1、1. Introduction 2. Case 3. Discussion case discussionintroductionSNTCSsino nasal terato carcino sarcoma 80 cases reported case discussionintroductionHistoryVencent J. HyamsDirector of the Otolaryngic Pathology branch of the Armed Forces Institute of Pathology， 1968-1984 Teratoid carcinosarcoma ? Mix
2、ed mesodermal tumour ? Malignant teratoma and blastomas ?1984case discussionintroductionCharacteristicsT1-weighted MR reveals a soft tissue filling the left ethmoid sinus, as uniformly high signal (*), and effusion (white arrowhead) in the left sphenoid sinus. Takasaki, K.,2006Epithelial glandular c
3、arcinoma (at right) and osteosarcoma component (at left). (hematoxylin-eosin, original magnification x40). Smith, S. L.,2008Endoscopic examination showing a left sinonasal tumor in the left middle turbinate. M, middle turbinate; S, nasal septum. Su, Y. Y., 2010CBATreatmentcase discussionintroduction
4、1. Patients generally present with locally advanced-stage disease the highly malignant, aggressive biological behavior the presence of air filled paranasal spaces permits silent growth 2. Distant metastasis of SNTCS is unusual and the most common cause of treatment failure is local recurrence3. Surg
5、ical excision and postoperative radiotherapy has become the most widely accepted therapeutic plan 1. Introduction 2. Case 3. Discussion HPIintroduction discussioncase 42-year-old man Two weeks history of progressive left nasal obstruction and intermittent nasal bleeding Nasal examination showed a mo
6、derately firm, reddish-purple mass in the left meatus Biopsy of the tumor revealed a heterogeneous admixture of epithelial and mesenchymal elements, suggesting SNTCSTeratocarcinosarcoma Teratocarcinosarcoma consists of two components, epithelial and mesenchymal (hematoxylin-eosin, original magnifica
7、tion 200)cT3N0M0MRIintroduction discussioncaseMRI revealed a soft tissue filling the left meatus, maxillary and ethmoid sinus, and effusion in the left maxillary sinusintroduction discussioncasep Anterior craniofacial resectionp IMRT GTV included the residual gross disease in the nasal cavity and pa
8、ranasal sinus CTV-60 includes the GTV with a 510 mm margin, the whole nasal cavity and the involved paranasal sinus CTV-54 a) high-risk local structures (including the whole nasopharynx, lower half of sphenoid sinus, et al)b) lymphatic regions (including ipsilateral lymph node levels IB, II, III and
9、 VA) A 3-mm margin was added to produce PTVsa) PTV-66 was prescribed to 66 Gy with 2.2 Gy/fractionb) PTV-60 was prescribed to 60 Gy with 2.0 Gy/fractionc) PTV-54 was prescribed to 54 Gy with 1.8 Gy/fractionTreatmentFollow-upintroduction discussioncase1. Now 3.5 years have passed since the irradiation therapy2. No severe dry-eye syndrome, and other severe radiation-induced ocular toxicities happened3. No evidence of recurrence or metastasis
