Locally Advanced Oncocytic Carcinoma of the Nasal Cavity Treated With Surgery and Intensity-modulated Radiotherapy

Abstract

Oncocytic carcinomas of the nasal cavity are extremely rare. We report 1 patient whose primary tumor and neck lymphadenopathies were under control nearly 2 years after combined surgery and radiotherapy. An 80-year-old man with a history of nasal oncocytoma had received excision twice previously. Computed tomography demonstrated locally advanced recurrent tumor invading the paranasal sinuses and orbit with lymphadenopathies in the right neck. Skull base surgery was performed. Pathological examination revealed oncocytic carcinoma. Positron emission tomography showed hypermetabolic lesions in the surgical bed and right neck. The patient subsequently received intensity-modulated radiotherapy to the primary site and the whole neck. Follow-up computed tomography 4 months later showed marked shrinkage of the neck lymphadenopathies. There was no progression after nearly 2 years. Although these tumors have historically been regarded as radioresistant, the combined treatment of surgery followed by radiotherapy may offer the best chance for control of locally advanced disease.

Nasolacrimal Duct Obstruction Caused by Oncocytic Carcinoma

“…Due to the rarity of these tumors affecting nasal cavity and nasolacrimal duct, the pattern of clinical behavior and long-term follow-up is difficult to predict. However, postoperative radiation therapy has been demonstrated to reduce local recurrence rates in parotid gland malignancies and previous case reports [3,17,19]. We hypothesize that delayed radiotherapy may explain the local recurrence in the present patient.…”

A systematic review of sinonasal oncocytomas and oncocytic carcinomas: Diagnosis, management, and technical considerations

“…There were 9 cases of oncocytomas, including the current case, and 12 cases of oncocytic carcinomas (Table ). Three of the 12 cases of oncocytic carcinomas were initially described as oncocytomas and recurred as oncocytic carcinomas . Of the total 21 cases, there was a male predominance (3:2, 60%) with an average age of 61.3 ± 15.8 years at diagnosis (range, 23–84 years).…”

“…These diseases have varying courses, ranging from limited sinonasal involvement with surgical resection to multiple recurrences and metastases with both surgery and radiotherapy employed. In addition to involvement of the sinonasal space, 3 cases had regional lymph node involvement (14%) . Furthermore, regional metastasis occurred in 2 cases, specifically with the involvement of skin and subcutaneous tissue, (9%) and distant metastasis was present in only 1 case (5%) .…”

Skull base oncocytoma presenting as epistaxis: an unusual presentation of a rare tumour successfully managed with active surveillance

“…They are most frequently found in the parotid gland, but also rarely occur in endocrine system (thyroid, parathyroid and adrenal glands), buccal mucosa, breast, kidney, upper aerodigestive tract, ovary and the nasolacrimal system 3 4. Their occurrence within the nasal cavity is rare and they may exhibit either benign2 3 5 6 or malignant7 8 characteristics. Diagnostic criteria have been developed for malignant oncocytomas which include the invasion into and destruction of adjacent structures; perineural, intravascular or lymphatic invasion; local lymph node involvement of distant metastases 2.…”

“…Management of oncocytomas differs depending on the nature, ranging from simple excision in benign cases, to adjuvant therapies such as intensity-modulated radiotherapy in malignant cases 7. From a surgical perspective, excision can be performed either intranasally of, where necessary, through craniofacial approaches such as a Le Fort I osteotomy and CO 2 laser excicion as described by Colveary et al 6 depending on the anatomical location.…”