An alternative therapeutic procedure for sinonasal undifferentiated carcinoma

We describe two cases of sinonasal undifferentiated carcinoma, a rare and highly aggressive neoplasm of the paranasal sinuses. Case 1 had first been diagnosed as esthesioneuroblastoma, and intra-arterial and systemic chemotherapy and radiotherapy were performed. The tumor became smaller but did not disappear, and the patient died 2 months later. Case 2 received systemic chemotherapy and chemoradiotherapy, with daily venous administration of cisplatin during radiotherapy. The tumor became much smaller but also remained, and the patient died a month later. Although the therapy failed, chemoradiotherapy has some possibility of controlling the disease. Received: 15 February 2001 / Accepted: 10 April 2001     

Sinonasal undifferentiated carcinoma and esthesioneuroblastoma recurring as nonintestinal adenocarcinoma

Numerous distinct neoplasms are encountered at the anterior cranial base. Management of these primary tumors and their locoregional recurrences are dictated by the histopathologic diagnosis. We present two unusual cases of extra‐axial anterior cranial base malignancies with locoregional recurrence where the recurrent tumor encountered was of a distinct histopathologic type. While rare, this report highlights the possibility of encountering a distinct tumor type in the posttreatment surveillance of patients with anterior cranial base malignancies.     

Parotid carcinoma: impact of clinical factors on prognosis in a histologically revised series

OBJECTIVE: To analyze clinical data and possible prognostic factors of patients with primary carcinoma of the parotid gland. STUDY DESIGN: A retrospective study was made of 85 patients with suspected parotid cancer who were admitted to the Center of Head and Neck Oncology at Odense University Hospital (Odense, Denmark) from 1975 to 1994. METHODS: Patient records were retrospectively reviewed and tabulated for relevant clinical parameters. A complete revision of histological examination was performed by the same pathologist and the tumors were classified according to the 1991 international guidelines from the World Health Organization. Five tumors (6%) did not fulfill the criteria of malignancy and were reclassified as benign. In another five cases the assumed primary parotid carcinomas were found to be metastatic disease from cancers of the breast, prostate, skin, and lungs. Ten patients (12%) were excluded from the analysis, leaving 75 individuals for the study. RESULTS: Twenty-four percent of patients were classified as T1, 32% as T2, 15% as T3, and 28% as T4. One patient (1%) was not classifiable (TX). Regional lymph node metastases were found in 17 cases (23%). Two of these were classified as N1 (3%), 2 as N2A (3%) and 13 as N2B (17%). Four patients were registered as not classifiable (NX) (5%). No patients were classified as N3. Distant metastases were found in four patients (5%) (one patient had bone and liver metastases and three patients had lung metastases). Five-year recurrence-free survival of the entire study group was 63%, disease-specific survival was 69%, and crude survival was 52%. In univariate analysis, tumor size, histological appearance, T status, stage, the presence of lymph node metastases, distant metastases, pain, and facial nerve dysfunction had a significant influence on survival. CONCLUSIONS: A thorough histological revision is pivotal in retrospective parotid carcinoma studies, and tumor size; histological appearance; T, N, and M status; stage; facial nerve dysfunction; and pain from the face and/or neck seem to be significant prognostic indicators for patients with primary parotid carcinoma.     

Relationship between 18FDG-PET and different types of sinonasal malignancies

Conclusion: The sensitivity and specificity of a ¹⁸FDG-PET scan may be different according to the histology. The SUV_max and SUV ratio may reflect the tumor’s aggressive behavior.

Objectives: To describe the characteristics of PET/CT scans, including the maximum standard uptake values (SUV_max), at initial diagnosis according to six main types of sinonasal malignancies: sinonasal adenocarcinoma (SNAC), sinonasal undifferentiated carcinoma (SNUC), adenoid cystic carcinoma (ACC), sinonasal malignant melanoma (SMM), olfactory neuroblastoma (ONB), and sinonasal neuroendocrine carcinoma (SNEC).

Methods: A chart review of 50 patients who were diagnosed and treated for six sinonasal malignancy types over a period of 6 years was conducted. Any ¹⁸F-FDG PET/CT scans for each patient were searched using the hospital’s intranet. The SUV_max of the primary sinonasal site was recorded. The liver SUVs were utilized as reference SUVs. The SUV ratio was defined as the ratio of the SUV_max of the primary tumor and the SUV_liver.

Results: The most common malignancy was SNAC (32%), followed by SNUC (24%), ONB (14%), ACC (10%), SMM (10%), and SNEC (10%). The SUV_max and SUV ratio values were significantly different between tumor types (p?=?0.002 and 0.012, respectively). SNUC had the highest mean SUV_max (14.2), followed by SNAC (9.9). A similar mean SUV_max was observed for SMM, ONB, and ACC (～ 7.0). SNEC up-takes the least ¹⁸FDG among these six tumor types (mean SUV_max?=?4.7).     

Adenoid cystic carcinoma of the sinonasal tract: treatment results

OBJECTIVES: Malignancies arising from the sinonasal tract, which includes the nose, paranasal sinuses, and nasopharynx, are uncommon. Although adenoid cystic carcinoma (ACC) is the second most common cancer occurring in the sinonasal tract, only few studies have been reported. This retrospective review was performed to identify the clinical features and treatment outcomes of sinonasal ACC. METHODS: Thirty-five patients diagnosed and treated for ACC of the sinonasal tract were included in this study. Medical records, radiographs, and pathologic slides were retrospectively reviewed. RESULTS: In two thirds of the patients, the maxillary sinus was the site of origin and cribriform was the most common histologic subtype (61%). Seventy-one percent of the patients had advanced disease (T3, T4) at the time of diagnosis. Five-year overall survival rate was 86% and treatment failure occurred in 18 patients (51%). Five-year local recurrence rate and distant metastasis rate were 30% and 25%, respectively. Adjunctive radiotherapy appeared to reduce local recurrence. Presence of distant metastasis correlated with decreased 5-year survival (P = .001). Five-year survival rate after development of distant metastasis or local recurrence were 17% and 58%, respectively. CONCLUSIONS: Based on our findings, we suggest that sinonasal ACC be treated by a combined modality of radical surgery followed by postoperative radiation. The prognosis of sinonasal ACC seems to be determined by the presence of distant metastasis.     

SMARCB1(INI-1)缺失性鼻腔鼻窦癌的病理临床特征分析

目的 总结SMARCB1(INI-1)缺失性鼻腔鼻窦癌(SDSC)的临床特征、组织形态、免疫组化表达、诊断、鉴别诊断、治疗及随访状况,提高对该病的认识水平。方法 对深圳大学总医院诊治的1例SDSC患者的临床及病理相关资料进行整理,回顾性分析相关文献。结果 患者TNM分期为T3N0M0;CT和MRI显示右侧鼻腔及筛窦内占位,伴骨质破坏;组织学见肿瘤细胞形态较为一致,伴轻度多形性,呈上皮样或基底细胞样形态,核分裂像较易见,未见明显鳞状或腺样分化特征,肿瘤周边可见少许残留的正常黏膜上皮;免疫组化染色分析见肿瘤细胞INI-1细胞核表达完全缺失。结论 SDSC是鼻窦未分化癌的一种新亚型,较为罕见;具有高度侵袭性,易复发、早期转移、预后差等特点;形态学分化差的鼻腔鼻窦癌行INI-1免疫组化检测,有助于该亚类的准确诊断;术前TPF(多西他赛+顺铂+5-氟尿嘧啶)化疗方案促使病灶缩小,有助于根治性手术切除。     

A Clinicopathological Study of Sinonasal Neuroendocrine Carcinoma and Sinonasal Undifferentiated Carcinoma

Objective Sinonasal undifferentiated carcinoma (SNUC) and sinonasal neuroendocrine carcinoma (SNEC) are relatively newly recognized, rare entities requiring further clinicopathological analysis to advance our understanding and determine prognostic distinctions between them. Study Design Retrospective chart review. Methods Cases were retrieved from the Copath system. One patient was seen in consultation from an outside institution. Histological and immunohistochemical findings, patient demographics, treatment regimens, and outcomes were analyzed and compared. Results Ten patients (7 men, 3 women) ranging in age from 17 to 58 years (mean age, 44.7 y) were included. Four patients were classified with SNEC, six as having SNUC. The predominant site was the superior nasal cavity or ethmoids (seven cases), followed by the maxilla (four cases). Disease in four patients was clinically staged as N1 (three with SNUC, one with SNEC), and in six patients as N0 (three with SNEC, three with SNUC). Of the nine patients who were treated initially with surgical resection, seven received postoperative radiation therapy alone, one received postoperative radiation and chemotherapy, and one had only limited postoperative chemotherapy. One patient was treated with radiation therapy and chemotherapy alone, without surgical resection. Follow‐up was obtained ranging from 6 to 108 months (mean period, 26.4 mo). Three patients died of disease 10, 14, and 41 months, respectively, after diagnosis. Three patients had persistent disease at 6, 9, and 21 months, respectively, two of them with distant metastases. Four patients were disease free after 6, 18, 31, and 108 months, respectively. Conclusions SNUC and SNEC are both aggressive tumors, usually presenting in middle age as a nasal mass. Both tumors have the capacity to metastasize locally and distantly, and both can result in poor outcomes. This small series precludes a demographic or prognostic distinction between the two groups.     

Desmoglein 3 is overexpressed in inverted papilloma and squamous cell carcinoma of sinonasal cavity

Objectives/Hypothesis:

We sought to investigate the role of desmoglein 3 in pathogenesis of sinonasal inverted papilloma (IP) and its malignant transformation.

Methods:

Fifteen subjects with sinonasal IP and 15 subjects of normal sphenoid sinus mucosa were enrolled. Each specimen was divided into two portions: one for mRNA expression analysis by real‐time polymerase chain reaction, and the other for detection of targeted proteins by immunohistochemistry analysis. In addition, another 10 cases of IP with squamous cell carcinoma (SCC) were added for immunohistochemistry analysis.

Results:

The mRNA expression level of desmoglein 3 was significantly higher in IP tissues than in the normal sinus mucosa (P < .001). In immunohistochemistry study, desmoglein 3 was detected in plasma membrane areas of IP and IP with SCC tissues, but no obvious expression was found in normal sinus mucosa (total score; both P < .001). Positive desmoglein 3 staining was strongly present in nearly all malignant transformation areas of IP with SCC cases (90%), but only in scattered areas of some cases of IP (53%) (total score; P < .001).

Conclusions:

Desmoglein 3 was overexpressed in IP and IP with SCC, and the overexpression was correlated with malignant transformation of IP. It may provide valuable insight into the pathobiology of this disease, and can potentially provide a venue to predict malignant transformation in sinonasal IP. Laryngoscope, 2010     

Case report: HPV‐related carcinoma with adenoid cystic‐like features of the sinonasal tract

Human papillomavirus‐related carcinoma with adenoid cystic‐like features is a newly described histologic variant of sinonasal tract carcinoma. The implications of this sinonasal malignancy is still being evaluated. There are a limited number of cases reported in the literature, and thus we seek to further characterize this patient population and review the histologic features of this malignancy with the following two cases. The behavior of this entity is as yet uncertain. Laryngoscope, 128:1515–1517, 2018     

CD4+CD25+Foxp3+调节性T细胞在鼻腔鼻窦鳞状细胞癌中的表达和免疫抑制功能研究

目的　分析鼻腔鼻窦鳞状细胞癌中CD4+CD25+Foxp3+调节性T细胞的表达数量,并评估其免疫抑制功能。方法　入选鼻腔鼻窦鳞状细胞癌患者（均为T1-2N0M0）和正常对照者各15例,分别采集研究对象外周血标本、患者肿瘤组织及正常对照者鼻黏膜组织。应用流式细胞术分析组织匀浆和外周血中调节性T细胞、Th1细胞和Th2细胞数量。免疫组化染色计数局部组织内调节性T细胞数量。将外周血调节性T细胞与外周血效应性T细胞共培养,72 h后采集细胞培养上清液,应用ELISA方法检测IFN-γ和IL-4水平,比较两组患者调节性T细胞的免疫抑制功能。结果　鳞癌组肿瘤组织内调节性T细胞、Th2细胞数量显著高于正常鼻黏膜,而Th1细胞数量显著降低。与正常对照组相比,鳞癌组患者外周血中调节性T细胞增加,Th1细胞减少,Th2细胞无显著差异。外周血调节性T细胞对Th1细胞的抑制功能在鳞癌组较正常对照组增强。结论  鼻腔鼻窦鳞状细胞癌肿瘤组织内和外周血中的调节性T细胞数量升高、对Th1细胞免疫抑制能力增强。调节性T细胞参与鼻腔鼻窦鳞状细胞癌的肿瘤局部免疫和全身免疫调节,可作为预后的生物学指标之一。     

Programmed death ligand-1 expression is associated with stage and histological grade of parotid carcinoma

Abstract

Background: The immune checkpoint ligand programmed death ligand-1 (PD-L1) is expressed by various cancers, including those of the head and neck. However, the role of PD-L1 is still unknown.

Objectives: To investigate the relationship between PD-L1 expression and survival rate in parotid carcinoma.

Methods: PD-L1 expression was investigated by immunohistochemical analysis in 127 patients with parotid carcinoma. The relationship between PD-L1 expression and stage, histological grade, and survival was assessed.

Results: PD-L1 expression was found in 28.3% of parotid carcinomas, with the expression being higher in tumors with a higher stage, a higher-grade, and node positive cases. However, the 5-year disease-specific survival rate was 82.2% for the patients with PD-L1 positive and 86.9% for those with PD-L1 negative tumors, showing no significant difference.

Conclusions: PD-L1 expression was positive in approximately 50% of high- grade carcinomas, which was similar to the level in head and neck squamous cell carcinoma. In patients with other cancers, it has been reported that an anti-PD-1 monoclonal antibody was more effective against tumors with higher PD-L1 expression. Therefore, it could be a possible new therapeutic option for patients with highly malignant parotid tumors that have a poor prognosis.