Locally advanced squamous cell carcinoma of the hard palate invading the maxillary sinus with ipsilateral maxillary chromoblastomycosis: Simply a rare coexistence or a causal relationship?

Abstract

Chromoblastomycosis is a rare chronic fungal infection typically affecting the cutaneous regions of the lower extremities, predominantly in male agricultural workers. However, its extracutaneous manifestations, particularly in the maxillary sinus, are exceedingly rare, with only three cases reported in the literature. This case report presents a 59-year-old female with a history of chronic tobacco use, who presented with an ulceroproliferative lesion of the hard palate, later diagnosed as moderately differentiated squamous cell carcinoma (SCC) invading the maxillary sinus. During surgery, necrotic debris in the maxillary sinus revealed chromoblastomycosis on histopathological examination, confirmed by the presence of characteristic sclerotic bodies.

The co-occurrence of maxillary chromoblastomycosis and SCC is unprecedented, raising important questions about their etiological interplay. The fungal infection may have been facilitated by trauma, cortical erosion, and immunosuppression induced by the invasive carcinoma. This case emphasizes the importance of careful intraoperative evaluation and highlights the need for a multidisciplinary approach to manage rare co-pathologies effectively. Postoperative treatment included antifungal therapy with oral itraconazole (400 mg/day) and adjuvant radiotherapy for SCC.

The unique combination of an aggressive malignancy with a rare fungal infection in this patient underscores the importance of detailed documentation and exploration of such atypical presentations. Further studies are required to elucidate potential causative links and to develop evidence-based guidelines for the diagnosis and management of such rare and complex clinical scenarios.