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CASE REPORT |
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Year : 2015 | Volume
: 5
| Issue : 3 | Page : 184-186 |
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Mucoepidermoid carcinoma of the nasal cavity mimicking a simple nasal polyp
Tokan Silas Baduku1, Saadatu Ladan2, Mainasara Mohammed2, Joshua Jibrin2
1 Department of Radiology, Kaduna State University, Kaduna, Nigeria 2 National Ear Care Centre, Kaduna, Nigeria
Date of Web Publication | 19-Oct-2015 |
Correspondence Address: Dr. Tokan Silas Baduku Department of Radiology, Kaduna State University, Kaduna Nigeria
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/2278-9596.167519
Mucoepidermoid carcinoma (MEC) of the sinonasal area is very rare and frequently misclassified. We report a 43-year-old woman who presented with persistent nasal blockage, epistaxis, progressive right cheek swelling and ipsilateral proptosis. The affected eye's vision was low, to identifying only fingers at 6 m. She also had hypoesthesia over the right cheek and distortion of the ipsilateral external nasal pyramid. There was also a fleshy mass filling the right nasal cavity, causing the deviation of the nasal septum to the contra-lateral side. A diagnosis of a malignant nasal mass was made. Following the nasal polypoidal mass biopsy a histological diagnosis of MEC was made. The patient had complete evaluation including computed tomography scan of the sinuses and underwent extensive surgical resection and postoperative radiotherapy. The patient is doing well on follow-up. Keywords: Mucoepidermoid carcinoma, nasal polyp, sinonasal carcinoma
How to cite this article: Baduku TS, Ladan S, Mohammed M, Jibrin J. Mucoepidermoid carcinoma of the nasal cavity mimicking a simple nasal polyp. Arch Int Surg 2015;5:184-6 |
Introduction | | |
Mucoepidermoid carcinoma (MEC) is a common malignant neoplasm of the salivary gland, with the parotid being the main site of occurrence. [1] However, the sinonasal location of this tumor is extremely rare, [2] constituting only 0.6% of all MECs. [3] Mucoepidermoid carcinoma is defined by the WHO as a malignancy consisting of mucous-secreting squamous and intermediate cell types, usually arising from the squamous, mucus-secreting cells of the salivary glands, but can also be found in other organs such as the lacrimal sac, larynx, lungs, thyroid, and the sinonasal tract. [1] The management of MEC depends on its grade, location and the extent of spread. Early diagnosis gives a better prognosis. Also, a low-grade tumor will generally have a good prognosis compared with a high-grade tumor. Treatment options include surgery, radiation therapy, and chemotherapy. A combination of these will produce more excellent results.
We present the case of a 43-year-old female with sinonasal MEC that mimicked a simple nasal polyp, but histology gave a diagnosis. She was successfully operated upon and subsequently referred for radiotherapy.
Case Report | | |
A 43-year-old female presented with a 4-year history of recurrent rhinorrhea, and 3-year history of bilateral alternating nasal blockage, worse in the right nasal cavity, which had become persistent 6 months prior to the presentation. She had associated blood-tinged nasal discharge, postnasal drip, hyposmia, and hyponasal speech. She is a known hypertensive on antihypertensive medication and neither smokes cigarette nor ingests alcohol. Initial assessment revealed insensitive polypoidal masses filling both nasal cavities that were not friable and had no contact bleeding.
She was sent to the Radiology Department for sinus radiographs and computed tomography (CT) sinuses during which she absconded for 2 years after which she reappeared. She represented with persistent nasal blockage, epistaxis, progressive right cheek swelling and ipsilateral proptosis. The affected eye's vision was low, to identifying only fingers at 6 m. She also had hypoesthesia over the right cheek and distortion of the ipsilateral external nasal pyramid. There was also a fleshy mass filling the right nasal cavity, causing the deviation of the nasal septum to the left. There was also tenderness over the right maxillary dentition, but no loose teeth, or palatal bulge were demonstrated. No cervical lymphadenopathy was seen.
Plain radiographs showed opacification of all the paranasal sinuses and the nasal cavities, more extensive to the right. CT showed isodense, poor contrast enhancing masses infiltrating the sinuses and the nasal cavities. There was an erosion of the frontal, maxillary and nasal bones on the right side, with mid-line deviation to the contra-lateral side [Figure 1]. The retro-antral fat, pterygoids and the base of skull were intact. | Figure 1: Axial slice showing isodense, poor contrast-enhancing tumor invading the sinuses and nasal cavities and also eroding the facial bones
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The patient had a wide exenteration of the tumor via an endoscopic approach and was referred for radiotherapy. Histology showed an infiltrating tumor growing in singles, sheets, tubules and trabeculae. It was composed of epithelial cells with dark round nuclei, variable amounts of amphophilic to clear cytoplasm. The stroma was lionized and collagenous. The conclusion was a mucoepidermoid carcinoma (MEC).
She was referred to the oncology unit where she had radiochemotherapy. Follow-up visits to our clinic for the last 8 months showed a stable middle-aged woman. She is still being followed-up.
Discussion | | |
Sinonasal malignancies account for <1% of all cancers and <3% of all upper aerodigestive tract tumors. [4] The National Ear Care Centre, which is a foremost referral center mainly for such illnesses, is reporting this case of MEC. To the best of our knowledge, there is no documented case of sinonasal MEC in Africa in the available English literature. MEC is thought to arise from the mucoserous glands lying within the mucosa, below the respiratory type epithelium of the nasal cavity and paranasal sinuses. However, MEC in these anatomic sites is uncommon, accounting for only 0.6% of malignant neoplasms in this region. [5] MEC is the most frequent salivary gland malignant tumor, affecting mainly the parotid glands. [4] Its origin is the epithelium of the glandular excreting ducts lining the larynx, vocal cords, trachea, lungs, lacrimal glands, nasopharynx, and the sinonasal tracts. [6]
When the tumors occur in the sinonasal tract, the most common site is the maxillary antrum. Other sites include the nasal cavity, nasopharynx and ethmiodal sinuses. This pattern probably reflects the relative distribution of minor salivary glands in this area of the upper aero-digestive tract. [7] Our patient presented with a nasal mass. CT showed the extensiveness of the mass in the right maxillary sinus. The adjoining bones were also eroded. This is similar to other reports and is due to a late presentation by the patient.
The incidence of MEC is about equal in both sexes, with a wide occurrence at 15-75 years. The peak incidence is between the fourth and fifth decades. [8] Our patient presented within the period of peak incidence. However, MEC of the lungs have been reported in the first decade of life. [2],[9] According to combined reports of four large series of major and minor salivary gland tumors at different centers, sinonasal MEC accounts for 0.6% of all salivary tumors. [10] Patients with sinonasal MEC present with a mass within the nasal cavity or sinus. The majority of the patients show obstructive symptoms, difficulty in breathing and chronic sinusitis. Other symptoms include pain, proptosis, diplopia, and epistaxis. Our patient presented with these symptoms probably because of delayed presentation.
Conclusion | | |
Sinonasal MEC is a rare tumor entity. Though rare, it should be considered among the differentials of nasopharyngeal tumors. Histology is required to confirm the diagnosis while the tumor responds well to surgical resection and radiochemotherapy.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References | | |
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[Figure 1]
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