1. Metastatic sarcoma to the nasal bone
James Fowler1, BSc & Christopher J. Chin1,2, MD, FRCSC
1 . Dalhousie University, Faculty of Medicine, Saint John, New Brunswick
2. Division of Otolaryngology- Head and Neck Surgery, Saint John, New Brunswick
Case Continued
Background A. C. B.
The patient’s history was significant for HGUPS of the left upper thigh, which was resected in Between 2014 and 2015, she developed five separate lung metastases which were treated with video assisted thoracic surgery (VATS).
Fine needle biopsy of the mass confirmed metastatic HGUPS. After neoadjuvant radiation, it was resected via an open approach.
Soft tissue sarcomas (STS) are neoplasms that affect connective tissue and account for approximately 1% of all human cancers1,2. Primary STS are common in the extremities, especially the legs, but can also occur to a lesser extent in the abdomen, thorax, and head and neck
High Grade Undifferentiated Pleomorphic Sarcoma (HGUPS), once known as Malignant Fibrous Histiocytoma, is one of the most prevalent soft tissue sarcomas in adults1.
Lung metastasis is the most common site for distant disease2. Metastasis to the head and neck is rare.
Figure 1. CT images in the sagittal (A) and axial (B) planes show invasion of the left nasal bone by a soft tissue mass. MRI scan of orbit in the axial plane (C) shows preservation of the orbital fat and musculature A.
Figure 2. Intraoperative photos of the resection. The palpable lesion is marked out in A. Note the excoriated skin from the radiation therapy. In B, the tumour has been resected. Intraoperative frozen sections were negative. A paramedian forehead flap has been used to close the defect.
Discussion
A literature review of PubMed and Embase was performed to determine the prevalence of HGUPS metastases to the head and neck.
No published work was found relating to metastatic HGUPS to the nasal bone. Review revealed two cases of HGUPS metastasis to the scalp, one to the maxillary gingiva, and one to the thyroid gland.
To our knowledge, we present the first reported case of High Grade Undifferentiated Pleomorphic Sarcoma with metastasis to the nasal bone.
Case
A 49-year-old female patient presented to an Otolaryngology- Head & Neck Surgery clinic with swelling in the left medial canthus region. It had been slowly enlarging over the past four months.
On examination, the mass was painful to palpation and seemed to be fixed to the overlying skin. The skin itself was intact and non-ulcerated. The remainder of the head and neck examination, including nasal endoscopy, were unremarkable. B. C.
References:
Delisca, G. O., Mesko, N. W., Alamanda, V. K., Archer, K. R., Song, Y., Halpern, J. L., ... & Holt, G. E. (2015). MFH and high‐grade undifferentiated pleomorphic sarcoma—what's in a name?. Journal of surgical oncology, 111(2),
Weiss, S. W., & Enzinger, F. M. (1978). Malignant fibrous histiocytoma. An analysis of 200 cases. Cancer, 41(6),