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sinonasal teratocarcinosarcoma ( sntcs ) is a distinctly rare tumor characterized by variegated histologic features and has combination of both epithelial and mesenchymal components .
malignant tumors which consisted of carcinoma and teratoma were previously reported as teratoid carcinoma , malignant teratoma , blastomatous tumors , and blastoma .
it was first described by shanmugaratnam et al . in 1983 and was aptly termed as " teratocarcinosarcoma " by heffner and hyams in 1984 . probably , this is the first case report of sntcs from eastern india . by reported accounts ,
a 60-year - old man presented with occasional bleeding from nose and nasal obstruction for last two months .
x ray of paranasal sinus showed a mass in the posterior nasal cavity . a computed tomography ( ct ) scan revealed a solid tumor with isodensity .
the mass was in the posterior nasal cavity and nasopharyngeal wall extending into left ethmoidal sinus [ figure 1 ] .
diagnostic imaging suspected of sinonasal malignancies such as poorly differentiated carcinoma , adenocarcinoma , and malignant lymphoma .
ct scan showing a mass involving the left paranasal sinus and ethmoid sinus the patient was operated with all antiseptic measures under general anesthesia during caldwell - luc operation .
cheek was retracted and an incision was made above the canine teeth in the buccogingival sulcus .
it was about 3 - 5 cm long and was placed high enough to prevent damage to the dental roots .
a part of the anterior wall of left antrum was removed with a chisel and hammer to make an opening allowing an access into the antral cavity .
multiple gray - white tissue bits , largest measuring 3.5  3  2.5 cm received grossly for histopathological examination .
the epithelial portion of the tumor was composed of benign and malignant squamous epithelium , glandular structure , and primitive neuroectodermal / blastemal cells [ figures 2 and 3 ] .
teratoid components included this " fetal appearing " clear cell squamous epithelium and primitive neuroectodermal / blastemal cells . in the mesenchymal components ;
mib1 ( ki 67 ) positivity was detected in 25% of the mesenchymal components and 37% of the epithelial components of the malignant tumor , whereas the clear cell epithelia revealed mib1 ( ki67 ) positivity in 5% of cells .
a whole body ct scan was done at six months interval to detect any recurrence or metastasis .
follow - up examination for two years after combined surgery and radiotherapy has shown no evidence of recurrence or metastasis .
photomicrograph showing fetal appearing ( clear ) squamous epithelial cells , glandular components , and primitive neuroectodermal / blastemal cells in the background .
[ h and e ,  100 ] photomicrograph showing malignant epithelial cells arranged in glandular pattern .
malignant tumors having teratoma and carcinoma were reported previously as teratoid carcinoma , malignant teratoma , or blastematous tumors . heffner and hyams in 1984 first suggested the tumor to be called as teratocarcinosarcoma in order to describe the complex histological pattern of these neoplasms .
histologically , it is different from true carcinosarcoma which consists of a single malignant epithelial and a single malignant mesenchymal component , whereas sntcs has one or many epithelial and mesenchymal components ( both benign and malignant).- variegated architecture and tissue heterogeneity are characteristics of this malignancy .
fetal - type " clear cells , squamous epithelium , and immature neuroepithelium represent important histologic characteristics useful in diagnosis .
though immature neuroepithelium ( primitive neuroectodermal / blastemal ) was present , differentiated neuroepithelial cells with rosette formation were not evident . despite several studies ,
heffner and hyams postulated that the tumor originates from olfactory membrane due to presence of neural tissue .
some authors believe that sntcs probably originates from primitive embryonic tissue or immature pleuripotential cells . a histogenetic origin from a multipotential adult somatic stem cell with divergent differentiaton has been favored over a germ cell origin .
this assumption has been based on the lack of germ cell elements and , until recently , the absence of demonstrable amplification of 12p in tumor cells .
tumor cells showing squamous cell differentiation were characterized by desmosome - like junction and intracellular tonofilaments . some of the stromal spindle cells had actin filaments with dense patches and dense core granules .
shubhada et al . , observed chemotherapy - induced neuronal maturation in sinonasal teratocarcinosarcoma . in that case , the tumor was excised after four cycles of neo - adjuvant chemotherapy . on microscopic examination
this case highlighted morphologic evidence of chemotherapy - induced maturation in the neuroectodermal component within sntcs . in a study by budrukkar et al . , disease recurred in 11 out of 14 patients , with a median time to recurrence of seven months .
multimodality treatment , in the form of a combination of surgery , radiation therapy , and chemotherapy , appears to be the optimal approach . a combination of radiotherapy and surgical treatment offers the best five - year survival rate ( 50% ) ; followed by only surgical treatment ( 47% ) . in the recurrent or metastasis lesion
, adjuvant chemotherapy may improve the survival rate since the metastatic tissue often contains sarcomata components .
sinonasal teratocarcinosarcoma ( sntcs ) is a very rare and aggressive malignant neoplasm histologically characterized by the combination of one or many components of epithelial and mesenchymal elements . here 
 , we report a sntcs in a 60-year - old man involving posterior nasal and nasopharyngeal wall extending into left ethmoidal sinus . the patient complained of bleeding from nose , nasal obstruction , and generalized weakness for last two months . 
 tumor was completely removed by caldwell - luc operation and postoperative radiation therapy was given . 
 the follow - up of the patient for two years has shown no evidence of recurrence or metastasis .