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Jauhiainen MK, Mohanraj U, Perdomo MF, Hagström J, Haglund C, Mäkitie AA, Söderlund-Venermo M, Sinkkonen ST. Presence of herpesviruses, parvoviruses, and polyomaviruses in sinonasal lymphoma. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08702-0. [PMID: 38758242 DOI: 10.1007/s00405-024-08702-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Sinonasal lymphoma (SL) is a rare lymphatic neoplasm of the nasal cavities, paranasal sinuses and nasopharynx. Whereas some risk factors for SL subtypes have been identified, their aetiology is unknown. Along with other predisposing factors, the viral association of lymphomas, such as Epstein-Barr virus (EBV) and Burkitt and Hodgkin lymphomas, is well-established. Modern molecular biology techniques have enabled the discovery of novel human viruses, exemplified by the protoparvovirus cutavirus (CuV), associated with cutaneous T-cell lymphoma. These findings, and the anatomical location of the sinonasal tract with its rich microbiome and infectious agents, justify in-depth studies among SL. METHODS We analysed the presence of 20 viruses of Orthoherpesviridae, Parvoviridae, and Polyomaviridae by qPCR in 24 SL tumours. We performed RNAscope in situ hybridisation (RISH) to localize the viruses. Parvovirus-specific IgG was analysed by enzyme immunoassay and targeted next-generation sequencing (NGS) was applied to detect CuV in plasma. RESULTS We detected viral DNA in 15/24 (63%) tumours; nine of EBV, six of human herpesvirus (HHV) -7, four each of HHV-6B and parvovirus B19, two of cytomegalovirus, and one each of CuV and Merkel-cell polyomavirus. We found tumours with up to four viruses per tumour, and localized CuV and EBV DNAs by RISH. Two of the ten plasma samples exhibited CuV IgG, and one plasma sample demonstrated CuV viremia by NGS. CONCLUSION Viruses were frequent findings in SL. The EBV detection rate was high in diffuse large B-cell lymphoma, and co-detections with other viruses were prevalent.
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Affiliation(s)
- Maria K Jauhiainen
- Department of Otorhinolaryngology, Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, POB 263, 00029 HUS, Helsinki, Finland.
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- The Doctoral Programme in Clinical Research, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Ushanandini Mohanraj
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maria F Perdomo
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, University Hospital of Helsinki, Helsinki, Finland
- Department of Oral Pathology and Radiology, University of Turku, Turku, Finland
- Translational Cancer Research Medicine, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Caj Haglund
- Translational Cancer Research Medicine, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Surgery, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, POB 263, 00029 HUS, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Maria Söderlund-Venermo
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Saku T Sinkkonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, POB 263, 00029 HUS, Helsinki, Finland
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2
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Jang HB, Lee DH, Song GY, Yang DH, Lim SC. Clinical characteristics analysis of sinonasal diffuse large B-cell lymphoma and extranodal NK/T-cell lymphoma. Int Forum Allergy Rhinol 2023; 13:2256-2258. [PMID: 37329243 DOI: 10.1002/alr.23217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 06/18/2023]
Abstract
KEYPOINTS Extranodal NK/T-cell lymphoma (ENKL) was the most common sinonasal lymphoma at our hospital. ENKL occurs at a younger age, and is more prevalent in the nasal cavity. ENKL had a lower Ann Arbor stage, and a better prognosis than diffuse large B-cell lymphoma (DLBLC).
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Affiliation(s)
- Hye-Bin Jang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea
| | - Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea
| | - Ga-Young Song
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea
| | - Deok-Hwan Yang
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea
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3
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Zheng YH, Tian B, Qin WW, Zhu QW, Feng J, Hu WY, Chen RA, Liu L. Distribution and survival outcomes of primary head and neck hematolymphoid neoplasms in older people: a population-based study. Clin Exp Med 2023; 23:3957-3967. [PMID: 37093452 DOI: 10.1007/s10238-023-01069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/05/2023] [Indexed: 04/25/2023]
Abstract
Primary head and neck hematolymphoid neoplasms (PHNHLN) are defined as a series of hematolymphoid system-derived neoplasms which primarily emanate in head and neck region. Due to the rarity and absence of symptomatic specificity, PHNHLN is easily neglected. The objective of this study is to investigate demographics, pathological subtype distribution, anatomical location, survival outcomes and prognostic factors of PHNHLN among older patients aged ≥ 60. The individual patient information in our study was derived from Surveillance, Epidemiology and End Results database. Descriptive epidemiological methods were used to analyze the distribution of histologic subtypes and primary anatomical sites. Kaplan-Meier survival curves and log-rank test were conducted to evaluate the effect of variables on the prognosis. Cox hazard regression was conducted to identify the independent prognostic factors. The male-to-female ratio in most pathological subtypes was close to 1:1. The most common pathological subtype was diffuse large B-cell lymphoma. The most commonly involved sites outside the lymph nodes were salivary glands, especially parotid gland, followed by tonsil, thyroid gland and tongue. The prognosis of mature T- and NK-cell non-Hodgkin lymphoma (NHL) was bleaker than Hodgkin lymphoma, mature B-cell NHL and plasma cell neoplasm. Age at diagnosis, presence of second primary malignancy (SPM), pathological subtype, Ann-Arbor stage, chemotherapy and radiation were independent prognostic factors of overall survival. Our study comprehensively reported the subtype distribution, anatomical sites and survival outcomes of PHNHLN among older patients, improving understanding of this rare group of cancer entities.
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Affiliation(s)
- Yan-Hua Zheng
- Department of Hematology, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), No.1 Xin'si Road, Xi'an, 710038, Shaanxi, China
- National Clinical Research Center for Hematological Diseases of China, Shaanxi Branch Center, Clinical Research Center for Hematologic Disease of Shaanxi Province, Xi'an, Shaanxi, China
| | - Biao Tian
- Department of Hematology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, Shaanxi, China
| | - Wei-Wei Qin
- Department of Hematology, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), No.1 Xin'si Road, Xi'an, 710038, Shaanxi, China
- National Clinical Research Center for Hematological Diseases of China, Shaanxi Branch Center, Clinical Research Center for Hematologic Disease of Shaanxi Province, Xi'an, Shaanxi, China
| | - Qing-Wen Zhu
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, Shaanxi, China
| | - Juan Feng
- Department of Hematology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, Shaanxi, China
| | - Wu-Yue Hu
- Department of Hematology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, Shaanxi, China
| | - Ren-An Chen
- Department of Internal Medicine II, Tumour Hospital of Shaanxi Province, No.309 Yan'ta West Road, Xi'an, Shaanxi, China.
| | - Li Liu
- Department of Hematology, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), No.1 Xin'si Road, Xi'an, 710038, Shaanxi, China.
- National Clinical Research Center for Hematological Diseases of China, Shaanxi Branch Center, Clinical Research Center for Hematologic Disease of Shaanxi Province, Xi'an, Shaanxi, China.
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4
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Peng J, Chen J, Liu Y, Lyu J, Zhang B. Nomograms for predicting overall survival and cancer-specific survival in patients with head and neck non-Hodgkin lymphoma: A population-based study. Medicine (Baltimore) 2023; 102:e32865. [PMID: 36820559 PMCID: PMC9908000 DOI: 10.1097/md.0000000000032865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
This study aimed to develop comprehensive nomograms for patients with head and neck non-Hodgkin lymphoma (H&NNHL) to determine their overall survival (OS) and cancer-specific survival (CSS). In this study, 602 H&NNHL patients were analyzed from the Surveillance, Epidemiology, and End Results database. The R software was used to randomly divide the patients into the training cohort (n = 421) and the validation cohort (n = 181) in a 7-to-3 ratio. To develop nomograms for projecting OS and CSS, multivariable Cox regression was used to acquire independent predictive factors. We have constructed nomograms to predict the 3-, 5-, and 8-year OS and CSS probabilities of H&NNHL patients. The consistency index of the nomograms for OS (CSS) was 0.74 (0.778) and 0.734 (0.775), in the training and validation cohort respectively, and was higher than that of the Ann Arbor staging system. Calibration plotting showed that our models have good calibration ability. Moreover, assessments of the area under the time-dependent receiver operating characteristics curve, net reclassification improvement, integrated discrimination improvement and decision curve analysis demonstrated that our nomograms performed better and were more clinically useful than the Ann Arbor staging system. This is the first research to establish comprehensive nomograms for predicting OS and CSS in patients with H&NNHL at 3-, 5-, and 8-year. The validation of the models demonstrated good performance. It can provide clinicians with reference information for determining customized clinical treatment options and providing personalized prognoses. Indexes such as the concordance index, the area under the time-dependent receiver operating characteristics curve, calibration curves, the net reclassification improvement, the integrated discrimination improvement, and decision-curve analysis were used to compare new survival models to the classical Ann Arbor staging system.
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Affiliation(s)
- Jing Peng
- Department of Orthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
| | - Jianming Chen
- Department of Orthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
| | - Yucheng Liu
- Department of Orthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Bin Zhang
- Department of Orthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
- * Correspondence: Bin Zhang, Department of Orthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong 510182, China (e-mail: )
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5
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Tanaka H, Mori E, Akutsu T, Saito S, Tei M, Otori N. Characteristics of Extranodal NK/T-Cell Lymphoma, Nasal Type, Compared with Nasal Diffuse Large B-cell Lymphoma. Clin Med Insights Oncol 2023; 17:11795549231156692. [PMID: 36908718 PMCID: PMC9996724 DOI: 10.1177/11795549231156692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/26/2023] [Indexed: 03/11/2023] Open
Abstract
Background Extranodal NK/T-cell lymphoma, nasal type (ENKL), is an aggressive tumour with poor prognosis. Its early diagnosis may improve the prognosis of patients; however, it is often overlooked in many cases and misdiagnosed as an inflammatory sinus disease during its initial stage. Identifying the clinical characteristics of ENKL may aid otorhinolaryngologists in indicating cases early for a pathologic examination. In this study, we aimed to investigate the clinical characteristics of ENKL compared with that of diffuse large B-cell lymphoma (DLBCL), which is the most common nasal malignant lymphoma. Methods The backgrounds, clinical symptoms, blood test results, and computed tomography images of patients with nasal/paranasal malignant lymphoma in our hospital between 2012 and 2017 were investigated. The characteristics of ENKL and nasal DLBCL were compared to differentiate them. Results A total of 27 patients with nasal cavity and/or paranasal sinus lymphoma were included. Extranodal NK/T-cell lymphoma, nasal type, was diagnosed in 10 patients, while DLBCL was diagnosed in 17 patients. The median age of patients with ENKL was significantly lower than that of patients with DLBCL. All patients with ENKL had a unilateral lesion in the nasal cavity, with most located at the inferior turbinate. They also experienced nasal symptoms with significantly higher incidence of nasal obstruction and tendency of bleeding. Conclusion ENKL was often unilateral and caused nasal obstruction, unlike DLBCL. Those who are younger in age and have sinonasal tumour with unilateral nasal obstruction and bleeding should be considered for early and repeated biopsies at multiple sites, with ENKL taken into consideration.
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Affiliation(s)
- Hirotaka Tanaka
- Department of Otorhinolaryngology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan.,Department of Otorhinolaryngology, Jikei University School of Medicine, Minato-ku, Japan
| | - Eri Mori
- Department of Otorhinolaryngology, Jikei University School of Medicine, Minato-ku, Japan
| | - Taisuke Akutsu
- Department of Otorhinolaryngology, Jikei University School of Medicine, Minato-ku, Japan
| | - Shota Saito
- Department of ENT/Head & Neck Surgery, Dokkyo Medical University, Mibu, Japan
| | - Masayoshi Tei
- Department of Otorhinolaryngology, Jikei University School of Medicine, Minato-ku, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, Jikei University School of Medicine, Minato-ku, Japan
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Desai MA, Sethi TK, Yenamandra AK, Morgan D, Thompson MA, Reddy NM, Kovach AE. Primary sinonasal large B cell lymphoma is as histopathologically heterogeneous as systemic large B cell lymphoma but may show subtype-specific tropism for specific sinonasal anatomic sites. J Hematop 2021. [DOI: 10.1007/s12308-021-00473-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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7
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Brown HJ, Varelas EA, Ganti A, Papagiannopoulos P, Mark M, Kuan EC, Tajudeen BA. Prognostic Indicators of Survival in Sinonasal Diffuse Large B-Cell Lymphoma: A National Cancer Database Analysis. Laryngoscope 2021; 132:1515-1522. [PMID: 34542177 DOI: 10.1002/lary.29864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/18/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study offers an update on the epidemiologic and prognostic factors and treatment-specific outcomes in patients diagnosed with sinonasal diffuse large B-cell lymphoma (DLBCL). STUDY DESIGN Retrospective cohort study. METHODS National Cancer Database was queried from 2004 to 2016 for patients with sinonasal DLBCL. Univariate Kaplan-Meier and multivariate Cox-regression analyses were performed to evaluate the association of suspected prognostic factors with overall survival (OS). RESULTS A total of 2,222 patients with sinonasal DLBCL were analyzed. OS was 62% at 5 years and 42% at 10 years. Prognostic factors associated with increased survival included African-American race (HR: 0.48, 95% CI: 0.33-0.70), chemotherapy (HR: 0.30, CI: 0.25-0.35), and radiation (HR: 0.80, CI: 0.69-0.93). Prognostic factors associated with decreased survival included patients with Charlson-Deyo scores of 1 (HR: 1.51, CI: 1.25-1.84), 2 (HR: 2.25, CI: 1.67-3.03), and 3 (HR: 2.36, CI: 1.49-3.74) and patients with Lugano stage III (HR: 1.69, CI: 1.09-2.62) and IV (HR: 1.96, CI: 1.46-2.64) disease. Stage-based split multivariate analysis was performed and revealed chemotherapy was independently associated with increased OS in patients with stage I (HR: 0.24, CI: 0.19-0.30), II (HR: 0.17, CI: 0.11-0.28), and IV (HR: 0.41, CI: 0.26-0.64) disease. Radiotherapy was independently associated with increased OS in patients with stage I disease only (HR: 0.67, CI: 0.55-0.83), while immunotherapy was an independent prognostic factor in patients with stage IV disease only (HR: 0.60, CI: 0.37-0.98). CONCLUSION This study is the largest to date to analyze the association of demographic features and treatment modalities with OS in patients with sinonasal DLBCL. It is the first to investigate the association of immunotherapy with OS in this population. A combination treatment of immunochemotherapy or radioimmunochemotherapy confers increased survival, particularly in patients with advanced disease. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Eleni A Varelas
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ashwin Ganti
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Peter Papagiannopoulos
- Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Michelle Mark
- Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Bobby A Tajudeen
- Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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8
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Song Y, Li J, Wang S, Zhou Z, Qiao X, Zhao X. The promising outcome with simultaneous integrated boost intensity modulated radiotherapy in confined nasal extranodal NK/T-cell lymphoma. Leuk Lymphoma 2021; 62:2907-2914. [PMID: 34261418 DOI: 10.1080/10428194.2021.1948035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
The study aimed to retrospectively analyze the prognosis of patients with stage IE nasal extranodal natural killer/T-cell lymphoma (ENKTL) with dose reduction to clinical target volume (CTV) by using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT). Forty-four patients were reviewed retrospectively. The prescribed dose was 45 Gy/25 fractions for extended involved-field site and 50-55 Gy/25 fractions for primary tumor site by using SIB-IMRT. The 5-year overall survival (OS), local control (LC) and progression-free survival (PFS) were 81.2%, 93.0%, and 78.8%, respectively. The complete response (CR) rate was 85.4% (37/44). Three patients (6.8%) patients had local failure and 3 (6.8%) patients developed systemic failure. There was only one patient had grade 3 mucositis and 2 patients had grade 3 or grade 4 hematologic toxicities. For patients with stage IE nasal ENKTL, appropriate dose reduction to CTV by SIB-IMRT strategy is feasible and safe with a promising outcome.
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Affiliation(s)
- Yuzhi Song
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jing Li
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shuoshuo Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiguo Zhou
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xueying Qiao
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinming Zhao
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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9
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Mustafa N, Nee AHF, Chooi JY, Toh SHM, Chung TH, Selvarajan V, Fan S, Ng SB, Poon M, Chan E, Lee J, Chee YL, Jeyasekharan AD, Zhou L, Yang J, Chng WJ. Determinants of response to daratumumab in Epstein-Barr virus-positive natural killer and T-cell lymphoma. J Immunother Cancer 2021; 9:jitc-2020-002123. [PMID: 34215687 PMCID: PMC8256838 DOI: 10.1136/jitc-2020-002123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2021] [Indexed: 12/22/2022] Open
Abstract
Background The potential therapeutic efficacy of daratumumab in natural killer T-cell lymphoma (NKTL) was highlighted when its off-label usage produced sustained remission in a patient with highly refractory disease. This is corroborated recently by a phase II clinical trial which established that daratumumab monotherapy is well tolerated and displayed encouraging response in relapsed/refractory NKTL patients. However, little is known regarding the molecular factors central to the induction and regulation of the daratumumab-mediated antitumor response in NKTL. Methods CD38 expression was studied via immunohistochemistry, multiplex immunofluorescence and correlated with clinical characteristics of the patient. The therapeutic efficacy of daratumumab was studied in vitro via CellTiter-Glo (CTG) assay, complement-dependent cytotoxicity (CDC), antibody-dependent cell cytotoxicity (ADCC), and in vivo, via a patient-derived xenograft mouse model of NKTL, both as a single agent and in combination with L-asparaginase. Signaling mechanisms were characterized via pharmacologic treatment, RNA silencing, flow cytometry and corroborated with public transcriptomic data of NKTL. Results Epstein-Barr virus-positive NKTL patients significantly express CD38 with half exhibiting high expression. Daratumumab effectively triggers Fc-mediated ADCC and CDC in a CD38-dependent manner. Importantly, daratumumab monotherapy and combination therapy with L-asparaginase significantly suppresses tumor progression in vivo. Ablation of complement inhibitory proteins (CIP) demonstrate that CD55 and CD59, not CD46, are critical for the induction of CDC. Notably, CD55 and CD59 expression were significantly elevated in the late stages of NKTL. Increasing the CD38:CIP ratio through sequential CIP knockdown, followed by CD38 upregulation via All-Trans Retinoic Acid treatment, potently augments complement-mediated lysis in cells previously resistant to daratumumab. The CD38:CIP ratio consistently demonstrates a statistically superior correlation to antitumor efficacy of daratumumab than CD38 or CIP expression alone. Conclusion This study characterizes CD38 as an effective target for a subset of NKTL patients and the utilization of the CD38:CIP ratio as a more robust identifier for patient stratification and personalisation of treatment. Furthermore, elucidation of factors which sensitize the complement-mediated response provides an alternative approach toward optimizing therapeutic efficacy of daratumumab where CDC remains a known limiting factor. Altogether, these results propose a strategic rationale for further evaluation of single or combined daratumumab treatment in the clinic for NKTL.
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Affiliation(s)
- Nurulhuda Mustafa
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore .,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Adina Huey Fang Nee
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Jing Yuan Chooi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sabrina Hui Min Toh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Tae-Hoon Chung
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Viknesvaran Selvarajan
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shuangyi Fan
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siok Bian Ng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Michelle Poon
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, Singapore
| | - Esther Chan
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, Singapore
| | - Joanne Lee
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, Singapore
| | - Yen Lin Chee
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, Singapore
| | - Anand D Jeyasekharan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, Singapore
| | - Longen Zhou
- Discovery Center, Janssen China R&D, Shanghai, China
| | - Jennifer Yang
- Discovery Center, Janssen China R&D, Shanghai, China
| | - Wee Joo Chng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, Singapore
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10
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Lehrich BM, Abiri A, Goshtasbi K, Birkenbeuel J, Yasaka TM, Papagiannopoulos P, Tajudeen BA, Brem EA, Kuan EC. Treatment Modalities and Survival Outcomes for Sinonasal Diffuse Large B-Cell Lymphoma. Laryngoscope 2021; 131:E2727-E2735. [PMID: 33899946 DOI: 10.1002/lary.29584] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/25/2021] [Accepted: 04/14/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study utilizes a large population national database to comprehensively analyze prognosticators and overall survival (OS) outcomes of varying treatment modalities in a large cohort of sinonasal diffuse large B-cell lymphoma (SN-DLBCL) patients. STUDY DESIGN Retrospective database study. METHODS The National Cancer Database was queried for all SN-DLBCL cases diagnosed from 2004 to 2015. Kaplan-Meier log-rank test determined differences in OS based on clinical covariates. Cox proportional-hazards analysis was used to determine clinical and sociodemographic covariates predictive of mortality. RESULTS A total of 2,073 SN-DLBCL patients were included, consisting of 48% female with a mean age of 66.0 ± 16.2 years. Overall, 82% of patients were Caucasian, 74% had early-stage disease, and 49% had primary tumors in the paranasal sinuses. Early-stage patients were more likely to receive multi-agent chemoradiotherapy compared to multi-agent chemotherapy alone (P < .001). Multivariable Cox proportional-hazards analysis revealed chemoradiotherapy to confer significantly greater OS improvements than chemotherapy alone (hazard ratio [HR]: 0.61; P < .001). However, subset analysis of late-stage patients demonstrated no significant differences in OS between these treatment modalities (P = .245). On multivariable analysis of chemotherapy patients treated post-2012, immunotherapy (HR = 0.51; P = .024) demonstrated significant OS benefits. However, subset analysis showed no significant advantage in OS with administering immunotherapy for late-stage patients (P = .326). Lastly, for all patients treated post-2012, those receiving immunotherapy had significantly improved OS compared to those not receiving immunotherapy (P < .001). CONCLUSIONS Treatment protocol selection differs between early- and late-stage SN-DLBCL patients. Early-stage patients receiving chemotherapy may benefit from immunotherapy as part of their treatment paradigm. LEVEL OF EVIDENCE III Laryngoscope, 2021.
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Affiliation(s)
- Brandon M Lehrich
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A.,Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, U.S.A
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Jack Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Tyler M Yasaka
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Elizabeth A Brem
- Department of Hematology and Oncology, University of California, Irvine, California, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
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11
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Manole C, Farrell E, Lang E. NK/T-cell lymphoma of the nasal cavity: an unexpected diagnosis. BMJ Case Rep 2021; 14:e240995. [PMID: 33762288 PMCID: PMC7993345 DOI: 10.1136/bcr-2020-240995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/04/2022] Open
Abstract
Nasal-type Natural Killer/T-cell Lymphoma (NKTL) is a rare form of extranodal non-Hodgkin's lymphoma, typically arising in the nasopharynx and displaying an aggressive and ultimately fatal clinical course. The disease is linked to Epstein-Barr virus infection and is endemic to Asia and South America, but extremely few cases have been reported in Europe. We present two cases of nasal NKTL unexpectedly diagnosed in elderly patients, following very different presentations to our otolaryngology service. The first case is that of a 73-year-old Irish man with recurrent nasal vestibulitis despite antibiotic treatment. The second case involves a 79-year-old Irish woman presenting with a large mass on the hard palate, found to invade into the floor of the nose. NKTL can pose diagnostic challenges, as the initial clinical presentation can be non-specific and overlap with other nasal conditions, leading to a delay in diagnosis. Biopsy with histopathological and immunohistochemistry analysis is required to establish the definitive diagnosis. Treatment involves multidisciplinary input from radiotherapy and medical oncologists. Clinicians must be aware of this disease and have an index of suspicion when dealing with persistent or aggressive nasal conditions.
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Affiliation(s)
- Constantin Manole
- Department of Otolaryngology/ Head and Neck Surgery, University Hospital Waterford, Waterford, Republic of Ireland
| | - Eric Farrell
- Department of Otolaryngology/ Head and Neck Surgery, University Hospital Waterford, Waterford, Republic of Ireland
| | - Emer Lang
- Department of Otolaryngology/ Head and Neck Surgery, University Hospital Waterford, Waterford, Republic of Ireland
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12
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Sánchez-Romero C, Bologna-Molina R, Paes de Almeida O, Santos-Silva AR, Prado-Ribeiro AC, Brandão TB, Carlos R. Extranodal NK/T cell lymphoma, nasal type: An updated overview. Crit Rev Oncol Hematol 2021; 159:103237. [PMID: 33493634 DOI: 10.1016/j.critrevonc.2021.103237] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 06/09/2020] [Accepted: 01/16/2021] [Indexed: 02/07/2023] Open
Abstract
Extranodal NK/T-cell lymphoma, nasal type (ENKTCL-NT) is an aggressive malignancy associated with Epstein-Barr virus infection, with a geographic and racial predilection for some Asian and Latin American countries. ENKTCL-NT manifests as a necrotic process affecting nasal or upper aerodigestive structures and, rarely, extranasal sites such as skin, and the gastrointestinal tract. ENKTCL-NT was characterized by its poor prognosis irrespective of clinical stage and therapy. However, during the last two decades, advances in its clinicopathologic, genetic and molecular characterization have been achieved, as have changes in the chemotherapy regimens that, in combination with radiotherapy, are significantly improving the survival of these patients, especially in initial stages. For these reasons, we present an overview of the historical background of ENKTCL-NT along with an updated review of its potential etiological factors, clinicopathologic and molecular features, as well as its prognostic models, current treatment protocols, and future directions on potential promising therapeutic approaches.
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Affiliation(s)
- Celeste Sánchez-Romero
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira 901, Piracicaba, Sao Paulo 1314‑903, Brazil; Department of Research, School of Dentistry, Universidad Juárez del Estado de Durango, Durango, Mexico.
| | - Ronell Bologna-Molina
- Molecular Pathology Area, Faculty of Dentistry, Universidad de la República, Montevideo, Uruguay; Department of Research, School of Dentistry, Universidad Juárez del Estado de Durango, Durango, Mexico
| | - Oslei Paes de Almeida
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira 901, Piracicaba, Sao Paulo 1314‑903, Brazil
| | - Alan Roger Santos-Silva
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira 901, Piracicaba, Sao Paulo 1314‑903, Brazil
| | - Ana Carolina Prado-Ribeiro
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Thaís Bianca Brandão
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Román Carlos
- Department of Pathology, Integra Cancer Center, Guatemala City, Guatemala
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13
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Differential diagnosis of sinonasal extranodal NK/T cell lymphoma and diffuse large B cell lymphoma on MRI. Neuroradiology 2020; 62:1149-1155. [PMID: 32562035 PMCID: PMC7410867 DOI: 10.1007/s00234-020-02471-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/03/2020] [Indexed: 12/25/2022]
Abstract
Purpose To evaluate whether imaging features on conventional magnetic resonance imaging (MRI) can differentiate sinonasal extranodal natural killer/T cell lymphomas (ENKTL) from diffuse large B cell lymphoma (DLBCL). Methods Consecutively, pathology-proven 59 patients with ENKTL and 27 patients with DLBCL in the sinonasal region were included in this study. Imaging features included tumor side, location, margin, pre-contrast T1 and T2 signal intensity and homogeneity, post-contrast enhancement degree and homogeneity, septal enhancement pattern, internal necrosis, mass effect, and adjacent involvements. These imaging features for each ENKTL or DLBCL on total 86 MRI scans were indicated independently by two experienced head and neck radiologists. The MRI-based performance in differential diagnosis of the two types of lymphomas was evaluated by multivariate logistic regression analysis. Results All ENKTLs were located in the nasal cavity, with ill-defined margin, heterogeneous signal intensity, internal necrosis, marked enhancement of solid component on MRI, whereas DLBCLs were more often located in the paranasal sinuses, with MR homogenous intensity, mild enhancement, septal enhancement pattern, and intracranial or orbital involvements (all P < 0.05). Using a combination of location, internal necrosis and septal enhancement pattern of the tumor in multivariate logistic regression analysis, sensitivity, specificity, and accuracy in differential diagnosis of ENKTL and DLBCL were 100%, 79.4%, and 91.9%, respectively, for radiologist 1, and were 98.3%, 81.5%, and 93.0%, respectively, for radiologist 2. Conclusion MRI can effectively differentiate ENKTL from DLBCL in the sinonasal region with a high diagnostic accuracy.
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14
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Xiao Z, Tang Z, Zheng C, Luo J, Zhao K, Zhang Z. Diffusion Kurtosis Imaging and Intravoxel Incoherent Motion in Differentiating Nasal Malignancies. Laryngoscope 2019; 130:E727-E735. [PMID: 31747056 DOI: 10.1002/lary.28424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/22/2019] [Accepted: 10/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the usefulness of diffusion kurtosis imaging (DKI) and intravoxel incoherent motion (IVIM) in the differentiation of sinonasal malignant tumors (SNMTs) with different histological types. STUDY DESIGN Retrospective observational and diagnostic study. METHODS Sixty-five patients with SNMTs who underwent DKI and IVIM were enrolled in this retrospective study, including 27 squamous cell carcinomas (SCCs), 13 olfactory neuroblastomas (ONBs), 14 malignant melanomas (MMs) and 11 lymphomas. The kurtosis (K) and diffusion coefficient (Dk) from DKI and the pure diffusion coefficient (D), pseudodiffusion coefficient (D*), perfusion fraction (f), and the product of D* and f (f∙D*) from IVIM were measured. Kruskal-Wallis and Dunn multiple comparison tests with Bonferroni correction, receiver operating characteristic curve, and logistic regression analyses were used for statistical analysis. RESULTS Lymphomas demonstrated the highest K values but lowest Dk, D, D*, f, and f∙D* values among these four malignant tumors. ONBs exhibited high K values and MMs had highest D*, f, and f∙D* values. The cutoff value of ≤0.887 × 10-3 mm2 /sec for f∙D* provided a sensitivity, specificity, and an accuracy of 100%, 98.1%, and 98.5%, respectively, for differentiating lymphomas from the other three entities. The combination of f∙D* and D values showed a sensitivity of 92.9% and a specificity of 92.5% for the discrimination of MMs from ONBs and SCCs. The K value was useful for differentiating ONBs from SCCs, with a threshold value of 0.942 (sensitivity, 84.6%; specificity, 63.0%). CONCLUSIONS The combined use of DKI and IVIM is helpful for differentiating among four histological types of SNMTs. LEVEL OF EVIDENCE 3 Laryngoscope, 2019.
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Affiliation(s)
- Zebin Xiao
- Department of Radiology, Eye and Ear, Nose, and Throat Hospital of Shanghai Medical School, Fudan University, Shanghai, China
| | - Zuohua Tang
- Department of Radiology, Eye and Ear, Nose, and Throat Hospital of Shanghai Medical School, Fudan University, Shanghai, China
| | - Chunquan Zheng
- Department of Otolaryngology, Eye and Ear, Nose, and Throat Hospital of Shanghai Medical School, Fudan University, Shanghai, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Keqing Zhao
- Department of Otolaryngology, Eye and Ear, Nose, and Throat Hospital of Shanghai Medical School, Fudan University, Shanghai, China
| | - Zhongshuai Zhang
- Department of Diagnostic Imaging, Siemens Healthcare Ltd., Shanghai, China
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Murakami D, Miyashita K, Koyama T, Omori H, Miyamoto Y, Sawatsubashi M, Nakagawa T. Clinicopathological analysis of sinonasal malignant lymphoma in an HTLV-1 endemic area in Japan -special focus on primary sinonasal diffuse large B-cell lymphoma. J Clin Exp Hematop 2019; 59:101-107. [PMID: 31391402 PMCID: PMC6798144 DOI: 10.3960/jslrt.18008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The present study investigated histological subtypes of lymphoma in patients newly diagnosed with malignant lymphoma in the human T-cell leukemia virus type 1 (HTLV-1) endemic area of Japan, and further analyzed the clinicopathological features and clinical outcomes of patients with primary sinonasal lymphoma. We retrospectively examined 151 patients aged 18-90 years in Fukuoka, Japan. Subtypes of lymphoma were determined according to the WHO classification. Among the 151 patients, 104 were diagnosed with malignant lymphoma, including 96 at the time of initial diagnosis. Ninety-two of the 96 lymphomas (96%) were non-Hodgkin lymphoma. Mature B-cell neoplasms comprised 78% (n = 75). Primary lymphoma of the sinonasal cavity was found in six patients (6%). The histological subtype of sinonasal lymphoma was diffuse large B-cell lymphoma (DLBCL) in all six tumors. Furthermore, overall survival was significantly different among three distinct DLBCL patient groups, including primary sinonasal lymphoma patients (p = 0.0016; 3-year overall survival: sinonasal DLBCL group, 53%; DLBCL of the CNS group, 0%; other DLBCL group, 83%). Our study suggests that primary DLBCL of the sinonasal tract is a distinct disease entity of DLBCL.
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16
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He M, Tang Z, Qiang J, Xiao Z, Zhang Z. Differentiation between sinonasal natural killer/T-cell lymphomas and diffuse large B-cell lymphomas by RESOLVE DWI combined with conventional MRI. Magn Reson Imaging 2019; 62:10-17. [PMID: 31212002 DOI: 10.1016/j.mri.2019.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To explore the feasibility of using RESOLVE DWI combined with conventional magnetic resonance imaging (MRI) to discriminate between sinonasal NKTLs and DLBCLs and to investigate the correlation between ADC value and Ki-67 expression in the two subtypes of NHLs. MATERIALS AND METHODS Sixty patients with NKTLs and twenty-six patients with DLBCLs in the sinonasal region who were confirmed by histopathology underwent high-resolution DWI and conventional MRI. The apparent diffusion coefficients (ADCs) and conventional MRI features associated with NKTLs and DLBCLs were compared using multivariate logistic regression. Receiver operating characteristic (ROC) curve analysis was performed, and the area under the curve (AUC) values for conventional MRI and MRI in combination with DWI were compared to determine the diagnostic performances of the approaches in the differentiation of NKTLs and DLBCLs. Spearman's rank correlations were used to analyze the correlation between ADC value with the higher AUC and Ki-67 expression. RESULTS For conventional MRI, localization in the nasal cavity and poor or moderate enhancement indicated an NKTL, whereas localization in the paranasal sinus and intense enhancement indicated a DLBCL, with sensitivity, specificity and area under the curve(AUC)value of 88.5%, 85.0% and 0.883, respectively. A combination with a cut-off ADC value of 0.646 × 10-3 mm2/s yielded sensitivity, specificity and AUC values of 100.0%, 80.0% and 0.951, respectively. A significant difference between the AUCs for conventional MRI and MRI in combination with DWI (p = 0.02) was identified. Ki-67 expression of NKTLs was significantly lower than that of DLBCLs (p < 0.001). Besides, there was an inversely poor correlation between them in the overall sample (r = -0.395, p < 0.001). However, the ADC value was not significantly correlated with Ki-67 LI in neither NKTLs nor DLBCLs (both p > 0.05). CONCLUSIONS Location and enhancement degree were the most valuable conventional MRI features for differentiating between NKTLs and DLBCLs. A combination of DWI and MRI could significantly improve the differential performance. ADC values may be used to noninvasively evaluate the proliferation level of sinonasal NHLs.
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Affiliation(s)
- Mengge He
- The Shanghai Institution of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Department of Radiology, Jinshan Hospital, Fudan University, Shanghai 201508, China; Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Zuohua Tang
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China.
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai 201508, China.
| | - Zebin Xiao
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Zhongshuai Zhang
- Scientific Marketing, Diagnostic Imaging, Siemens Healthcare, Shanghai 201318, China
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Vähämurto P, Mannisto S, Pollari M, Karjalainen-Lindsberg ML, Mäkitie AA, Leppä S. Clinical features and outcome of the patients with sinonasal tract diffuse large B-cell lymphoma in the pre-rituximab and rituximab eras. Eur J Haematol 2019; 102:457-464. [PMID: 30834564 DOI: 10.1111/ejh.13225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Sinonasal tract diffuse large B-cell lymphoma (SNT-DLBCL), a rare extranodal lymphoma, is not well characterized. We performed a population-based study to determine cell-of-origin, clinical presentation and impact of rituximab (R) and central nervous system (CNS) directed chemotherapy on survival. PATIENTS AND METHODS Patients with SNT-DLBCL were identified from pathology databases. Clinical information was collected and outcomes between different treatment modalities evaluated. RESULTS Thirty-two percent of the patients had germinal centre B-cell phenotype. Forty-six patients were treated with curative intent using CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or CHOP-like chemotherapy, 21 (46%) before and 25 (54%) in the R-era. Additionally, 24 (52%) received CNS-directed chemotherapy. Addition of R to chemotherapy reduced the risk of progression (RR = 0.368, 95% CI 0.138-0.976, P = 0.045) and death (RR = 0.245, 95% CI 0.068-0.883, P = 0.032), and translated into better survival (5-year PFS, 67% vs 38%, P = 0.037; 5-year OS, 81% vs 48%, P = 0.020). CNS-directed chemotherapy reduced the risk of progression (RR = 0.404, 95% CI 0.159-1.029, P = 0.057) and death (RR = 0.298, 95% CI 0.093-0.950, P = 0.041), and translated into favorable survival (5-year PFS, 67% vs 32%, P = 0.050; 5-year OS 82% vs 43%, P = 0.030). CONCLUSION Patients with SNT-DLBCL benefit from rituximab and CNS-directed chemotherapy.
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Affiliation(s)
- Pauli Vähämurto
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Otorhinolaryngology - Head and Neck Surgery and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Mannisto
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marjukka Pollari
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Oncology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | | | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Sirpa Leppä
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Maxillary Sinus Natural Killer/T-Cell Extranodal Lymphoma Mimicking a Dentoalveolar Abscess. Case Rep Dent 2019; 2019:6701783. [PMID: 30937196 PMCID: PMC6415291 DOI: 10.1155/2019/6701783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/16/2019] [Accepted: 02/06/2019] [Indexed: 11/17/2022] Open
Abstract
Extranodal natural killer/T-cell lymphoma (ENKL) is an aggressive and infrequent malignant neoplasm. Early sinonasal ENKL clinical symptomatology is often not specific which can mimic several clinical odontogenic processes such as dentoalveolar abscesses. A 41-year-old female was referred to our institution due to facial pain with skin rash, fever, and intraoral swelling in the left side of the maxillary region. Computed tomography (CT) revealed a soft tissue hypodense area in the left side with bone discontinuity in anterior and lateral maxillary sinuses. Initial laboratorial tests showed no alterations on hemogram, coagulation profile, and immune phenotype (CD3+/CD4+). However, the lesion progressed fastly showing an evident growth, so it was decided that an intraoral biopsy should be performed. The diagnosis was sinonasal ENKLs. This case is an example that the rare T-cell lymphoma can mimic an odontogenic lesion, thus puzzling the clinician. Fortunately, the rapid growth of the lesion prompted the correct diagnosis and early treatment.
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Varelas AN, Ganti A, Eggerstedt M, Tajudeen BA. Prognostic indicators of survival in sinonasal extranodal natural killer/T-cell lymphoma. Laryngoscope 2019; 129:2675-2680. [PMID: 30801751 DOI: 10.1002/lary.27886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/28/2018] [Accepted: 02/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Extranodal natural killer/T-cell lymphoma (ENKTL) is a highly aggressive tumor of the sinonasal tract associated with poor overall survival (OS). This study expands upon epidemiologic, prognostic, and treatment factors for OS and disease-specific survival (DSS), incorporating newly accessible chemotherapy data. METHODS Retrospective population-based cohort study performed on cases of sinonasal ENKTL identified through the Surveillance, Epidemiology, and End Results database. Univariate Kaplan-Meier analysis and subsequent multivariate Cox-regression analysis were performed to evaluate prognostic and treatment variables for OS and DSS. RESULTS Four hundred and sixty cases of sinonasal ENKTL were identified. Five-year OS and DSS were 46% and 56%, respectively. On multivariate analysis, higher Ann Arbor stage was associated with worse OS (P < 0.001) and DSS (P < 0.001), whereas administration of radiotherapy was associated with improved OS (P < 0.001) and DSS (P = 0.001). Additionally, a higher age at diagnosis was associated with reduced OS (P = 0.024). Chemotherapy was associated with improved OS (P < .01) and DSS (P = .04) for Ann Arbor stage I disease. Surgery was not associated with improved survival. CONCLUSION This represents the first study to investigate the use of chemotherapy for the treatment of sinonasal ENKTL using population-based analysis. Radiation therapy and chemotherapy significantly improve survival in all Ann Arbor stage patients and early-stage patients, respectively. Early-stage disease is significantly associated with improved survival. With no established treatment regimen for sinonasal ENKTL, these findings suggest combination chemoradiation is an effective therapy for prolonged survival, especially in early stages of disease. LEVEL OF EVIDENCE 3 Laryngoscope, 129:2675-2680, 2019.
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Affiliation(s)
- Antonios N Varelas
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Sinus Program, Rush University Medical Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ashwin Ganti
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Sinus Program, Rush University Medical Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Michael Eggerstedt
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Sinus Program, Rush University Medical Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Sinus Program, Rush University Medical Center, Rush University Medical Center, Chicago, Illinois, U.S.A
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Varelas AN, Eggerstedt M, Ganti A, Tajudeen BA. Epidemiologic, prognostic, and treatment factors in sinonasal diffuse large B -cell lymphoma. Laryngoscope 2018; 129:1259-1264. [PMID: 30570148 DOI: 10.1002/lary.27639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/16/2018] [Accepted: 09/04/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To further characterize the epidemiology, prognostic disease-specific factors, and treatment outcomes-including newly available chemotherapy data-for patients with sinonasal diffuse large B-cell lymphoma (DLBCL). METHODS The Surveillance, Epidemiology, and End Results registry was queried from 1973 to 2015 for patients with DLBCL of the nasal cavity and paranasal sinuses. Demographic and disease parameters were collected. Prognostic disease-specific survival and overall survival factors were evaluated with univariate Kaplan-Meier analysis. Significant variables were analyzed with multivariate Cox regression analysis. RESULTS A total of 1,273 cases of DLBCL of the sinonasal tract were identified. Significant differences in age of diagnosis between men (65.3) and women (71.1) existed (P < .01). Most common primary sites of DLBCL were maxillary sinus (36.1%) and nasal cavity (34.5%), with nasal cavity more common among Asian/Pacific Islands (43.4%) and maxillary sinus more common for Caucasians (36.3%) and African Americans (42.1%). Overall survival was 70% at 2 years, 54% at 5 years, and 38% at 10 years. Disease-specific survival was 81%, 73%, and 67%, respectively. Chemotherapy (hazard ratio [HR]: 0.551; P < .001) and radiation therapy (HR: 0.818; P = .012) were associated with improved prognosis, whereas higher Ann Arbor stage worsened prognosis (HR: 1.21; P < .001). Surgical intervention did not significantly impact survival. CONCLUSION This is the first study to include chemoradiation therapy in population-based analysis of sinonasal DLBCL. Chemotherapy and radiation therapy use significantly improve survival in these patients, whereas Ann Arbor staging is significantly associated with poorer outcomes. The mainstay of treatment for DLBCL should remain combination chemoradiation. LEVEL OF EVIDENCE NA Laryngoscope, 129:1259-1264, 2019.
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Affiliation(s)
- Antonios N Varelas
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Michael Eggerstedt
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ashwin Ganti
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Steele TO, Buniel MC, Mace JC, El Rassi E, Smith TL. Lymphoma of the nasal cavity and paranasal sinuses: A case series. Am J Rhinol Allergy 2017; 30:335-9. [PMID: 27657899 DOI: 10.2500/ajra.2016.30.4347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lymphomas of the sinonasal tract are a rare and heterogeneous subset of solid sinonasal neoplasms. OBJECTIVE To characterize, in this case series, presenting symptoms, treatment modalities, and outcomes for patients with sinonasal lymphoma within a single institution. METHODS Retrospective patient data were collected from an academic, oncologic center and entered into a repository designed to capture outcomes for sinonasal malignancies. Patient demographics, presenting symptoms, imaging findings, treatment modalities, and health status were retrospectively extrapolated and evaluated by using Kaplan-Meier estimations for survival probability. RESULTS Patients with sinonasal lymphoma with a mean follow-up of 50 months were identified (n = 18). Histologic diagnosis included the following: diffuse large B-cell lymphoma (n = 9), natural killer/T-cell lymphoma (n = 5), follicular lymphoma (n = 1), T-cell lymphoma (n = 1), and lymphoma-not otherwise specified (n = 2). The most frequent presenting symptoms were nasal obstruction (78%), facial pain (72%), facial swelling (50%), and nasal discharge (44%). Treatment before lymphoma diagnosis included antibiotics (83%), oral steroids (22%), decongestants (22%), and topical steroids (11%). Treatment regimens after diagnosis included both chemotherapy (94%) and chemoradiotherapy (56%). Survival rates by lymphoma subtype were 56% for B-cell lymphoma and 40% for natural killer/T-cell lymphoma. Overall, 2- and 5-year survival rates were 67% and 50%, respectively. The combination of chemotherapy and radiation resulted in significantly higher survival rates (p ≤ 0.001) than chemotherapy alone. CONCLUSION Sinonasal lymphomas are characterized by meager survival rates, which differ by histopathologic subtype. The diagnosis of sinonasal lymphoma is challenging because symptoms frequently parallel those of chronic rhinosinusitis. Increased awareness of these rare malignancies may improve detection and more timely treatment. Clinical trial registration NCT01332136.
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Affiliation(s)
- Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
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22
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Huang Y, Yang J, Liu P, Zhou S, Gui L, He X, Qin Y, Zhang C, Yang S, Xing P, Sun Y, Shi Y. Intensity-modulated radiation therapy followed by GDP chemotherapy for newly diagnosed stage I/II extranodal natural killer/T cell lymphoma, nasal type. Ann Hematol 2017; 96:1477-1483. [DOI: 10.1007/s00277-017-3046-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/04/2017] [Indexed: 11/28/2022]
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23
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New tumor entities in the 4th edition of the World Health Organization classification of head and neck tumors: Nasal cavity, paranasal sinuses and skull base. Virchows Arch 2017; 472:315-330. [DOI: 10.1007/s00428-017-2116-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
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24
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Huang Y, Jia B, Jiang S, Zhou S, Yang J, Liu P, Gui L, He X, Qin Y, Sun Y, Shi Y. Different clinical characteristics and treatment strategies for patients with localized sinonasal diffuse large B cell lymphoma and extranodal NK/T cell lymphoma. J Hematol Oncol 2017; 10:7. [PMID: 28057019 PMCID: PMC5217200 DOI: 10.1186/s13045-016-0368-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/06/2016] [Indexed: 11/10/2022] Open
Abstract
The difference in clinical features and treatment outcomes between localized sinonasal diffuse large B cell lymphoma (SN-DLBCL) and sinonasal extranodal NK/T cell lymphoma (SN-ENKTL) is unclear. Therefore, we analyzed a total of 47 patients with localized SN-DLBCL and 211 patients with localized SN-ENKTL. The age distribution for these two subtypes is very distinct and the B symptoms were more common in SN-ENKTL. However, both SN-DLBCL and SN-ENKTL patients could achieve high overall response rate (ORR) and favorable prognoses. The 3-year overall survival (OS) rates for patients with SN-DLBCL and SN-ENKTL were 79.7 and 83.6% (p = 0.707), and the 3-year progression-free survival (PFS) rates were 61.4 and 70.1% (p = 0.294), respectively. For SN-DLBCL patients, chemotherapy followed by involved-field radiotherapy (IFRT) resulted in higher OS (83.7 vs 62.5%) and PFS (63.9 vs 50.0%) compared with chemotherapy alone, but the difference was not significant. No significant difference was found in the OS or PFS between radiotherapy alone and radiotherapy combined with chemotherapy for all patients with SN-ENKTL. But in extensive stage I and stage II SN-ENKTL patients, radiotherapy combined with chemotherapy could significantly improve the PFS (73.8 vs 50.0%) compared with radiotherapy alone. These results indicate that remarkable clinical disparities exist between localized SN-DLBCL and SN-ENKTL. However, different treatment strategies for them can result in similarly favorable prognoses.
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Affiliation(s)
- Yu Huang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Bo Jia
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Shiyu Jiang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Shengyu Zhou
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jianliang Yang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Peng Liu
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Lin Gui
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Xiaohui He
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yan Qin
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yan Sun
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yuankai Shi
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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Iida E, Anzai Y. Imaging of Paranasal Sinuses and Anterior Skull Base and Relevant Anatomic Variations. Radiol Clin North Am 2016; 55:31-52. [PMID: 27890187 DOI: 10.1016/j.rcl.2016.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This article reviews the normal anatomy and variants of the anterior skull base and sinonasal cavities that are relevant to endoscopic sinus and skull base surgery. Radiologists should be aware of sinonasal anatomy that can be impediments to surgical access and increase risk of vascular or cranial nerve injury during surgery. Imaging features of the paranasal sinuses and anterior skull base pathologies are also discussed.
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Affiliation(s)
- Estushi Iida
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Yoshimi Anzai
- Department of Radiology, University of Utah Health Sciences Center, 30 North, 1900 East #1A071, Salt Lake City, UT 84132-2140, USA.
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26
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Malignant Primary Neoplasms of the Nasal Cavity and Paranasal Sinus. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0134-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Hachem RA, Beer-Furlan A, Elkhatib A, Rangarajan S, Prevedello D, Blakaj D, Bhatt A, Carrau R. Modern Treatment Outcomes in Sinonasal Malignancies. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0133-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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28
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Kiessling SY, Soyka MB, Huber GF, Holzmann D, Laske RD. Delayed diagnosis of sinonasal lymphoma due to bilateral manifestation. Eur Arch Otorhinolaryngol 2016; 274:823-827. [PMID: 27581721 DOI: 10.1007/s00405-016-4275-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/18/2016] [Indexed: 01/03/2023]
Abstract
The objective of this study is to analyze the presenting symptoms, the time to correct diagnosis and outcome of a European patient cohort with sinonasal lymphoma focusing on unilateral vs. bilateral sinonasal involvement. In a retrospective setting in a European tertiary referral center, eleven patients (9 males, 2 females) with sinonasal lymphoma diagnosed between 2002 and 2015 were identified and divided into a unilateral and bilateral group according to their CT finding. Clinical findings on first presentation, the presence of B symptoms, the radiologic findings, overall survival and disease-specific survival were assessed. 55 % of the patients suffered from bilateral manifestation, which was associated with a delayed diagnosis (10 vs. 1.5 months, p < 0.05). B symptoms (67 vs. 0 %) and death of disease (50 vs. 0 %) were observed only in the bilateral group. Nasal NK/T-cell lymphoma was the most frequent diagnosis, followed by diffuse large B-cell lymphoma. Bilateral mucosal manifestation with B symptoms was shown to be common within the rare entity of sinonasal lymphomas and patients with bilateral sinonasal manifestation are at risk for a delayed diagnosis with worse outcome.
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Affiliation(s)
- Si-Young Kiessling
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich and University of Zurich, Frauenklinikstr. 24, 8091, Zurich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich and University of Zurich, Frauenklinikstr. 24, 8091, Zurich, Switzerland
| | - Gerhard F Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich and University of Zurich, Frauenklinikstr. 24, 8091, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich and University of Zurich, Frauenklinikstr. 24, 8091, Zurich, Switzerland
| | - Roman D Laske
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich and University of Zurich, Frauenklinikstr. 24, 8091, Zurich, Switzerland.
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29
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Clinical findings of extranodal SNT lymphoid malignancies in a four-decade single-centre series. Eur Arch Otorhinolaryngol 2016; 273:3839-3845. [PMID: 27010643 DOI: 10.1007/s00405-016-3992-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/15/2016] [Indexed: 01/01/2023]
Abstract
Sinonasally located lymphoid malignancies are rare lesions with first symptoms similar to other obstructive conditions. Additionally, they often coexist with nasal inflammation and mucosal necrosis. Therefore, time from the first symptoms to diagnosis tends to be long. Awareness and early diagnosis of this disease entity could improve treatment outcome. Altogether, 142 patients with sinonasal or nasopharyngeal (i.e. sinonasal tract, SNT) lymphoid malignancies, diagnosed and treated at the Helsinki University Hospital, during a 39-year period from 1975 to 2013, were retrospectively reviewed. There were 90 males (63 %) and 52 females (37 %) with a median age of 64 years (range 26-92). Eighty-four percent of the patients had primary diseases and 16 % had relapses of lymphoid malignancies primarily diagnosed at other locations. The mean duration of symptoms prior to diagnosis was 4.8 months (range 0.5-24). The most common histological entity was diffuse large B-cell lymphoma (43 %), followed by plasmacytoma (18 %). The most common location was nasopharynx (58 %) followed by nasal cavity (44 %) and paranasal sinuses (35 %). Sixty-nine percent of the lesions were at a single anatomic location of the sinonasal tract. Fifty-two percent of the cases were of Ann Arbor Stage I. Lymphoid malignancies form an important and diverse group in the differential diagnosis of SNT tumours. They most often present with general obstructive nasal symptoms due to tumour location. Most of them are primary lesions, highlighting the importance of an accurate diagnosis as early as possible.
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30
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Ghosh R, Dubal PM, Chin OY, Patel TD, Echanique KA, Baredes S, Liu JK, Eloy JA. Sphenoid sinus malignancies: a population-based comprehensive analysis. Int Forum Allergy Rhinol 2016; 6:752-9. [PMID: 26891865 DOI: 10.1002/alr.21733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 12/18/2015] [Accepted: 01/01/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sinonasal malignancies are rare, representing less than 1% of all cancers, with the sphenoid sinus accounting for 1% to 2% of these cases. Sphenoid sinus malignancies exhibit very poor outcomes. There is a paucity of literature describing their histopathological features, incidence trends, treatment, and survival. We seek to elucidate these factors using a national population-based resource. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was used to identify malignant sphenoid sinus tumors. The results were analyzed for demographics, incidence, and clinicopathologic trends. Survival was calculated using Kaplan-Meier analysis. RESULTS The search identified 472 cases. The mean and median age at diagnosis was 60.0 years. Males represented 54.9% of cases. By race/ethnicity, 82.4% were white and 8.5% were black. The four most common histopathologies were squamous cell neoplasms (29.4%), adenocarcinomas (14.4%), non-Hodgkin's mature B-cell lymphomas (13.1%), and unspecified epithelial neoplasms (11.0%). The overall incidence from 2000 to 2012 was 0.030 per 100,000. Kaplan-Meier analysis demonstrated an overall 5-year disease-specific survival (DSS) of 48.1%. Of the most common histopathological subtypes, 5-year DSS was best for mature B-cell NHL (64.0%) and worst for unspecified epithelial neoplasms (25.6%). CONCLUSION Sphenoid sinus malignancies are rare, with high prevalence in white males. The most common histopathology is squamous cell neoplasms. They exhibit significant locoregional extension. Of the common sphenoid sinus malignant subtypes, 5-year DSS is best for mature B-cell NHL and worst for unspecified epithelial neoplasms.
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Affiliation(s)
- Ritam Ghosh
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Pariket M Dubal
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Oliver Y Chin
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Tapan D Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Kristen A Echanique
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ
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31
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Abstract
Hematolymphoid neoplasms of the sinonasal tract are rare and the majority represents non-Hodgkin lymphomas. This review will focus on morphologic, immunophenotypic, and genetic characteristics of the most common types of non-Hodgkin lymphoma, namely diffuse large B cell lymphoma and extranodal natural killer/T-cell lymphoma, nasal type, but also include the discussion of less frequent other hematolymphoid entities, such as extranodal plasmacytomas and Rosai-Dorfman disease.
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Affiliation(s)
- Friederike H. Kreisel
- Department of Pathology and Immunology, Washington University, 660 S. Euclid Ave, Box 8118, St. Louis, MO 63110 USA
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32
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Bhojwani A, Unsal A, Dubal PM, Echanique KA, Baredes S, Liu JK, Eloy JA. Frontal Sinus Malignancies: A Population-Based Analysis of Incidence and Survival. Otolaryngol Head Neck Surg 2015; 154:735-41. [PMID: 26701175 DOI: 10.1177/0194599815621878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/20/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Primary neoplasms originating in the frontal sinus are rare. As such, existing literature describing frontal sinus malignancies (a subset of frontal sinus neoplasms) is limited. Prognostic implications of these malignancies are difficult to determine. This study seeks to analyze trends in epidemiology, clinicopathology, incidence, and survival for these rare malignancies. STUDY DESIGN Retrospective database analysis. METHODS The SEER 18 database (Surveillance, Epidemiology, and End Results; 1973-2012) was searched for frontal sinus malignancies from 1973 to 2012 and analyzed for demographic and clinicopathologic trends. The Kaplan-Meier model was utilized for survival analysis. RESULTS A total of 171 cases of frontal sinus malignancies were identified. Incidence was 0.011 per 100,000 individuals. The mean age at diagnosis was 61.1 years, with males constituting the majority of cases (61.4%). 80.1% of patients were white, 9.4% Asian, and 8.2% black. The average tumor size was 3.8 cm. The most common histology encountered was squamous cell carcinoma (39.8%). Overall 5-year disease-specific survival was 44.2%. Five-year disease-specific survival was highest for mature B-cell non-Hodgkin's lymphomas (72.3%) and lowest for adenocarcinomas (15.4%). CONCLUSIONS Malignant tumors of the frontal sinus are rare and are more common in males. Squamous cell carcinoma is the most common entity encountered. Of the 4 most common histologies, survival is best for mature B-cell non-Hodgkin's lymphomas and worst for adenocarcinomas.
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Affiliation(s)
- Amit Bhojwani
- Department of Otolaryngology and Facial Plastic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Aykut Unsal
- Department of Otolaryngology and Facial Plastic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Pariket M Dubal
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Kristen A Echanique
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Kumai T, Kobayashi H, Harabuchi Y. Novel targets for natural killer/T-cell lymphoma immunotherapy. Immunotherapy 2015; 8:45-55. [PMID: 26642249 DOI: 10.2217/imt.15.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Extranodal natural killer/T-cell lymphoma, nasal type (NKTL) is a rare but highly aggressive Epstein-Barr virus-related malignancy, which mainly occurs in nasopharyngeal and nasal/paranasal areas. In addition to its high prevalence in Asian, Central American and South American populations, its incidence rate has been gradually increasing in Western countries. The current mainstay of treatment is a combination of multiple chemotherapies and irradiation. Although chemoradiotherapy can cure NKTL, it often causes severe and fatal adverse events. Because a growing body of evidence suggests that immunotherapy is effective against hematological malignancies, this treatment could provide an alternative to chemoradiotherapy for treatment of NKTL. In this review, we focus on how recent findings could be used to develop efficient immunotherapies against NKTL.
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Affiliation(s)
- Takumi Kumai
- Department of Otolaryngology, Head & Neck Surgery, Asahikawa Medical University, Midorigaoka-East 2-1-1-1, Asahikawa 078-8510, Japan
| | - Hiroya Kobayashi
- Department of Pathology, Asahikawa Medical University, Midorigaoka-East 2-1-1-1, Asahikawa 078-8510, Japan
| | - Yasuaki Harabuchi
- Department of Otolaryngology, Head & Neck Surgery, Asahikawa Medical University, Midorigaoka-East 2-1-1-1, Asahikawa 078-8510, Japan.,Department of Pathology, Asahikawa Medical University, Midorigaoka-East 2-1-1-1, Asahikawa 078-8510, Japan
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34
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Dubal PM, Unsal AA, Echanique KA, Vazquez A, Reder LS, Baredes S, Eloy JA. Laryngeal adenosquamous carcinoma: A population-based perspective. Laryngoscope 2015; 126:858-63. [DOI: 10.1002/lary.25704] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/26/2015] [Accepted: 09/02/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Pariket M. Dubal
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey
| | - Aykut A. Unsal
- Department of Otolaryngology & Facial Plastic Surgery; Rowan University School of Osteopathic Medicine; Stratford New Jersey
| | - Kristen A. Echanique
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey
| | - Alejandro Vazquez
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey
| | - Lindsay S. Reder
- Department of Otolaryngology-Head and Neck Surgery; University of Southern California; Los Angeles California
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School; Newark New Jersey
- Department of Neurological Surgery; Rutgers New Jersey Medical School; Newark New Jersey
- Department of Ophthalmology and Visual Science; Rutgers New Jersey Medical School; Newark New Jersey U.S.A
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35
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Shaigany K, Fang CH, Patel TD, Park RC, Baredes S, Eloy JA. A population-based analysis of Head and Neck hemangiopericytoma. Laryngoscope 2015; 126:643-50. [DOI: 10.1002/lary.25681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/03/2015] [Accepted: 08/24/2015] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | | | - Soly Baredes
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey
- Department of Neurological Surgery
- Department of Ophthalmology and Visual Science; Rutgers New Jersey Medical School; Newark New Jersey U.S.A
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36
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Dubal PM, Bhojwani A, Patel TD, Zuckerman O, Baredes S, Liu JK, Eloy JA. Squamous cell carcinoma of the maxillary sinus: A population-based analysis. Laryngoscope 2015; 126:399-404. [PMID: 26393540 DOI: 10.1002/lary.25601] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 07/16/2015] [Accepted: 07/30/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS Squamous cell carcinoma (SCC) accounts for > 90% of head and neck cancers and 60% to 75% of malignancies of the paranasal sinuses. The most commonly affected paranasal sinus is the maxillary. Epidemiologic, incidence, and survival trends have been studied for maxillary sinus SCC (MSSCC), but far less is known about its metastatic potential. STUDY DESIGN Retrospective database analysis. METHODS The Surveillance, Epidemiology, and End Results database was used to extract frequency, incidence, and survival data for MSSCC between 2004 and 2012. The resultant cases were stratified according to patient demographics and collaborative stage information, including extent of disease, lymph node involvement, TNM staging, and regional and distant metastasis. RESULTS A total of 854 cases of MSSCC were identified. The mean age at diagnosis was 66.6 years, with 87.4% presenting at > 50 years. Most patients (65.1%) were male. Whites accounted for 74.6% of cases. A majority (64.3%) of cases presented with stage IV disease. Overall 5-year disease-specific survival was 23.4%. Neck involvement was seen in 7.6% of T1 tumors, 22.2% of T2 tumors, 18.5% of T3 tumors, and 12.2% of T4 tumors. Distant metastasis was not seen in T1-T3 tumors, but was present in 6.8% of T4 tumors. CONCLUSIONS MSSCC is a rare entity with poor overall prognosis. The majority of patients included in this study were white males aged ≥50 years, with most tumors presenting at advanced stages. Nodal involvement and distant metastasis are poor prognostic indicators. T1-T3 tumors did not metastasize to distant sites. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Pariket M Dubal
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Amit Bhojwani
- Department of Otolaryngology and Facial Plastic Surgery, Rowan University School of Osteopathic Medicine, Stratford
| | - Tapan D Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Omry Zuckerman
- Rowan University School of Osteopathic Medicine, Stratford
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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Nasal NK/T-Cell Lymphoma. A Comparative Analysis of a Mexican Population with the Other Populations of Latin-America. Mediterr J Hematol Infect Dis 2015; 7:e2015052. [PMID: 26401241 PMCID: PMC4560257 DOI: 10.4084/mjhid.2015.052] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/24/2015] [Indexed: 12/30/2022] Open
Abstract
Nasal natural killer/T-cell lymphoma (nasal NKTCL), is a rare presentation of extranodal lymphoma in North-America and Europe, but in some countries, as China and Korea, nasal NKTCL occurred in 20 to 46 % of T-cell lymphomas. Some studies, analyzing the incidence in Latin-America, observed some differences between the various populations. However, this comparison included Argentina and Chile, Peru, and other Latin-America but not the Mexico. Thus, we performed a retrospective analysis of the patients diagnosed and treated as nasal, NKTCL, in our institution that is an academic tertiary national reference hospital of Mexico. From 1988 to 2014, we diagnosed and treated 14,816 cases of non-Hodgkin’s lymphoma, 10,957 (73%) were of B-cell histology and 3822 (26%) were of T-cell histology. Nasal, NKTCL, was the most frequent of the T-cell histology: 40%. We compared our results with those of other countries and observed that nasal, NKTCL have a small number of cases in North-America, and in some countries of Latin-America, as Argentina, Brazil, and Chile. However, the number of NKTCL cases found in Mexico was similar to that found in Guatemala and Peru, and also in China and Korea. Our study suggests that this neoplasm could have a racial basis, but environmental factors should also be considered.
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Unsal AA, Dubal PM, Patel TD, Vazquez A, Baredes S, Liu JK, Eloy JA. Squamous cell carcinoma of the nasal cavity: A population-based analysis. Laryngoscope 2015; 126:560-5. [PMID: 26297930 DOI: 10.1002/lary.25531] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVES/HYPOTHESIS Squamous cell carcinoma of the nasal cavity (NCSCC) is an infrequent malignancy that has been historically difficult to characterize. This study provides new insight into NCSCC utilizing a population-based database. We analyze the propensity for cervical and distant metastasis from NCSCC, as well as survival outcomes. STUDY DESIGN Retrospective database analysis. METHODS The Surveillance, Epidemiology, and End Results (SEER) database (2004-2012) was queried for NCSCC cases. Data were analyzed with respect to various demographic and clinicopathologic factors. The results were further examined for regional and distant metastasis. Survival was analyzed using the Kaplan-Meier model. RESULTS A total of 1,180 cases of NCSCC were identified in the SEER database between 2004 and 2012. The mean age at diagnosis was 65.8 years. American Joint Committee on Cancer stage was known in 1,050 cases, of which 53.4% were stage I, 13.3% were stage II, 10.2% were stage III, and 23.0% were stage IV. By tumor (T) stage classification, T1 was the most common (56.6%), followed by T4 (19.3%). Most cases had no nodal (N) involvement at diagnosis (90.8%). Cervical nodal involvement was present in 9.1% of cases, while distant metastasis was seen in 1.9%. Five-year disease-specific survival was 69.5% overall, 39.6% in cases with neck involvement and 0.0% for metastatic cases. CONCLUSIONS This study represents the only known population-based investigation of NCSCC. Metastasis to cervical nodes or distant sites, especially with T1 tumors, is rare. However, any cervical involvement or distant metastasis discovered on presentation is a poor prognostic indicator. LEVEL OF EVIDENCE 4. Laryngoscope, 126:560-565, 2016.
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Affiliation(s)
- Aykut A Unsal
- Department of Otolaryngology and Facial Plastic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Pariket M Dubal
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Tapan D Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Alejandro Vazquez
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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Dutta R, Dubal PM, Svider PF, Liu JK, Baredes S, Eloy JA. Sinonasal malignancies: A population-based analysis of site-specific incidence and survival. Laryngoscope 2015; 125:2491-7. [PMID: 26228792 DOI: 10.1002/lary.25465] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/12/2015] [Accepted: 05/29/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS Sinonasal malignancies vary in behavior according to histology and anatomical location. Incidence, survival, and optimal treatment for these lesions are thus uncertain in various cases. Our objective was to utilize a national population-based registry to identify the most common sinonasal histopathologies by anatomical site, and subsequently analyze the data by incidence trends, survival rates, patient demographics, and treatment modalities. STUDY DESIGN Retrospective analysis of the United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry. METHODS The SEER database was examined for patients diagnosed with sinonasal malignancies between 1973 and 2011. Data were stratified according to anatomical site, incidence, survival, histology, staging, and patient demographics. Therapy-based outcomes were analyzed for cases from 1983 to 2011. RESULTS A total of 13,295 patients were identified, with an incidence of 0.83 per 100,000 people. Males comprised 58.6% of cases. Whites represented 81.5% of cases, while blacks comprised 8.7%. Squamous cell carcinoma was the most common histology (41.9%) across all sites of the sinonasal tract. The most common anatomical site of malignancy was the nasal cavity (45.7%), and least common was the frontal sinus (1.2%). For single sites, 5-year disease-specific survival (DSS) was highest for nasal cavity tumors (67.1%) and lowest for overlapping sinus malignancies (37.6%). The overall 5-year DSS for all sinonasal malignancies was 53.7%. CONCLUSION Sinonasal malignancies are rare entities with poor overall prognosis. By anatomical site, prognosis is best for nasal cavity cancers and worst for overlapping lesions. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Rahul Dutta
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Pariket M Dubal
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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40
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Dubal PM, Svider PF, Folbe AJ, Lin HS, Park RC, Baredes S, Eloy JA. Laryngeal adenoid cystic carcinoma: A population-based perspective. Laryngoscope 2015; 125:2485-90. [PMID: 26153623 DOI: 10.1002/lary.25448] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/05/2015] [Accepted: 05/24/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES/HYPOTHESIS Adenoid cystic carcinoma (ACC) occurs infrequently in the larynx. Consequently, no large samples describing its clinical behavior are available in the literature. Our objective was to use a nationally representative population-based resource to evaluate clinical behavior, patient demographics, and outcomes among patients diagnosed with laryngeal ACC (LACC). STUDY DESIGN Retrospective database analysis. METHODS The National Cancer Institute's Surveillance, Epidemiology, and End Results database was analyzed for patients diagnosed with LACC between 1973 and 2011. Patient demographics, incidence, treatment, and survival between LACC and other laryngeal malignancies were compared. RESULTS Of 69 LACC patients, 63.8% were female, 78.2% Caucasian, and the median age was 54 years. LACC patients were much more likely to have subglottic lesions (44.9%) than individuals with other malignancies (1.6%). The incidence of LACC was 0.005/100,000 individuals. The majority of patients with LACC harbored T4 lesions at initial diagnosis, although 87.9% had N0 disease, and only 6.1% had distant metastasis at diagnosis. Disease-specific survival (DSS) was greater at 1 year for LACC compared to other laryngeal malignancies, but not at 5 or 10 years. Five-year DSS was greater for LACC patients who underwent surgery versus those who did not undergo surgery. CONCLUSIONS This analysis notes that LACC has a low incidence with no significant change in incidence over the study period. Compared to other laryngeal malignancies, LACC has a female preponderance, is much more common in the subglottis, presents at a younger age, and more often presents with T4 disease. Surgery was noted to confer a survival advantage in LACC. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Pariket M Dubal
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Adam J Folbe
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Ho-Sheng Lin
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.,Section of Otolaryngology, Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan
| | - Richard C Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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