Epidemiologic analysis of 72 carcinomas of the nasal cavity and paranasal sinuses

ObjectiveThe aim of this study is to define the epidemiological aspects of carcinoma of the nasal cavity and paranasal sinusesMaterial and methodsWe performed a retrospective study of 72 carcinomas of the nasal cavity and paranasal sinuses. Various sites, age and sex distribution, drug consumption, TNM stage grouping and treatment were reported.ResultsThe average age was 63. Seventy- five percent of patients (54/72) were male and 25% (18/72) female. The site of origin was paranasal sinuses in 46 patients (64%), 30 in ethmoid sinus, 15 in maxillary sinus and 1 in sphenoid sinus. Twenty-six patients (36%) were located in nasal cavity.Squamous cell carcinoma was the most frequent histological type in both localizations. The 5-yea adjusted survival rate for all patients was 60% (IC: 54-66), 36% (IC: 28-44) for paranasal sinus carcinoma and 86% (IC: 79-93) for nasal cavity carcinoma. The 5-year adjusted survival rate according to the T distribution in 46 carcinomas paranasal sinus was 80% T2, 71% T3, 19% T4a and 6% T4b.(p=0.0002).ConclusionsCarcinoma of nasal cavity and paranasal sinuses represent a group of tumors that differ from the rest of carcinomas of the head and neck.     

A clinico-pathological study of adenocarcinomas of the nasal cavity and paranasal sinuses

A adenocarcinoma arises rarely in the nasal cavity and paranasal sinus, 19 patients with this disease hospitalized in Shikoku Cancer Center Hospital were investigated. They were five with colonic-type, three with adenosquamous cell-type, and twelve with adenocarcinomas derived from mucous duct. Three cases of benign adenomas, i.e. one mucous duct-type adenomas and two pleomorphic type were also studied as references. In order to investigate the histological oncogenesis of adenocarcinomas, the histochemical studies were performed on the tissues in a comparison with those of squamous cell carcinomas. The methods employed were routine H-E stain, PAS stain, Alcian blue stain as well as special stains of immunohistological method using ABC (avidin biotin peroxidase complex) method, to identify a localization of CEA and cytokeratin. CEA was found to be localized at the apical surface with papillary or tubular shapes in colonic-type adenocarcinomas and adenosquamous carcinomas. On the other hand the mucous epithelium of the ductal portion was positive for CEA on the ductal-type adenocarcinomas. The positive localization of cytokeratin was found only in adenosquamous carcinoma and mucoepidermoid carcinoma, where squamous metaplasia of ductal epithelium was seen as the same pattern. This study concluded that the nature of the apical membrane surface and squamous metaplasias, which were often seen in the nasal and paranasal mucosa, might become one of the causes in the developing the squamous cell carcinoma predominantly rather than adenocarcinoma in the nasal and paranasal sinuses.     

Malignant salivary gland tumors of the paranasal sinuses and nasal cavity

Of a total of 122 patients with minor salivary gland tumors of the nose and paranasal sinuses, 66 patients were identified who had had their therapy at the University of Texas M.D. Anderson Hospital and Tumor Institute, Houston. Adenoid cystic carcinomas and adenocarcinomas were the most frequent tumors. Eighty percent of the patients were treated for relatively advanced (T3 and T4) cancers. Low-grade and high-grade carcinomas could be identified in the two groups studied, and the pathologic grading influenced prognosis in addition to the amount of local extent and degree of invasion of the neoplasm. The adequate preoperative documentation of tumor extension is mandatory, and a team effort in the surgical resection is worthwhile. Radiation therapy remains an important adjuvant in this treatment and occasionally has been used effectively as the only modality of treatment.     

Mucosal melanoma of the nasal cavity and paranasal sinuses

Mucosal melanoma of the nasal cavity and paranasal sinuses is a rare disease, but its incidence appears to be increasing. The mean age at diagnosis is between 65 and 70 years. Unilateral nasal obstruction and epistaxis are the most common presenting complaints. Melanoma arises in the septum or lateral wall of the nasal cavity in the great majority of cases. The histological diagnosis is based on specific immunohistochemical labelling and is usually established at an advanced stage of disease: stage T3 or T4 tumours according to the 7th edition of the American Joint Committee on Cancer (AJCC) classification of tumours. First-line treatment consists of surgery. The place of intranasal endoscopic surgery remains controversial due to the difficulty of controlling surgical margins and should be reserved for experienced teams. Adjuvant radiotherapy is usually performed due to its efficacy on local and regional disease control. Five-year overall survival of mucosal melanoma of the nasal cavity and paranasal sinuses in the most recent series does not exceed 40%. Local recurrence is observed in about 50% of cases and metastatic disease is common. The quality of initial tumour resection with negative surgical margins is the most important prognostic factor for tumours confined to the nasal cavity. Hopes for improvement of survival are based on early diagnosis, progress in radiotherapy techniques and cell and gene therapy that are currently under evaluation.     

Malignant neoplasms of the nasal cavities and paranasal sinuses: (A retrospective study)

This study presents a retrospective look at 115 patients evaluated here from 1957 to 1974. In this series, 57 percent were males and 43 percent females, 84 percent were Caucasian and 16 percent Negro. Lesions confined to or originating in the antrum made up 67 percent while non-antral lesions were 33 percent. Mean age at diagnosis was 59.1 years. Smoking and drinking history did not appear to be contributory. Antral lesions were retrospectively staged according to Sisson's TNM classification. Sixteen tumor types were involved, with the most common being epidermoid. Diagnosis was most often made by intranasal or Cald-well-Luc biopsy. Most frequent symptoms, as well as earliest symptoms, were nasal obstruction, localized pain, and epistaxis. Average duration of symptoms was 6.4 months. Therapy was generally in the form of radiotherapy alone, preoperative radiotherapy and surgery, surgery and postoperative radiotherapy, or surgery alone. Local recurrences occurred in 44 percent of antral lesions and 50 percent of non-antral lesions. Regional (cervical) nodal metastases developed in 25 percent of antral lesions and 11 percent of non-antral lesions. Distant metastases developed in 30 percent of antral cases and 35 percent of non-antral cases. Five-year survival was 32 percent (35 percent determinate) for the total group. The more advanced the staging of the antral lesions, the worse the prognosis. Best survival figures were in the areas of preoperative radiotherapy and surgery at 38 percent (43 percent) and surgery alone at 56 percent (59 percent).     

57例鼻腔鼻窦T细胞淋巴瘤临床疗效及预后分析

目的探讨鼻腔鼻窦T细胞淋巴瘤临床疗效及预后因素。方法回顾性分析1983年7月~2001年4月我院收治的57例鼻腔鼻窦T细胞淋巴瘤,其中单纯放疗(R组)22例,放疗 化疗(R C组)35例。Kaplan-Meier法计算3,5年生存率和局控率,Logrank进行显著性检验和单因素分析,Cox模型进行多因素分析。结果放疗组(R组)和放疗 化疗组(R C组)3,5年生存率分别为64.7%,55.2%和74.4%,69.8%。两组3,5年生存率比较有统计学意义(P<0.05)。两组3,5年局控率分别为95.4%,87.2%和94.5%,89.7%。两组3,5年局控率比较无统计学意义(P>0.05)。多因素分析显示,B症状、临床分期、治疗方式和放疗剂量是影响鼻腔鼻窦T细胞淋巴瘤生存率的独立预后因素;影响鼻腔鼻窦T细胞淋巴瘤局控率的独立预后因素是累及部位、临床分期、治疗方式、放疗剂量。结论放疗 化疗组(R C组)明显提高了鼻腔鼻窦T细胞淋巴瘤3,5年生存率,但不能改善局控率。B症状、临床分期、治疗方式和放疗剂量是影响鼻腔鼻窦T细胞淋巴瘤生存率的重要因素,累及部位、临床分期、治疗方式、放疗剂量与鼻腔鼻窦T细胞淋巴瘤局控有关。     

Malignant sialogenic tumours of the larynx

Laryngeal manifestations of malignant sialogenic neoplasias are rare. This paper documents the clinical features, treatment, biological behaviour and prognosis of 15 cases of malignant sialogenic tumours of the larynx that were reviewed in a retrospective clinical and histopathological study. The 15 cases of malignant sialogenic tumours of the larynx were diagnosed at the University Hospital, Eppendorf, over a period of 33 years (1965-1998). Forty per cent were adenoid cystic carcinomas, 33 per cent mucoepidermoid carcinomas and 27 per cent were poorly differentiated adenocarcinomas. Local tumour resection, if necessary in combination with bilateral neck dissection and post-operative radiotherapy, was associated with a five-year survival rate in 80 per cent of the mucoepidermoid carcinoma cases. Adenoid cystic carcinoma was associated with a less favourable five-year survival rate of 33 per cent. Low-differentiated adenocarcinomas were associated with the least favourable prognosis with a five-year survival rate (25 per cent). The prognosis for these tumours is thus poorer than for squamous cell carcinomas with the same localization and TNM status.     

Masses of nasal cavity, paranasal sinuses and nasopharynx: A clinicopathological study

An analysis of clinicopathological features of 240 cases presenting as mass in nasal cavity, paranasal sinuses and nasopharynx observed, both retrospectively and prospectively, over a period of 5 years in Jawaharlal Nehru Medical College. Aligarh. The incidence of masses in nasal cavity, paranasal sinuses and nasopharynx was 34.3 cases per year. Amongst the 240 cases studied, there were 144 cases (60%) of non-neoplastic lesions, 56 cases (23.33%) of benign lesions and 40 cases (16.67%) of malignant lesions. All age groups were involved and the mean age of presentation with the increasing age were: — non-neoplastic (22.5 years), benign tumors (26.8 years) and malignant tumors (35.3 years). The male to female ratio was 1.7:1 for non-neoplastic lesions; 3:1 for benign tumors: and 2.3:1 for malignant lesions. In this study maximum number of cases were present in nasal cavity (65%) followed by paranasal sinuses (20%) and least number of cases involved the nasopharynx (15%). The relative number of non-neoplastic and neoplastic lesions varies from region to region. A provisional diagnosis was made after clinical assessment and radiological investigation but final diagnosis was made after histopathological examination.     

Extranasopharyngeal angiofibroma of the nasal cavity and paranasal sinuses

BACKGROUND: Angiofibromas commonly arise in the nasopharynx in young male patients. Diagnosis is widely based on radiographic imaging to avoid ill-advised biopsy which may result in brisk bleeding. This study was undertaken to evaluate the incidence, clinical features and complications that may occur during the process of diagnosis and surgical therapy of angiofibromas outside the nasopharynx. METHODS AND PATIENTS: Case report of a 13-year-old female patient and review of the literature. RESULTS: Our patient received multi-agent chemotherapy elsewhere due to a misdiagnosed angiofibroma. Computed Tomography (CT) revealed a maxillary tumor which was repeatedly biopsied. Hypervascularity was excluded by arteriography and the lesion removed after lateral rhinotomy. The data of 42 patients were analyzed including our own case. 32 patients were male, 10 female. The majority became symptomatic aged 19 years or younger (71.4 %). The maxilla was most commonly affected (38 %), less frequently the ethmoid, nasal cavity or septum, beside others. In 38 patients, symptoms developed within 12 months or less (average: 8.5 months). Epistaxis, nasal obstruction and facial swelling were reported for most patients. Brisk bleeding occurred in 10 patients during tumor removal and resulted from biopsies in 11 of 20 patients. Angiography detected hypervascularity in 3 of 4 patients. There was no case with lethal outcome. CONCLUSION: Extranasopharyngeal angiofibromas of the nasal cavity or paranasal sinuses should be included in the differential diagnosis of nasal tumors. Compared to nasopharyngeal angiofibromas, more female patients are involved, symptoms develop more quickly but hypervascularity is less common. Signs of questionable hypervascularity in Computed Tomography and Magnetic Resonance Imaging (MRI) should indicate arteriography prior to surgical procedures. Preoperative embolization of hypervascular lesions during arteriography will reduce the risk of brisk bleeding during biopsy or surgical tumor removal.     

复发性鼻腔及鼻窦恶性肿瘤的挽救性治疗

目的 探讨鼻腔及鼻窦恶性肿瘤复发后的临床表现、与复发有关的因素、再手术的意义及缺损组织的修复。方法 排除原发性鼻腔鼻窦恶性肿瘤，仅收集治疗后复发并且有再手术意义的病例。应用乘积极限法估计生存率，Stata7．0统计软件进行统计运算。结果 1993～2002年共有25例患者符合要求。男19例，女6例，年龄13～66岁，平均46．1岁。所有患者均有至少1次手术或放射治疗史。末次治疗至复发的时间2周～46个月，中位时间18个月，80％的患者肿瘤复发出现于末次治疗后2年内。术后随访1～65个月。再手术中无死亡病例。5例健在无肿瘤复发；局部复发2例，颈部淋巴结转移1例，经过1刀或手术治疗后2例健在、1例带瘤生存；死于局部复发13例，死于肺转移1例，死于无关疾病1例，失访2例。1年生存率62．5%，2年生存率43．7％，3年生存率29．1％，中位生存时间18个月。术后发生脑脊液漏3例次，中枢性尿崩症1例次，皮瓣部分坏死1例次。手术修补脑脊液漏l例。结论 鼻腔及鼻窦恶性肿瘤局部复发多发生于末次治疗后2年之内，主要症状是头痛及局部隆起。肿瘤的类型和分化程度与复发密切相关。合理、及时的综合治疗有助于减少复发。运用有效修复手段的再手术可改善晚期患者的生活质量，延长生命。并发症主要是脑脊液漏，多数可通过保守方法治愈。     

Primary mucosal melanoma of the nasal cavity and paranasal sinuses: 12 years of experience

INTRODUCTION: Melanomas that arise in the nasal cavity or paranasal sinuses are rare and have a poor prognosis. In this study, we reviewed 15 patients in a tertiary referral centre and analyzed their treatment results and patterns of treatment failure. MATERIALS AND METHODS: Fifteen patients diagnosed from January 1994 to February 2005 at the Chang Gung Memorial Hospital were retrospectively reviewed. RESULTS: Eight men (53.3%) and seven (46.7%) women ranged in age from 51 to 85 years (mean 69.0 years) at the time of diagnosis. All patients presented with symptoms related to the nose. The majority of patients presented with epistaxis (93.3%). Ten patients received surgery and postoperative radiotherapy, three patients received surgery and postoperative chemo- and radiotherapy, and one patient received radiotherapy alone. The overall actuarial survival revealed that 49.5% were alive at 2 years and 33.0% were alive at 5 years. The average time from surgery to local recurrence was 5 months, the average time from surgery to the occurrence of regional recurrence was 7.45 months, and the time from surgery to the diagnosis of distant metastasis was 10.3 months. The sites of distant metastasis according to frequency are the lung, liver, bone, and brain. The average survival after the diagnosis of distant metastasis was 8 months. CONCLUSION: The prognosis of mucosal melanoma of the nasal cavity is poor in our experience. Most of the local recurrence, regional recurrence, and distant metastasis occurs in the first year after surgery. For those patients in the first year after surgery, frequent and regular follow-up is mandatory.     

鼻腔鼻窦腺样囊性癌88例临床分析

目的 总结鼻腔鼻窦腺样囊性癌的临床特征和治疗方法,探讨影响鼻腔鼻窦腺样囊性癌患者预后的因素.方法 总结中山大学肿瘤防治中心头颈外科1975年11月至2003年8月收治的88例原发于鼻腔鼻窦的腺样囊性癌患者的临床及病理资料,回顾性分析单纯手术、单纯放疗与放疗结合手术、化疗等治疗方式的疗效.对其治疗与预后进行统计分析.生存分析采用Kaplan-Meier法,组间比较采用Log-rank检验,多因素分析采用Cox比例风险模型.结果 就诊时56例鼻腔鼻窦腺样囊性癌患者为Ⅲ、Ⅳ期病变,治疗多采用手术+放疗.全组患者的5年、10年、15年生存率分别为0.640、0.341、0.190;Ⅲ期患者的5年、10年生存率分别为0.833、0.221;Ⅳ期患者的5年、10年生存率分别为0.323、0.145.手术+放疗组、单纯手术组及单纯放疗组的5年、10年生存率分别为0.761、0.415,0.750、0.367,0.286、0.143.结论 鼻腔鼻窦腺样囊性癌的治疗应以综合治疗为主,临床分期及治疗方式是影响鼻腔鼻窦腺样囊性癌患者预后的独立因素.     

Primary adenocarcinoma of the nasal cavity and paranasal sinuses.

Eight cases of primary adenocarcinoma of the nasal cavity associated with wood dust exposure are reported. The patients include seven men and one woman between the ages of 31 and 81 years. All the patients had a history of wood dust exposure. Carpentry was the occupation in four patients; inspector for railroad boxcars in one; teacher in a wood-work shop in another and worker in a desk factory in the other. The only female patient was a school teacher whose husband had a wood-work shop at home. Clinically, epistaxis and/or nasal obstruction were the most common symptoms. The histology of the tumors varied and consisted of well differentiated adenocarcinoma, clear cell adenocarcinoma, papillary-mucinous adenocarcinoma, and "colonic-type" adenocarcinoma. Follow-up data showed that three patients were alive of whom two had either recurrent or metastatic disease at one and three years following the initial diagnosis, respectively. The third patient was alive and well four years after initial diagnosis. Three other patients died but a direct cause of death was not identified. The remaining two patients were lost to follow-up.     

Treatment of carcinoma of the nasal cavity and paranasal sinuses

The results of the radical treatment of 528 cases of carcinoma of the nasal cavity and paranasal sinuses are presented. These cases were analysed according to treatment modes of surgery or radiotherapy alone and surgery, radical or subradical, with radical radiotherapy. Of necessity the survey is retrospective but the results can be interpreted as demonstrating that while surgery without radiotherapy is appropriate to certain tumours near the nasal vestibule, to transitional cell carcinoma in men, and to some salivary carcinomas, for the remainder surgery, either radical or subradical with radiotherapy, is appropriate. No significant difference can be shown between radical and subradical surgery, when combined with radiotherapy. Radiotherapy alone appears inappropriate.     

鼻腔鼻窦腺样囊性癌的临床分析

目的 探讨鼻腔鼻窦腺样囊性癌(ACC)的临床特点及手术疗效分析。方法 回顾性分析云南省第三人民医院2010年6月—2017年6月收治的31例病理确诊为鼻腔鼻窦ACC患者主要临床表现及生物学特性,针对不同部位、分期患者进行不同方式的手术及术后放疗。结果 31例鼻腔鼻窦ACC患者随访30例,1例失访;3年生存率为87.1%(27/31),5年生存率为71.0%(22/31),3年局部复发率为16.2%(5/31),5年局部复发率为25.8%(8/31)。结论 鼻腔鼻窦ACC生长部位深在,毗邻结构复杂,肿瘤的高侵袭性和沿神经浸润生长的习性,手术彻底切除较难,易复发。传统手术结合鼻内镜颅底技术以及神经追踪技术是减少复发、提高生存率的有效方法。     

Results of preoperative chemoradiotherapy for patients with advanced cancer of the nasal cavity and paranasal sinuses

Objectives: Curative treatment of nasal cavity and paranasal sinus cancer is challenging due to the proximity to critical anatomical structures. The purpose of this study was to analyze the impact of trimodality therapy with preoperative chemotherapy and reduced-dose radiotherapy followed by organ-preserving surgery for treating patients with nasal cavity and paranasal sinus cancer.

Methods: This retrospective study included all 156 patients diagnosed with sinonasal cancer in western Sweden between 1986 and 2009. We determined the treatment selection pattern and treatment outcomes for 79 patients treated with preoperative chemoradiotherapy.

Results: Squamous cell carcinoma was the most common histology. The five-year overall survival was 54%, and 85% of these patients had T3 or T4 tumors. The five-year cumulative incidence rate of local recurrence was 32%. The five-year overall survival in patients with squamous cell carcinoma and adenocarcinoma was 45% and 76%, respectively. The median preoperative radiation dose was 48?Gy. Orbital exenteration was performed in 7% of patients.

Conclusions: Preoperative chemoradiotherapy may be beneficial for patients with advanced sinonasal cancer when primary radical surgery is challenging. Survival outcomes were comparable to outcomes reported in the literature despite conservative surgery and relatively low radiation doses in patients with locally advanced tumors.     

Glomangioma in the nasal cavity and paranasal sinuses

The glomangioma is a hyperplastic lesion of the glomus body. This uncommon tumor is seldom located in the nasal cavity or paranasal sinuses. We present what is to our knowledge the eleventh documented case of an intranasal glomangioma. The differential diagnosis of this lesion, its symptoms, pathogenesis and therapy are discussed. Complete excision is normally curative for this tumor.     

Microsurgery of the nasal cavity and paranasal sinuses

Out of a total of 295 cases in which endonasal microsurgery of the nasal cavity and the paranasal sinuses was performed, 221 were submitted to a detailed analysis. Compared with transfacial sinus surgery, the rate of complications was significantly lower. Further advantages of the transnasal microsurgical technique are better functional results, considerably fewer complaints during the postoperative period, and a reduced duration of hospitalization.     

Failure patterns and prognostic factors of patients with primary mucosal melanoma of the nasal cavity and paranasal sinuses

Objectives: To analyse the failure patterns and prognostic factors influencing survival in patients with primary mucosal melanoma of the nasal cavity and paranasal sinuses.

Materials and methods: Fifty-one patients were analysed retrospectively. Forty-eight, 33, 10, and 13 patients underwent surgery, radiotherapy, chemotherapy, and immunotherapy, respectively. Failure events, including local recurrence, regional relapse, distant metastases, and death, were examined.

Results: During follow-up (median: 59.0 months), 36 patients experienced failure after treatment, including local (n?=?17), regional (n?=?8), and distant organ (n?=?23) metastases. The median failure times for local, regional, and distant metastases were 13.0, 14.0, and 8.0 months, respectively. The median survival times from local, regional, and distant failure to death were 10.5, 8.0, and 4.0 months, respectively. The 5-year overall survival rates of patients with and without distant organ metastases were 14.4% and 72.6%, respectively (p?Conclusions: Distant metastasis was mainly owing to failure. Radiotherapy and the disease stage were prognostic factors for survival.     

Glomangioma of the nasal cavity and paranasal sinuses

The glomangioma, a benign vascular tumour, derived from the cutaneous glomus bodies, should not be confused with paragangliomas, which are occasionally also referred to as glomus tumours. Up to now, only eleven cases of a glomangioma of the nasal cavity and the paranasal sinuses have been published. We report the case of a patient with a glomangioma of the ethmoidal aircell system. The tumour was completely removed under endoscopic-microscopic vision via endonasal access. A tumour recurrence was not observed over a period of eighteen months. The clinical signs, diagnosis, therapy and histological features will be discussed with reference to the literature.