The specimen was interpreted as inflammatory granulation tissue. There was clear response to oral etodolac (400 mg; 3×1) with significant resolution of the lesion without any recurrence. Biopsies were also performed for the skin lesions and subsequently interpreted as leukocytoclastic vasculitis (Figure 8), which was research use characterized with perivascular infiltration of granulocytes (PMN), karrhyorhexis of their nuclei (leukocytoclasia) and damage of the vessel wall, coupled with compromise of the lumen and extravasations of erythrocytes within the dermis (100xHE). Figure 8 Histopathological section of leukocytoclastic vasculitis. Section is characterized with perivascular infiltration of granulocytes (PMN), karrhyorhexis of their nuclei (leukocytoclasia) and damage of the vessel wall, coupled with compromise of the lumen .
.. Patient had no local recurrences at the primary sites; however, had distant metastases to lung, spinal and femoral bones two-years after the first operation as detected with scintigraphy. Patient rejected further chemotherapy and was followed on regular calls for another 6-month until died following increased intracranial edema induced paralysis. DISCUSSION We reported a case, who developed synchronous maxillary sinus fibrosarcoma and gemistocytic astrocytoma of brain. Synchronous malignancies are rare occurrences and, in general, their pathogenesis is unknown. In general, the possible mechanisms for synchronous malignancies may range from heredity, age, a genetic link between the cancers, immunological-, and environmental-state to simply coincidence.
Up to 44% of paranasal sinus malignancies are attributed to occupational exposures, including nickel, chromium, isopropyl oils, volatile hydrocarbons, and organic fibers that are found in the wood, shoe, and textile industries.12 In addition, human papillomavirus can be a cofactor.12 Specific associations found include squamous cell carcinoma in nickel workers and adenocarcinoma in workers exposed to hardwood dust and leather tanning.12 Since the presented case is the first, it is difficult to identify etiology of both tumors. However, the presence of cancer in his family and his occupation may suggest either genetic tendency or occupational exposure as causative factors. No other etiologies or risk factors were identified.
Early diagnosis seems to be the most important factor in the management AV-951 of paranasal sinus malignancies, since the primary cause of death is failure to control local disease. However, in accordance with our case (T4 stage), malignant tumors of the paranasal sinuses are often found to be greatly advanced at the primary site by the time diagnosis is established (~75% patients).12 In that sense, the relative lack of specific symptoms indicating that malignancy is present or lack of awareness and cautious on routine radiographic findings seems to be reasons behind such misinterpretation and delay in diagnosis.