[Clinical aspects and prognosis of paranasal sinus tumors with special reference to their etiology]

Sixty-one patients operated on for malignant paranasal sinus tumours were investigated to elucidate the incidence and route of metastasis; survival rate, incidence of recurrent tumours, sex distribution etc. as well as possible exogenous causative factors. Adenocarcinomas have a better prognosis in women than in men and sometimes show local recurrences even 10 years and more after primary operation. Tumours of the paranasal sinuses often produce primarily hematogeneous distant metastases, with a fatal outcome. Occupational carcinogenic influence of wood dust seems very likely.

Nasopharyngeal cancer, sinonasal cancer, and occupations related to formaldehyde: a case-control study

Formaldehyde vapor induces cancer of the nasal passages in laboratory animals. In this case-control epidemiologic study, occupational information was obtained for 198 persons with sinonasal cancer (SNC), for 173 with nasopharyngeal cancer (NPC) identified as incident cases by the Connecticut Tumor Registry over 41 years among Connecticut males dying of any cause, and for 605 controls sampled from Connecticut death certificates. City directories and death certificates provided information on job, industry, employer, and year of employment for exposure classification. Without knowledge as to case-control status, an industrial hygienist particularly experienced in epidemiologic studies of formaldehyde classified each study subject with respect to probability and degree of formaldehyde exposure. For those with probable exposure to the high level 20+ years prior to death the odds ratio for NPC was 2.3 [95% confidence limits (CL): 0.9, 6.0], and for those with this same risk factor among men dying at age 68+ (the median study age at death or older) the odds ratio was 4.0 [95% CL: 1.3, 12.0--with two-sided P = .015, unadjusted for multiple significance tests, and with two-sided P = .129 in testing for interaction between this risk factor (never any exposure vs. probable exposure to high level 20+ years prior to death) and age (age less than 68 yr vs. age 68+ yr)]. Odds ratios were close to unity for 9 of 13 industries. Formaldehyde-related occupations in printing appeared to be associated with any type of nasal cancer (either SNC or NPC).

Tobacco use and sinonasal cancer: a case-control study

The risk for sinonasal cancer associated with tobacco use was examined in a case-control study in males diagnosed between 1978 and 1981 in the Netherlands. Of the 116 cases of sinonasal cancer and 259 controls identified, interviews were completed for 92 (79%) of the cases and 195 (75%) of the controls. Ever-users of cigarettes had a moderately elevated risk for sinonasal cancer. The association was strongest for squamous cell carcinoma among recent users of tobacco (RR = 3.1, P less than 0.05, one-sided). For recent tobacco users, there was also a trend in risk associated with the amount of cigarette use (P less than 0.05, one-sided). Associations between tobacco use and adenocarcinoma were inconsistent, and no positive associations were found for the other histologic types, largely undifferentiated tumours. The study findings indicate that tobacco use, and in particular recent tobacco use, is associated with the development of squamous cell sinonasal cancer.

Epidemiology of sinonasal cancer in Denmark, 1943-1982

Long-term trends in the incidence of cancer of the nasal cavity and paranasal sinuses were studied on the basis of notifications of cancer cases in Denmark over 40 years. A total of 1436 cases of sinonasal cancer were reported in 1943-1982, giving steady annual incidences of 0.8 per 100,000 males and 0.5 per 100,000 females. These contrast with the simultaneous increases in risk for cancers of the middle and lower respiratory tract, and indicate that cigarette smoking does not play any significant role in the aetiology of sinonasal cancer. Since this tumour type has many occupational aetiologies, the stable time trends observed further indicate that all the major risk factors have been present in work places in a relatively unchanged form for more than half a century. A curious time-dependent distribution of cases according to subsite of the tumour, however, leaves open for possibility that some of the environmental carcinogens may have changed.

[Mucinous adenocarcinoma of the nose and paranasal sinuses, an occupational disease?]

In Great Britain and other countries there have been reports of an increased frequency of adenocarcinoma of the nose and paranasal sinuses, mimicking histologically mucinous colonic carcinoma, among workers exposed to wood dust and workers in the leather industry. No such cases have been reported so far in Switzerland. 31 patients with this type of adenocarcinoma of the nose and paranasal sinuses observed between 1953 and 1984 have been reviewed. In 13 of these patients there was occupational exposure to wood dust, and 4 were shoemakers. The study suggests an association of this type of nasal carcinoma with occupational exposure to wood dust and leatherwork. The nature of the postulated carcinogen is unknown. The authors propose further investigations to define the magnitude of the cancer risk associated with exposure to wood dust and leather.

Inverted papillomas of the nose and the paranasal sinuses

A series of 21 patients with inverted papillomas of the nose and/or the paranasal sinuses is presented. In 19 patients the tumour arose from the lateral nasal wall or paranasal sinuses, in 2 it arose from the nasal septum. Nine patients had been previously treated by nasal polypectomy. None of the patients with recurrences after primary surgical treatment showed any evidence of a progression from benign to malignant lesions. Only 14% of the patients suffered from recurrence, and it seems likely that this is because extensive surgical extirpation was recommended as primary treatment in most cases. We feel justified in recommending early and radical surgery.

Sinonasal cancer and exposure to softwood

In order to study the connection between occupation and sinonasal cancer we have reviewed the files and histological sections of 70 patients (24 females and 46 males) treated at the Department of Oto-rhino-laryngology, National Hospital of Norway. Detailed information concerning previous occupations was obtained by telephone interviews according to a standardized questionnaire. This pilot study revealed a strong association between wood dust exposure and sinonasal cancer. Of 12 wood dust exposed men, 11 had been exposed exclusively to softwood. While squamous cell carcinoma was the predominant type of cancer in joiners, carpenters and loggers, non-Hodgkin lymphomas appeared to be associated with employment in saw- and planingmill firms. A nationwide case-control study is under preparation for further substantiation of the health hazards connected with exposure to softwood and other possible occupational factors related to sinonasal cancer.

Cancer mortality in nonsmoking women with smoking husbands based on a large-scale cohort study in Japan

Mortality of 91,540 nonsmoking wives was studied in relation to the smoking habits of their husbands by means of a cohort study in Japan. During 16 years of follow-up, 200 deaths from lung cancer took place. The relative risks of lung cancer in these nonsmoking wives were 1.00, 1.36, 1.42, 1.58, and 1.91 when husbands were nonsmokers, ex-smokers, or daily smokers of 1-14, 15-19, or 20 or more cigarettes daily, respectively. Specificity of association and internal consistencies were observed. Among cancers of each site, a similar tendency toward risk elevation in nonsmoking wives with smoking husbands was observed for nasal sinus cancer, brain tumors, and cancer of all sites besides lung cancer. In interpreting these results, the significance of proximity in exposure to sidestream smoke in Japanese homes was stressed.

Adenocarcinoma of the ethmoid sinuses. A review of 28 cases with special reference to wood dust exposure

Adenocarcinoma makes up only a small percent of all nasal and paranasal sinus carcinomas, and is most often found in the ethmoid sinuses. Adenocarcinoma of the ethmoid sinuses is known to be associated with exposure to wood dust. Twenty-eight patients with ethmoid adenocarcinomas were collected, mainly during the last decade from a region with approximately 900,000 inhabitants and with a large amount of furniture industries. There were 4 women and 24 men in the study. Twenty of the men were exposed to dust from hardwood for 20 to 55 years (mean, 40 years) which is in accord with other reports and supports data on the increased risk for workers of developing adenocarcinoma of the ethmoid sinuses when exposed to dust from hardwood. Radiologic diagnosis is necessary to delineate the extent of these tumours, and computerized tomography (CT) especially furnishes important information. Most patients received preoperative radiotherapy followed by surgery, 50% of them survived 5 years, which is in accord with other reports.

A case-control study of cancers of the nasal cavity and paranasal sinuses

To examine occupation, smoking, and other risk factors for nasal cancer, a case-control study was conducted among 160 patients, who were admitted to four hospitals in North Carolina and Virginia between 1970 and 1980, and 290 controls. Employment in the furniture industry was not associated with squamous cell tumors, but such employment increased the risk of nasal adenocarcinoma by fivefold. In addition, approximately threefold excess risks of adenocarcinoma were observed for those employed in other industries involving possible exposure to wood dust. Elevated risks among males were also associated with occupational exposures to chromates (relative risk (RR) = 5.1) and chemicals (RR = 2.7). Among females, an excess risk was associated with employment in the textile industry, particularly for jobs involving dust exposure (RR = 2.3). Although there was no evidence that alcohol consumption affected risk, heavy cigarette smokers were at a two- to threefold excess risk (predominantly for squamous cell tumors); in addition, there was evidence that there was an elevated risk associated with the use of snuff. Elevated risks were also associated with histories of nasal polyps (RR = 8.3), recurrent nose bleeds (RR = 2.0), and sinus trouble (RR = 2.7). These findings provide leads for further studies, and underscore the importance of distinguishing between histologic types.

Problems in pediatric otorhinolaryngic pathology. IV. Epithelial and lymphoid tumors of the sinonasal tract and nasopharynx

The clinical and histopathologic diagnostic problems of childhood nasopharyngeal carcinoma, sinonasal epithelial tumors, and Burkitt's lymphoma are described, and the relationship of the Epstein-Barr virus to tumors is discussed.

Nasal and sinonasal cancer. Connection with occupational exposures in Denmark, Finland and Sweden

A joint Danish-Finnish-Swedish case-referent investigation was initiated in 1977 in order to study the connection between nasal and sinonasal cancer and various occupational exposures. All new cases of nasal and sinonasal cancer were collected from the national cancer registers (Finland and Sweden) or from the hospitals (Denmark). Those still alive who agreed to an interview (N = 167) were individually matched for age and sex with patients with colonic or rectal cancer. A detailed telephone interview was made according to standardized forms. Both cases and referents thought that their condition was the one under study. The exposures were coded blindly by an industrial hygienist. The results showed associations between nasal and sinonasal cancer and exposure to (i) hardwood or mixed wood dust (discordant pairs 14: 2), (ii) softwood dust alone (13:4), (iii) chromium (16: 6), (iv) nickel (12: 5, not significant), (v) welding, flame-cutting and soldering (17: 6), and (vi) lacquers and paints (14: 0). The last finding was probably due to confounding from wood dust exposure. Hardwood dust exposure was associated with adenocarcinoma. Softwood dust exposure alone was associated with epidermoid and anaplastic carcinomas. No associations were found for a number of exposures, including agricultural chemicals, textile dust, asbestos, quartz dust, organic solvents and leather work. Possible exposure to formaldehyde was evenly distributed between the cases and referents.

Nasal cancer and occupational exposures. Preliminary report of a joint Nordic case-referent study

Nasal and sinus paranasal cancers have been associated with several occupational exposures, for example, dust from hardwood, nickel and unspecific agents occurring in the boot and shoe industry. A joint Danish-Finnish-Swedish case-referent investigation was initiated in 1977 to study further the connection between nasal and sinus paranasal cancers and various occupational exposures. All new cases of these cancers were collected from the national cancer registers (Finland & Sweden) or from hospitals (Denmark). Those still alive who agreed to the interview (N = 167) were individually matched for age and sex with patients with colonic or rectal cancer. A detailed telephone interview was performed according to a standardized procedure. Both the cases and referents thought that their condition was the one under study. The exposures were coded blindly by an experienced industrial hygienist. The results showed associations between nasal or sinus paranasal cancer and exposure to hardwood or mixed wood dust (discordant pairs 14/2); softwood dust alone (13/4); chromium 16/6); nickel (12/5, not significant); welding, flamecutting, and soldering (17/16); and lacquers and paints (12/0). Hardwood dust exposure showed a connection with adenocarcinoma. Softwood dust exposure alone was associated with epidermoid and anaplastic carcinomas. No associations were found for a number of exposures, including agricultural chemicals, textile dust, asbestos, quartz dust, organic solvents, and leather work. Possible exposure to formaldehyde was evenly distributed between the cases and referents.

A case-referent study on nasal cancer and exposure to wood dust in the province of Siena, Italy

The aim of the present study was to assess the risk of nasal cancer associated with exposure to dust in the wood and furniture industry in the province of Siena, Italy. Four to seven percent of the active male population is employed in this sector. A case-referent approach was used. The cases included male subjects seen at the Ear, Nose and Throat Clinic and the Radiotherapy Unit of Siena and diagnosed as having cancer of the nasal cavities or paranasal sinuses between 1963 and 1981. The referents were male patients admitted to the Medical Clinic of Siena for all causes except nasal neoplasia; they were matched 5:1 to the cancer patients for age and time of admission. Information was gathered (by postal questionnaires) on the occupational histories of all 36 of the cancer patients and 164 of the 180 referents. The odds ratio associated with exposure to wood dust was 5.4 (1.7-17.2) for all carcinomas, and 87.7 (19.8-407.3) for mucinous adenocarcinoma. The woods used by the exposed cancer patients were mainly oak, chestnut, poplar, and fir. The median duration of exposure was 40 years; no exposed cancer patient reported the presence of exhaust systems in their work environment.

[Rhinogenic adenocarcinoma in wood-workers]

In a retrospective epidemiological study, 127 patients with malignant tumours of the nose and paranasal sinuses were studied during a period of ten years. There was a remarkable coincidence between adenocarcinomas and adenocystic carcinomas on the one hand, and patients who were occupationally exposed to wood dust on the other; it was established that the duration of this exposure in the course of their professional life had been between 15 and 35 years. Adenocarcinomas represented 22.8% of the total amount of malignant tumours. The share of the woodworkers in the total number of occupationally active patients in our area of examination was 2.14%, whereas 17.2% of the patients with adenocarcinoma and adenocystic carcinoma had been occupationally exposed to wood dust. The statistical examination of the postulated connection between exposure to wood dust and the occurrence of malignant tumours of the histological type of the adenocarcinoma and adenocystic carcinoma, showed a highly significant correlation.

Ossifying capillary hemangioma of the maxillary and ethmoid sinuses - a case report

A rare lesion of the maxillary and ethmoid sinuses, an ossifying capillary hemangioma, is presented. The therapeutic options and our choice of embolization followed one day later by radical surgery under hypotensive, hypothermic anesthesia are discussed. The principles of therapy involved in this lesion apply to the management of any large vascular tumor of the head and neck.