A 31-year-old man presented to the emergency room of the otorhinolaryngology department with a 3-month history of difficulty in breathing through the left nostril together with protrusion of the eyeball. On the day before, cranial computed tomography elsewhere had shown a partially calcified, destructively spreading mass arising from the left maxillary sinus (Figure a). The investigations after presentation included irrigation cytology of the left nasal cavity. This identified vimentin- and Ki67-positive cells suspicious of malignancy (Figure b). After confirmation of the diagnosis of high-grade osteosarcoma—histologically and by pathological comparison with reference materials (DÖSAK, Basel)—we administered chemotherapy according to the EURAMOS-1 protocol (doxorubicin/cisplatin/MTX), followed by definitive bimodal radiotherapy according to the OSCAR protocol. Restaging showed partial remission, so the residual tumor was resected and the defect reconstructed unilaterally using a transplant from the fibula with microvascular anastomosis. Osteosarcoma of the maxillary sinus is a rare entity that requires individualized interdisciplinary management of the treatment. Nasal irrigation cytology is not a widely used procedure, but in this scenario it proved to be feasible on an outpatient basis, was non-invasive, and pointed swiftly to the correct diagnosis.
Figure.
a) Computed tomography of the head and neck (without contrast medium, coronary reconstruction). Arrow: Partially calcified destructive mass in the left maxillary sinus
b) Cytological demonstration of malignant dells (asterisk) with a double-positive reaction on dual vimentin (red, cytoplasmic signal) and Ki67 immunocytochemistry (brown, nuclear signal)
Acknowledgments
Translated from the original German by David Roseveare.
Footnotes
Conflict of interest statement: The authors declare that no conflict of interest exists.