and neck malignancies. An 85-year-old male evaluated for left nasal obstruction, swelling at the root of the nose, and epistaxis. On evaluation with nasal endoscopy, computed tomography (CT) and magnetic resonance imaging showed an enhancing proliferative soft tissue mass, involving the left nasal cavity, with destruction of the left frontal bone, extending up to the medial wall of the orbit. Biopsy showed a biphasic tumor with malignant squamous and sarcomatoid areas. He underwent medial maxillectomy and histology report was consistent with carcinosarcoma, with positive margins. Repeat CT showed gross residual disease. The patient was treated with palliative radiotherapy in view of advanced age, multiple comorbidities, and poor performance status and poor general health. He tolerated the treatment well. Surgery with or without adjuvant radiation is the mainstay of treatment. There is no role of adjuvant chemotherapy as of now. Chemotherapy can be tried in neoadjuvant or palliative setting. Radiotherapy can be delivered for postsurgical palliation of local recurrence. Palliative radiotherapy can be offered when no other options are available or not tolerated, or to relieve symptoms, or to treat the metastases, or in case of recurrent disease. There is no evidence for role of immunotherapy or targeted agents in the neoadjuvant or adjuvant setting. Molecular studies may pave way to the future therapeutic options for this rare variant.