Paranasal sinus cancer

This is a review of 65 patients with paranasal sinus malignancies who were treated by radical surgery. Most patients received either pre- or postoperative radiotherapy. Twenty-nine tumours arose in the maxillary antrum, seventeen in the ethmoid labyrinth and the remainder from the vestibule, nasal septum, lateral nasal wall and vault. There were 58 epithelial cancers. The 5-year survival rate for patients with adenocarcinoma was 78%, and 70% for antral squamous cell cancer and esthesioneuroblastoma. None of the melanoma patients survived free of disease for 5 years. The 5-year survival rate for the 21 patients undergoing orbital exenteration was 50%, compared with 70% when the eye was spared. Twelve free flap revascularized tissue transfer flaps were used to reconstruct large cranial and sino-orbital defects.     

Paranasal sinus and midfacial reconstruction

Midface defects pose the most difficult of the facial reconstruction problems. Current reconstruction relies heavily on microsurgical techniques, among which there are numerous possibilities. Although midface defects frequently extend to the upper and lower face, often an awareness of the midface subunits most involved can be of critical importance. This article presents an approach that will help the surgeon to identify the defect-related problems, prioritize the reconstructive goals, and select the best surgical option in the total patient context.     

Paranasal sinus radiology,part 3A: Sphenoidal sinus

This article describes the complex anatomy of the sphenoid bone. The development and size of the sphenoidal sinuses are quite variable and complete analysis of the sinus walls requires several views. The essential plain film projections and use of tomography and CT scans are described. Sphenoidal sinus inflammatory disease produces changes similar to those already discussed in the articles in this series on the frontal sinus and the ethmoidal sinus. Illustrations of sphenoidal sinus inflammatory disease are provided.     

Paranasal sinus radiology, Part 3B: Sphenoidal sinus

Mucoceles involving the sphenoidal sinus are not as common as those affecting the frontal and ethmoidal sinuses. The subtle expansile change produced by a sphenoidal sinus mucocele often requires conventional tomography or computed tomography examination to be detected. Similarly, involvement of surrounding structures by a sphenoidal mucocele may require special study, which this section illustrates. The sphenoidal enlargement and density change produced by fibrous dysplasia may mimic sinus disease. Focal or widespread bone destruction resulting from neoplastic involvement of the sphenoidal sinus requires special examination similar to that used with mucoceles.     

Bladder leiomyosarcoma following cyclophosphamide therapy for lupus nephritis

We report 2 cases of leiomyosarcoma of the bladder that occurred after long-term cyclophosphamide chemotherapy for lupus nephritis and rheumatoid arthritis. One patient had a tumor at the end of an 11-year course of chemotherapy and 1 approximately 7 years after completing a 7-year course of chemotherapy. Patient 1 underwent left partial cystectomy and patient 2 underwent cystectomy with ileal conduit urinary diversion. In patient 1 the tumor was a typical leiomyosarcoma and patient 2 had a myxoid variant. Both patients were free of disease at 4 months and 3 years, respectively. Whereas previous reports of the carcinogenic effects of cyclophosphamide have been questioned, since the induced tumors occurred in patients being treated for other neoplasms (lymphoproliferative and myeloproliferative disorders), the disease in both of our patients followed cyclophosphamide therapy for nonneoplastic disorders.     

Paranasal sinus involvement in a classic Sturge-Weber Syndrome patient

This report describes a Sturge-Weber syndrome patient with recurrent pansinusitis and purulent nasal discharge. Radiological examination showed uncommon massive enlargement of the paranasal sinuses, in particular the frontal and maxillary sinuses. Computed tomography or magnetic resonance imaging is advised to distinguish between a vascular malformation or soft tissue overgrowth.     

Paranasal sinus tumors: Peter MacCallum Cancer Institute experience

BACKGROUND: The purpose of this study was to evaluate the local control, pattern of recurrence, overall survival, and prognostic factors of patients with squamous cell carcinoma (SCC), adenocarcinoma, and undifferentiated carcinoma of the paranasal sinuses (PNS) and nasal cavity (NC) presenting to our center for curative treatment over a 10-year period. METHODS: Between 1991 and 2000, 60 patients with SCC (n = 32), adenocarcinoma (n = 25), and undifferentiated carcinoma (n = 3) of the PNS or NC were identified. Forty patients received surgery and postoperative radiotherapy, four surgery alone; 11, radiotherapy alone; three radical radiotherapy after surgical recurrence; one, chemoradiotherapy and surgery; and one, induction chemotherapy followed by radiotherapy. RESULTS: Forty-seven patients (78%) were seen with T3-4 disease; however, most (92%) were node negative on initial assessment. The predominant failure pattern was local disease persistence or recurrence. The estimated 2- and 5-year local control rates were 63% and 49%, respectively. Orbital and neural invasion significantly affected local control. The estimated 2- and 5 year overall survival rates were 57% and 40%, respectively. CONCLUSIONS: Local failure remains the dominant cause for poor outcome in this group of patients. Because of the proximity of critical normal structures, the ability to perform adequate surgery and to deliver effective radiotherapy is limited in many cases. The use of postoperative concurrent chemoradiotherapy warrants further investigation.     

Paranasal sinus radiology, Part 4B: Maxillary sinuses

The maxillary sinus is frequently involved by inflammatory change. It is also the sinus that is most often affected by intrinsic or neighboring neoplasms. Since neoplasia and inflammatory disease may mimic each other, radiologic examination often becomes the principal means of differentiating them. Principles of radiologic diagnosis, with attention to changes in the various bony margins in maxillary disease processes, form the basis of this article.     

Paranasal sinus radiology,part 2A: Ethmoidal sinuses

The clinician must have a high level of suspicion in order to detect ethmoidal sinus disease. Survey plain film radiographic examination may provide information about gross changes in ethmoidal sinus transparency and the sinus walls. Conventional tomographic study will often aid evaluation of the ethmoidal sinus walls which may be obscured by overlying structures on plain films. Computerized tomography adds a new dimension to ethmoidal sinus study. By revealing not only bone changes but soft-tissue abnormality as well, more complete understanding of the disease process is gained. Computerized tomography is particularly useful in evaluating orbital structural change due to ethmoidal sinus abnormality.     

Paranasal sinus radiology, Part 4A: Maxillary sinuses

The maxillary sinus is frequently involved by inflammatory change. It is also the sinus that is most affected by intrinsic or nearby neoplasms. Since neoplasia and inflammatory disease may mimic each other, radiologic examination often becomes the principal means of differentiating them. Principles of radiologic diagnosis, with attention to changes in the various bony margins in maxillary disease processes, form the basis of this article.     

Paranasal sinus radiology, Part 2B: ethmoidal sinuses

The clinician must have a high level of suspicion in order to detect ethmoidal sinus disease. Survey plain film radiographic examination may provide information about gross changes in ethmoidal sinus transparency and the sinus walls. Conventional tomographic study will often aid evaluation of the ethmoidal sinus walls which may be obscured by overlying structures on plain films. Computerized tomography adds a new dimension to ethmoidal sinus study. By revealing not only bone changes but soft-tissue abnormality as well, more complete understanding of the disease process is gained. Computerized tomography is particularly useful in evaluating orbital structural change due to ethmoidal sinus abnormality.     

Paranasal sinus radiology,Part IA: Introduction and the frontal sinuses

The radiologic techniques of plain film roentgenography, tomography, and computerized tomography are important supplements to patient history and physical examination in the diagnosis of diseases of the paranasal sinuses. Background historical information regarding these radiologic modalities is presented, and the development and anatomy of the sinuses and roentgenographic views are discussed. The development and anatomy of the frontal sinuses are discussed, and inflammatory disease of the frontal sinuses as it appears in various roentgenographic modalities is described and illustrated.     

Paranasal sinus radiology,part 1 B: The frontal sinuses

Alteration in the appearance of the mucosa, fluid accumulations, and changes in the shape and texture of the sinus wall form the basis of the radiologic information that aids in the diagnosis of frontal sinus disease. Inflammatory disease of the frontal sinuses was discussed in Part 1A of this article; other disease processes of the frontal sinuses as they appear in the various roentgenographic modalities are described and illustrated here.     

Combined chemotherapy and irradiation therapy after radical surgery for leiomyosarcoma of the vulva. A case report

Radical surgery failed to remove a leiomyosarcoma of the vulva completely, and residual tumour was left. Chemotherapy did not inhibit further local growth or the occurrence of secondary lesions in the lung. Irradiation therapy of the pelvis, including the area of the tumour, then successfully inhibited any further local growth, as evidenced by a marked decrease in size and eventual disappearance of the mass; however, the patient succumbed to distant metastasis.     

Urothelial carcinoma after cyclophosphamide therapy

We report a case of transitional cell carcinoma of the bladder after cyclophosphamide therapy for chronic lymphocytic leukemia. Urologic evaluation and histologic confirmation occurred only after low grade tumor cells were identified in multiple urine samples. Malignant cells can be distinguished from drug effect in urinary specimens from patients treated with cyclophosphamide and all such cases should include regular cytologic evaluations.     

Paranasal sinus mucoceles with skull-base and/or orbital erosion: is the endoscopic approach sufficient?

OBJECTIVE: The objective of this study was to review the management of paranasal sinus mucoceles with skull-base and/or orbital erosion in the endoscopic era. STUDY DESIGN: A retrospective data analysis. METHODS: A chart review was performed on 57 patients treated from January 2001 to March 2007. RESULTS: The average age at the time of presentation was 50.6 years with a 1:1 male: female ratio. The most common site was the frontal sinus (54.4%), followed by frontoethmoid (29.8%) and sphenoid (8.8%). Areas of erosion included skull base (40.4%), orbit (50.9%), and both orbit and skull base (8.8%). Endoscopic drainage using image guidance was used in all 57 patients without complications. Fifty-six cases (98.2%) had a functionally patent mucocele opening with a median follow-up of 15 months. CONCLUSIONS: The endoscopic approach can be safely used for the management of mucoceles with skull-base and/or orbital erosion. Open adjunct approaches can be avoided in most cases.