Dhaneshwor N Singh et al 76 aijoc Sinonasal Teratocarcinosarcoma: Is Minimally Invasive Resection followed by Adjuvant Histology-directed Chemoradiation a Better Alternative to Radical Excision? 1 Dhaneshwor N Singh, 2 Kanwar Sen, 3 Arun K Sharma, 4 Meenakshi Bharadwaj ABSTRACT Sinonasal teratocarcinosarcoma (SNTCS) is a rare, highly malig- nant tumor arising from the primitive embryonic sinonasal tissue or immature pluripotent cells occurring almost exclusively in the sinonasal tract. It is an aggressive tumor with high propensity for locoregional recurrence and mortality. Local recurrence of SNTCS after excision has been reported as high as 45% with a mean recurrence time of 21.3 months. Even though distant metastasis is rare, local recurrence frequently leads to treatment failure and subsequent death. In view of its aggressive behavior, radical excision with or without chemoradiation is advocated as the optimum treatment. Here, we share our experience of SNTCS in a 23-year-old male managed with endoscope-assisted cranio- facial resection followed by histocytology-directed chemotherapy with external beam radiation. He remains disease-free in last 3 years of follow-up. Keywords: Nasal mass, Olfactory neuroblastoma, Sinonasal teratocarcinosarcoma, Teratoid carcinosarcoma. How to cite this article: Singh DN, Sen K, Sharma AK, Bharadwaj M. Sinonasal Teratocarcinosarcoma: Is Minimally Invasive Resection followed by Adjuvant Histology-directed Chemoradiation a Better Alternative to Radical Excision? Int J Otorhinolaryngol Clin 2017;9(2):76-78. Source of support: Nil Confict of interest: None INTRODUCTION Sinonasal teratocarcinosarcoma is a rare highly malig- nant tumor arising from the primitive embryonic sinona- sal tissue or immature pluripotent cells occurring almost exclusively in the sinonasal tract. It is an aggressive tumor with high propensity for locoregional recurrence and mortality. 1 Local recurrence of SNTCS after excision has been reported as high as 45% with a mean recurrence time of 21.3 months. Even though distant metastasis case RepoRt 1 Senior Resident, 2 Consultant and Head, 3,4 Consultant 1-3 Department of ENT, Dr Ram Manohar Lohia Hospital, New Delhi, India 4 Department of Pathology, Dr Ram Manohar Lohia Hospital New Delhi, India Corresponding Author: Dhaneshwor N Singh, Senior Resident Department of ENT, Dr Ram Manohar Lohia Hospital, New Delhi India, Phone: +918794927922, e-mail: ndhaneshwor@gmail.com 10.5005/jp-journals-10003-1270 is rare, local recurrence frequently leads to treatment failure and subsequent death. 2 In view of its aggressive behavior, radical excision with or without chemoradiation is advocated as the optimum treatment. Here, we share our experience of SNTCS in a 23-year- old male managed with endoscope-assisted craniofacial resection followed by histocytology-directed chemo- therapy with external beam radiation. He remains disease-free in last 3 years of follow-up. CASE REPORT A 23-year-old male presented with a 3-month history of gradually progressing nasal obstruction, anosmia, intermittent epistaxis, and fullness of right cheek. Vision was normal and there was no cervical lymphadenopathy. Diagnostic nasal endoscopy revealed a smooth lobu- lated pale to pinkish mass completely filling up the right nostril. Contrast-enhanced computerized tomography showed a heterogeneously enhancing mass filling up the right nasal cavity, nasopharynx extending into maxillary, ethmoid, and sphenoid sinuses, with partial erosion of the lamina papyracea and the cribriform plate. On magnetic resonance imaging, the tumor was found closely abutting to dura at the cribriform area; however, no dural breach was noted (Fig. 1). Moderate vascularity of the mass, deriving its blood supply from both internal maxillary and anterior ethmoidal arteries, was confirmed in angiography. Histopathological examination of punch- biopsy specimen, submitted as multiple punched frag- ments, revealed heterogeneous admixture of epithelial, mesenchymal, and neuroepithelial elements, rendering a diagnosis of “sinonasal teratosarcocarcinoma.” With an informed consent from the patient, “endo- scope-assisted craniofacial resection” was performed under general anesthesia. The tumor had variable consistency, generally firm and fibrous with few friable patches mostly near the cribriform area. It was found adherent to nasal septum and the ethmoid sinus area, confusing the actual site of its origin. The tumor was removed in toto; care was taken near the cribriform area to ensure complete removal of visible tumor avoiding dural injury. Estimated total intraoperative blood loss was around 300 mL.