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Updated: Aug 28, 2025

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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High-Grade Biphenotypic Sinonasal Sarcoma: A Case Report.

Sukaina Hasnie1, Chad Glenn1, Jo E G Peterson2

  • 1Department of Otolaryngology, University of Oklahoma, Oklahoma City, Oklahoma, United States.

Journal of Neurological Surgery Reports
|September 16, 2022
PubMed
Summary

Biphenotypic sinonasal sarcoma (BSNS) is typically low-grade, but this case presents a rare high-grade variant. This finding expands the understanding of BSNS and may alter diagnostic and treatment approaches for this skull base neoplasm.

Keywords:
biphenotypicsinonasal sarcomasinonasal tumorsskull base neoplasm

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Area of Science:

  • Oncology
  • Pathology
  • Neurosurgery

Background:

  • Bipheninic sinonasal sarcoma (BSNS) is a rare, recently described entity characterized by low-grade malignancy with neural and myogenic differentiation.
  • Previously, BSNS was often misdiagnosed as other sinonasal tumors, including fibrosarcoma, leiomyosarcoma, and peripheral nerve sheath tumors.
  • The World Health Organization (WHO) recognized BSNS in its 2012 classification of head and neck tumors.

Observation:

  • This report details the first documented case of a high-grade biphenotypic sinonasal sarcoma in a 72-year-old female.
  • The patient presented with extensive skull base erosion, necessitating a combined endoscopic and open surgical approach.
  • Postoperative complications included infection and pneumocephalus, ultimately leading to patient death.

Findings:

  • Histological examination revealed pleomorphic, hyperchromatic cells with high mitotic activity and necrosis, indicative of high-grade malignancy.
  • Immunohistochemical findings differed from previously established standards for BSNS.
  • The tumor invaded adjacent bone structures, suggesting aggressive behavior.

Implications:

  • This case establishes a new category of high-grade BSNS, challenging the previously held notion of its exclusively low-grade nature.
  • The findings necessitate a re-evaluation of the differential diagnosis and management strategies for BSNS.
  • Updated diagnostic criteria and surgical recommendations may be required for this skull base neoplasm.