Introduction: Teratocarcinosarcoma (TCS) is an extremely rare malignant neoplasm that usually arises
in the nasal cavity. These tumors often present with nasal obstruction or epistaxis.
We review a case report of TCS initially managed by a multidisciplinary surgical and
radiation approach. Our patient subsequently developed a separate intracerebral metastasis.
To our knowledge this is the first case of intracranial metastasis of TCS.
Case Report: A 51-year-old woman presented whose chief complaints were anosmia, nasal airway obstruction,
proptosis of the right eye, and right facial pain. Magnetic resonance imaging (MRI)
showed a right nasal mass involving the maxillary and ethmoid and frontal sinuses
with invasion of the cribriform plate and without dural invasion. Nasal biopsy revealed
a diagnosis of TCS. A combined craniofacial approach was used to achieve a gross total
resection of the tumor. This was followed by adjuvant fractionated radiation therapy.
The patient presented again to our clinic 4 months later with increased headache and
confusion. Imaging revealed a large right temporal dural-based mass. A right temporal
craniotomy was performed and gross total resection of the metastatic TCS was achieved.
The patient is clinically doing well after both surgeries and radiation treatments.
Discussion: Teratocarcinosarcomas are very rare tumors. Almost all TCSs arise from the nasal
cavity or the paranasal sinuses; they are notoriously aggressive and grow very rapidly.
Our case highlights that TCS can lead to intraparenchymal brain metastasis. These
difficult tumors also require a collaborative multidisciplinary approach by neurosurgeons,
otolaryngologists, and radiation oncologists to achieve the best results possible.
The mainstays of treatment are surgical resection and radiation therapy; we have no
evidence of good chemotherapeutic options for both the primary tumor and the metastasis.
