鼻腔鼻窦神经内分泌癌8例并文献复习

目的 探讨鼻腔鼻窦神经内分泌癌的临床特征、病理表现、治疗手段、预后及影响预后的因素.方法 回顾经病理证实的8例原发性鼻腔鼻窦神经内分泌癌患者的临床病例资料.结果 随访5～70个月,中位随访时间23个月,8例中典型类癌1例、不典型类癌4例、小细胞神经内分泌癌2例、复合型神经内分泌癌1例(低分化神经内分泌癌伴内翻性乳头状瘤...     

Neuroendocrine carcinoma of the sphenoid sinus: a case report

The presentation of a neuroendocrine carcinoma in the paranasal sinuses is extremely rare. Until now only 25 cases have been reported in the literature. We report a case of a 65-year-old male with an atypical carcinoid of the sphenoid sinus which seemed to be associated with multiple endocrine neoplasia type 1 (MEN 1). To the best of our knowledge this is the first report on an atypical carcinoid in the sphenoid sinus.     

Adenoid cystic carcinoma of the paranasal sinuses or nasal cavity: a 40-year review of 35 cases

We retrospectively reviewed 35 cases of adenoid cystic carcinoma that had originated in the minor salivary glands of the paranasal sinuses or nasal cavity. All patients had been seen at two tertiary-care referral centers in western New York State between 1960 and 2000. Twenty patients had been treated with surgery and adjuvant radiotherapy, 10 patients with surgery alone, three with radiotherapy alone, and two with concurrent radiotherapy and chemotherapy. During the study, 22 patients developed recurrent disease--11 locally; three distantly; seven locally and distantly; and one locally, regionally, and distantly. At the conclusion of the study, 14 patients were alive and disease-free, and eight were alive with disease; 10 patients had died with disease, and three had died of other causes with no evidence of disease. Adenoid cystic carcinoma of the paranasal sinuses or nasal cavity is an aggressive neoplasm that results in a high incidence of both local recurrence and distant metastasis, regardless of treatment modality. Most cases are ultimately fatal, although long disease-free intervals have been observed. A combination of surgery and radiotherapy offers these patients the best chance for disease control.     

Endonasal endoscopic surgical treatment of paranasal sinus inverted papilloma--first experiences.

PURPOSE: Surgical excision is generally regarded as the treatment of choice for inverted papilloma. However, the approach and extent of surgery has been subject of much debate. The purpose of this study is to evaluate the results of endoscopic sinus surgery in the treatment of paranasal sinus inverted papilloma. PATIENTS AND METHODS: Thirteen cases of inverted papilloma of the paranasal sinuses treated via endoscopic sinus surgery were evaluated. The follow-up averaged from 9 months to 48 months with a mean of 27 months. RESULTS: A close follow-up of all patients was maintained. Seventy-seven per cent (10/13) of the patients had no recurrence after the initial endoscopic procedure. Three patients had recurrences of their tumor within 11 months after surgery, which means a rate of 23% (3/13). In 2 patients, the recurrences were treated endoscopically. In one patient, recurrence and malignant transformation (squamous cell carcinoma) developed after 36 months, which means that the associated carcinoma rate was 7% (1/13). This patient underwent radical maxillectomy and postoperative radiotherapy. None of the patients died of inverted papilloma. CONCLUSION: Endoscopic sinus surgery is a viable treatment alternative for paranasal sinus inverted papilloma in selected cases. This approach should be performed by experienced surgeons and a close follow-up is mandatory. When the disease is more extensive, it should be approached by radical surgery, e.g. en-bloc excision by medial maxillectomy via lateral rhinotomy or mid-facial degloving.     

鼻内镜或鼻内镜辅助下鼻腔鼻窦恶性肿瘤切除术的初步分析

目的：探讨鼻内镜或鼻内镜辅助下切除鼻腔鼻窦恶性肿瘤的可行性和疗效。方法：回顾性分析我院收治的40例鼻腔鼻窦恶性肿瘤患者的临床资料。病理类型为内翻性乳头状瘤恶变5例,上颌窦癌2例,筛窦癌3例,恶性黑色素瘤11例,嗅神经母细胞瘤7例,神经内分泌癌2例,肌上皮癌4例,鼻腔软骨肉瘤2例,腺样囊性癌3例,恶性血管外皮细胞瘤1例。所有患者均行鼻内镜或鼻内镜辅助下肿瘤切除术,其中32例术后采用放化疗。结果：所有患者随访1～5年,其中22例随访1～3年,随访3年以上者18例。4例患者术后6个月～2年症状复发,再次行鼻内镜手术后疗效满意;3例术后出现颈淋巴结转移,其中2例行颈淋巴结清扫术,1例因无手术指征而行放、化疗;4例出现远处转移;8例死亡;其余21例在随访期间未见复发及转移。结论：鼻内镜或鼻内镜辅助下手术切除鼻腔鼻窦恶性肿瘤切实可行,但必须严格选择适应证,辅以术后综合治疗,可取得满意的疗效。     

The management of acute visual loss after sinus surgery--two cases of rhinogenic optic neuropathy

INTRODUCTION: Different causative mechanisms of ophthalmic complications during endonasal sinus surgery have been reported. Only a few cases of blindness caused by affections of the optic nerve due to inflammatory paranasal sinus disease have been described. OBJECTIVE: Inflammatory optic neuropathy shall be considered among the causative factors for amaurosis after sinus surgery. MATERIAL: We present two patients with dramatic visual decrease occurring two weeks after sinus surgery as a result of inflammatory posterior paranasal sinus disease. RESULTS AND CONCLUSION: Our therapy including surgical intervention in form of orbital or optic nerve decompression accompanied by systemic steroids and antibiotic therapy resulted in a significant increase of visual acuity in one case and a complete restoration of vision in the other case. In these two cases surgical intervention in the described fashion along with systemic steroids and antibiotic therapy represented a successful therapeutical approach.     

Malignant schwannoma of the sinonasal tract

Malignant Schwannoma of the sinonasal tract is an extremely rare tumour. So far, only 19 cases have been reported in the literature. We report herein a case of malignant schwannoma involving nasal cavity, maxillary antrum and ethmoid sinus in a 60-year-old male patient. The patient was treated with surgery and post-operative radiotherapy. He currently remains free of the disease 15 months after the diagnosis and twelve months after completing therapy.     

原发性额窦癌三例临床分析

目的 总结诊断和治疗原发性额窦癌的经验与教训.方法 回顾性分析2006-2010年在解放军总医院诊治的3例原发性额窦恶性肿瘤的临床资料.3例均为鳞状细胞癌,其中基底细胞样鳞癌1例,内翻性乳头状瘤癌变(中分化鳞癌)1例,乳头状鳞癌1例.所有病例均通过内镜+额部颅骨切开进路切除肿瘤,手术后给予放疗+化疗.结果 例1放疗结束后半年复查,发现沿发际内冠状切口多发转移癌,遂给予化疗,术后16个月死亡.例2手术后40d(放疗期间)复查,左侧眶内和左侧额窦内上部肿瘤复发,遂行第二次手术(眶内容切除术+肿瘤切除术),第二次术后继续放疗+化疗,3个月后复查,发现骨转移.第一次术后10个月患者死亡.例3手术后出现右侧眶尖综合征,视力丧失.手术+放疗后14个月复查,肿瘤复发,侵犯颅内,患者拒绝再次手术,自动出院,手术后21个月电话随访,患者带瘤生存.结论 原发性额窦恶性肿瘤少见,早期诊断困难.确诊后应积极施行扩大切除术,彻底切除肿瘤,手术后辅助放疗和化疗.原发性额窦恶性肿瘤的预后不佳.     

Hemangiopericytoma: a rare head and neck tumor

Among the rare malignant tumors of the paranasal sinuses and the middle ear, the hemangiopericytoma represents a very rare tumor entity. Reviewing four cases treated in our ENT department, we present here our experiences with this tumor. Inpatient and outpatient medical records from 1976 to 2001 were evaluated retrospectively. For the whole period we found four patients, three women and one man, who were treated with the diagnosis of hemangiopericytoma. Three tumors were localized in the paranasal sinuses (two in the maxillary sinus, one in the frontal sinus) and one in the middle ear. While the two tumors of the maxillary sinus and the tumor of the middle ear were treated only by surgery, the patient with the tumor of the frontal sinus also received postoperative irradiation because of an endocranial infiltration. This patient was the only one who developed an endocranial recurrence 14 years later on the opposite site, which again was treated with a combination of surgery and radiotherapy. The hemangiopericytoma as a very rare tumor in the paranasal sinuses and the middle ear should be treated with surgery. In our view, an adjuvant radiotherapy is indicated only in selected individual cases.     

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.     

Meningioma of the paranasal sinus: a case report

Extracranial meningioma of the paranasal sinus is a very rare condition of unclear etiology. Surgical excision is currently the only curative treatment but sometimes entails difficulties because of the complicated anatomic loci of the tumor. For the case reported here, we used a navigation system in endoscopic surgery for an extracranial meningioma of the paranasal sinus and were able to remove the tumor without complications by a transnasal approach alone. This is the first report of the use of such a system with endoscopic surgery for this condition. We discuss the clinical presentation, diagnosis, and treatment of this case as well as present a review of the literature.     

Neuroendocrine carcinoma of the ethmoid sinus

The paranasal sinuses are a rare site for neuroendocrine carcinoma (NEC). In contrast to the other regions, NEC of the sinuses has been reported to be recurrent and locally destructive. We report a case of NEC of the ethmoid sinuses. The patient was a 16-year-old Indian boy and was treated with radiation therapy to 6500 rad. He has been disease free for the past 5 years. All the cases reported to date were also reviewed.Adapted from a presentation at the annual meeting of the American Academy of Otolaryngology Head and Neck Surgery, Inc., Washington, D.C., 13–17 September 1992     

A case of metastatic hepatocellular carcinoma in the nasal cavity

Metastatic hepatocellular carcinoma in the nasal cavity and paranasal sinuses is rare. We report the case of a 71-year-old male afflicted with hepatocellular carcinoma with metastasis in the maxillary sinus and nasal cavity. He underwent radiation therapy with a total dose of 36 Gy, but he died of terminal liver failure. The possible metastatic route and prognosis of metastatic hepatocellular carcinoma in the sinonasal tract are discussed.     

鼻内镜手术为主的鼻腔鼻窦恶性肿瘤的治疗

鼻腔鼻窦恶性肿瘤最初无明显临床表现,当进展到一定大小和范围时才引起重视,故多半患者确诊时已发展到中晚期.单一手术治疗对中晚期肿瘤的疗效不佳;而单一放疗,除极少对放射线特别敏感的肉瘤和未分化癌外,治疗效果远不如手术治疗.传统的方法是先放疗后手术或先手术后放疗,较单一手术治疗的生存率有明显提升.近年来经鼻内镜手术切除鼻腔鼻窦恶性肿瘤的安全有效性越来越受到认可,本文旨在对以鼻内镜手术为主辅以合理的放化疗的治疗进展做总结.     

Primary frontal sinus carcinoma with extradural anterior cranial fossa involvement

Paranasal sinus carcinoma is rare, with an estimated annual incidence of less than 1 per 100,000 population. Primary frontal sinus involvement is extremely rare, accounting for only 0.3% of all paranasal sinus malignancies. A frontal sinus cancer may be mistaken for a mucocele, pyocele, or osteomyelitis. We report the case of a 48-year-old woman with a carcinoma that originated in the frontal sinus. Computed tomography and magnetic resonance imaging demonstrated bony destruction with intracranial extension but no involvement of the bulbus. The patient underwent a frontal craniotomy, tumor excision, and postoperative radiotherapy. One year later, she remained symptom-free.     

Primary carcinoid tumor of the frontal sinus: A case report

Carcinoid tumors are rare, indolent, neuroendocrine tumors that are most commonly found in the gastrointestinal tract and lungs. They occasionally develop in the head and neck, either as a primary tumor or, more commonly, as a metastasis. The most common sites of head and neck carcinoids are the larynx and middle ear. Only a few cases of carcinoid in the nasal cavity and paranasal sinuses have been reported. We describe a case of primary typical carcinoid of the frontal sinus in a 61-year-old man, and we review the clinical, imaging, surgical, and histochemical findings in this case. The patient was treated with endoscopic resection. A subsequent workup for metastatic and occult primary disease was negative, confirming that the frontal sinus was the primary source. At follow-up 12 months postoperatively, the patient remained without disease. To the best of our knowledge, this is the first report of a primary typical carcinoid tumor originating in the frontal sinus.     

Small cell neuroendocrine carcinoma in the petrous apex

With the exception of moderately differentiated neuroendocrine carcinoma of the larynx, neuroendocrine carcinomas are very rare head and neck malignancies. We report a case of a small cell neuroendocrine carcinoma in the petrous apex of the temporal bone. This unusual site for this tumour has not yet been reported in the literature. We confirmed the location and extent of the primary tumour by positron-emission tomography scan. The final histopathological diagnosis was of small cell carcinoma, and this was confirmed by immunohistochemistry. We treated this patient with surgery followed by radiotherapy and chemotherapy. After the treatment was completed there was subtotal remission of the tumour, with no distant metastases.     

Eight cases of neuroendcrine carcinoma of the head and neck

Small cell neuroendocrine carcinoma of the head and neck is rare, and diagnosis may be difficult. Malignancy is high, as is the incidence of distant metastasis. We reported eight cases of stage IV small cell neuroendocrine carcinoma of the head and neck, all in men with a mean onset age of 62 years (range: 45 to 80 years). Three cases arose from the maxillary sinus, two from the ethmoid sinus, one from the parotid gland, one from the tonsil, and one from the larynx. Histological analysis by hematoxylin-eosin staining tentatively revealed malignant lymphoma and undifferentiated carcinoma in two cases each, while immunohistological and/or electron microscopy analysis confirmed histological diagnosis. All were treated by chemotherapy (VP-16, CDDP) and seven cases with radiotherapy based on the schedule of small cell carcinoma of the lung and two cases with lesional resection. Chemotherapy and radiotherapy were effective locally. Five patients died of distant metastasis to the brain, bone, lung, liver, or skin within 12 months. One is alive with liver metastasis. Two have no evidence of disease--one for eight years and the other for one year. Long-term survival thus requires the effective treatment of distant metastasis.     

Exostoses of the paranasal sinuses

While bony exostoses of the external auditory canal have long been recognized as a complication of cold-water swimming, bony exostoses of the paranasal sinuses have not been previously reported. We present an unusual case of multiple exostoses of the paranasal sinuses, which began coincident with nasal irrigation with cold gentamicin solution. The patient had had prior endoscopic sinus surgery. Topical antibiotic gentamicin irrigation lessened recurrence of bacterial sinus episodes. He admitted to using the irrigation directly from the refrigerator daily for two years. A biopsy was consistent with exostosis. Patients should be counseled to avoid irrigating their paranasal sinuses with cold irrigants. Laryngoscope, 2010.