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Keizer ME, Hovinga KE, Lacko M, Eekers DB, Baijens LW, Kremer B, Temel Y. Clinical Outcome in Patients with Large Sinonasal Tumors with Intracranial Extension. J Neurol Surg B Skull Base 2024; 85:347-357. [PMID: 38966298 PMCID: PMC11221902 DOI: 10.1055/a-2082-4951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/24/2023] [Indexed: 07/06/2024] Open
Abstract
Objectives Malignant tumors of the sinonasal cavities with extension to the frontal skull base are rare and challenging pathologies. Combined-approach surgery using a frontobasal craniotomy and endoscopic sinus surgery with reconstruction of the anterior skull base followed by adjuvant radiotherapy is a preferred treatment strategy in selected cases. Morbidity and mortality rates are high in this population. We aim to add our experience to the current literature. Design We performed a retrospective cross-sectional single center study of the long-term clinical outcome in a tertiary university referral hospital in the Netherlands between 2010 and 2021. Descriptive statistics and frequency distributions were performed Participants Patient, tumor, treatment, complications and survival characteristics of eighteen consecutive patients were extracted from the electronic health records. Main Outcome Measures The primary outcome measures are progression free survival, overall survival and complication rate. Results Eighteen consecutive patients were included with a mean age of 61 (SD ± 10) years (range 38-80); ten males and eight females. Gross total resection was achieved in 14 (77%) patients. Eleven (61%) patients underwent local radiotherapy, one (5%) chemotherapy and three (17%) a combination of both. Mean follow-up duration was 49 months (range 3 - 138). Three (17%) patients died in hospital due to post-operative complications. Six (33%) patients died during follow-up due to disease progression. Mean progression-free survival was 47 months (range 0 - 113). Conclusion In conclusion, the overall survival was 50% for this group of patients with large sinonasal tumors. Progressive disease affects survival rate severely. Surgical complications were seen in five (28%) patients. Radiotherapy is associated with high complication rates. Radiation necrosis was a serious complication in two patients and could be treated with high dose steroids.
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Affiliation(s)
- Max E. Keizer
- Department of Neurosurgery, Maastricht University Medical Centre + , Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht/Nijmegen, The Netherlands
| | - Koos E. Hovinga
- Department of Neurosurgery, Maastricht University Medical Centre + , Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht/Nijmegen, The Netherlands
| | - Martin Lacko
- Dutch Academic Alliance Skull Base Pathology, Maastricht/Nijmegen, The Netherlands
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre + , Maastricht, The Netherlands
- School for Oncology and Reproduction (GROW), Maastricht University Medical Centre + , Maastricht, The Netherlands
| | - Danielle B.P. Eekers
- Dutch Academic Alliance Skull Base Pathology, Maastricht/Nijmegen, The Netherlands
- School for Oncology and Reproduction (GROW), Maastricht University Medical Centre + , Maastricht, The Netherlands
- Department of Radiation Oncology (Maastro), Maastricht, The Netherlands
| | - Laura W.J. Baijens
- Dutch Academic Alliance Skull Base Pathology, Maastricht/Nijmegen, The Netherlands
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre + , Maastricht, The Netherlands
- School for Oncology and Reproduction (GROW), Maastricht University Medical Centre + , Maastricht, The Netherlands
| | - Bernd Kremer
- Dutch Academic Alliance Skull Base Pathology, Maastricht/Nijmegen, The Netherlands
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre + , Maastricht, The Netherlands
- School for Oncology and Reproduction (GROW), Maastricht University Medical Centre + , Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Centre + , Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht/Nijmegen, The Netherlands
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Liu Y, Peng C, Long P. Nasal Acinic Cell Carcinoma Misdiagnosed as Hemangioma of the Nasal Septum. EAR, NOSE & THROAT JOURNAL 2023:1455613231159131. [PMID: 36927078 DOI: 10.1177/01455613231159131] [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: 03/18/2023] Open
Abstract
Acinic cell carcinoma (AciCC) is a low-grade, slow-growing malignant tumor that commonly originates from the parotid gland and occasionally from the minor gland of the oral cavity, but rarely from the nasal cavity. Here, we present a 57-year-old woman who presented with an 8-month history of obstruction and epistaxis of the right nasal cavity. Rhinoscopy revealed a reddish-gray fleshy mass with tiny blood vessels on the surface blocking the right postnaris. Computed tomography showed a 3 × 2 cm2 well-demarcated tumor filling the right nasal common meatus with a clear boundary. There were no signs of local bone erosion in the bony window. Magnetic resonance imaging revealed abnormal signals in the nasal meatus with iso-intensity in the T1W1 sequence with homogeneous enhancement. We diagnosed it as a right nasal hemangioma, and the patient underwent endoscopic resection. However, histopathological evaluation of the surgical specimen confirmed a primary AciCC. The patient refused further radical surgery and instead underwent adjuvant radiotherapy. There was no clinical evidence of recurrence for 2 years, and the patient has returned for follow-up yearly. We discuss the clinical nature of sinonasal AciCC and the treatment of this rare condition.
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Affiliation(s)
- Yanan Liu
- Department of Otolaryngology, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - CongLi Peng
- Department of Otolaryngology, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Ping Long
- Department of Otolaryngology, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
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3
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Ryan JF, Tanavde VA, Gallia GL, Boahene KDO, London NR, Desai SC. Reconstruction in open anterior skull base surgery: A review and algorithmic approach. Am J Otolaryngol 2023; 44:103700. [PMID: 36473261 DOI: 10.1016/j.amjoto.2022.103700] [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: 08/13/2022] [Revised: 09/25/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Defects resulting from open resection of anterior skull base neoplasms are difficult to reconstruct. Our objective was to review the literature and describe an evidence-based algorithm that can guide surgeons reconstructing anterior skull base defects. METHODS A research librarian designed database search strategies. Two investigators independently reviewed the resulting abstracts and full text articles. Studies on reconstruction after open anterior skull base resection were included. Studies of lateral and posterior skull base reconstruction, endoscopic endonasal surgery, traumatic and congenital reconstruction were excluded. Based on the review, a reconstructive algorithm was proposed. RESULTS The search strategy identified 603 unique abstracts. 53 articles were included. Adjacent subsites resected, defect size, radiotherapy history, and contraindications to free tissue transfer were identified as key factors influencing decision making and were used to develop the algorithm. Discussion of the reconstructive ladder as it applies to skull base reconstruction and consideration of patient specific factors are reviewed. Patients with a prior history of radiotherapy or with simultaneous resection of multiple anatomic subsites adjacent to the anterior skull base will likely benefit from free tissue transfer. CONCLUSIONS Reconstruction of anterior skull base defects requires knowledge of the available reconstructive techniques and consideration of defect-specific and patient-specific factors.
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Affiliation(s)
- John F Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ved A Tanavde
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kofi D O Boahene
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shaun C Desai
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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4
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Bhalla AS, Mirza G, Manchanda S, Gehani A, Kumar R, Sahu A, Thakar A, Irodi A. Imaging Recommendations for Diagnosis, Staging, and Management of Sinonasal Tumors. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractSinonasal tumors are a relatively rare and heterogeneous group of tumors. Owing to their nonspecific presentation and rarity, they can be potentially overlooked resulting in delayed diagnosis and management, and increased patient morbidity. Imaging is crucial for the detection, staging, surgical planning, follow-up as well as surveillance of sinonasal masses, wherein computed tomography (CT) and magnetic resonance imaging (MRI) play complementary roles. CT is better at depicting bony changes, while MRI is useful for delineating the extent of soft tissue lesion, detect perineural, intracranial, or intraorbital spread as well as differentiate trapped sinus secretions from tumor tissue. Other modalities like fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and arteriography can be selectively employed. FDG-PET is useful for metastatic workup and detection of residual/ recurrent disease. Arteriography and endovascular image-guided interventions are useful to delineate supply of vascular tumors and perform preoperative embolization. A systematic evidence-based approach to a possible case of sinonasal tumor can go a long way in streamlining the detection and management of these tumors, while optimizing the use of available healthcare resources.
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Affiliation(s)
- Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Galib Mirza
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anisha Gehani
- Department of Radiology and Imaging Science, Tata Medical Center, New Town, West Bengal, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Arpita Sahu
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Alok Thakar
- Department of Otorhinolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
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Thawani R, Kim MS, Arastu A, Feng Z, West MT, Taflin NF, Thein KZ, Li R, Geltzeiler M, Lee N, Fuller CD, Grandis JR, Floudas CS, Heinrich MC, Hanna E, Chandra RA. The contemporary management of cancers of the sinonasal tract in adults. CA Cancer J Clin 2023; 73:72-112. [PMID: 35916666 PMCID: PMC9840681 DOI: 10.3322/caac.21752] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 05/21/2022] [Accepted: 06/27/2022] [Indexed: 01/25/2023] Open
Abstract
Sinonasal malignancies make up <5% of all head and neck neoplasms, with an incidence of 0.5-1.0 per 100,000. The outcome of these rare malignancies has been poor, whereas significant progress has been made in the management of other cancers. The objective of the current review was to describe the incidence, causes, presentation, diagnosis, treatment, and recent developments of malignancies of the sinonasal tract. The diagnoses covered in this review included sinonasal undifferentiated carcinoma, sinonasal adenocarcinoma, sinonasal squamous cell carcinoma, and esthesioneuroblastoma, which are exclusive to the sinonasal tract. In addition, the authors covered malignances that are likely to be encountered in the sinonasal tract-primary mucosal melanoma, NUT (nuclear protein of the testis) carcinoma, and extranodal natural killer cell/T-cell lymphoma. For the purpose of keeping this review as concise and focused as possible, sarcomas and malignancies that can be classified as salivary gland neoplasms were excluded.
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Affiliation(s)
- Rajat Thawani
- Division of Hematology and Oncology, Knight Cancer Institute, Oregon Health and Science University
| | - Myung Sun Kim
- Division of Hematology and Oncology, Knight Cancer Institute, Oregon Health and Science University
| | - Asad Arastu
- Department of Internal Medicine, Oregon Health and Science University
| | - Zizhen Feng
- Division of Hematology and Oncology, Knight Cancer Institute, Oregon Health and Science University
| | - Malinda T. West
- Division of Hematology and Oncology, Knight Cancer Institute, Oregon Health and Science University
| | | | - Kyaw Zin Thein
- Division of Hematology and Oncology, Knight Cancer Institute, Oregon Health and Science University
| | - Ryan Li
- Department of Otolaryngology, Division of Head and Neck Surgery, Oregon Health and Science University
| | - Mathew Geltzeiler
- Department of Otolaryngology, Division of Head and Neck Surgery, Oregon Health and Science University
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center
| | | | - Jennifer R. Grandis
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco
| | | | - Michael C. Heinrich
- Division of Hematology and Oncology, Knight Cancer Institute, Oregon Health and Science University
| | - Ehab Hanna
- Department of Head and Neck Surgery, MD Anderson Cancer Center
| | - Ravi A. Chandra
- Department of Radiation Medicine, Oregon Health and Science University
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Mathews M, Sara KB, Michael RC. Role of Human Papilloma Virus in the Aetiology of Sinonasal Cancers. Indian J Otolaryngol Head Neck Surg 2022; 74:4766-4770. [PMID: 36742802 PMCID: PMC9895438 DOI: 10.1007/s12070-022-03072-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/01/2022] [Indexed: 02/07/2023] Open
Abstract
Sino nasal carcinogenesis is attributed to numerous factors, namely tobacco, alcohol and snuff as the most common. Human Papilloma virus (HPV) has been associated with aetiopathogenesis of malignancies in the upper aerodigestive tract (UADT). The prevalence of HPV in Sino-nasal malignancy (SNM) which is closely related to UADT in location is not known. Hence, this study aims to explore if there is any such association between HPV and Sino nasal malignancies. This study aims to explore the association between HPV and SNM. A prospective case control study using tumour tissue specimens from 40 Sinonasal carcinoma patients and benign nasal tissue specimens from 50 cancer-free controls were conducted. Histopathological analysis and DNA extraction (DNeasy® Tissue kit) and polymerase chain reaction for detection of HPV was done. Positive samples underwent sequencing to detect the HPV serotype and statistical correlation was performed using SPSS software. All 90 patients were tested for HPV and we found that none of the patients had any association with HPV. Sino-Nasal malignancy in the Indian Sub-continent may not be related to HPV primarily.
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Affiliation(s)
- Miria Mathews
- Herbertpur Christian Hospital, Herbertpur, Uttarakhand India
| | - Katti Blessi Sara
- Unit 1, Department of ENT, Christian Medical College, Vellore, Tamilnadu 632004 India
| | - Rajiv C. Michael
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamilnadu India
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7
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Palade D, Hainarosie R, Pertea M, Anghelina F, Zaharia P, Pietroșanu C, Calu V, Ardeleanu V, Manole F. Reconstructive challenges of sinonasal tumors: A case report. Exp Ther Med 2022; 23:419. [PMID: 35601069 PMCID: PMC9117945 DOI: 10.3892/etm.2022.11346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/30/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dragos Palade
- Department of Otorhinolaryngology and Head and Neck Surgery, ‘Sf. Spiridon’ Clinical Hospital, 700111 Iasi, Romania
| | - Razvan Hainarosie
- Department of Otorhinolaryngology and Head and Neck Surgery, ‘Prof. Dr. D. Hociota’ Institute of Phonoaudiology and Functional ENT Surgery, 061344 Bucharest, Romania
| | - Mihaela Pertea
- Department of Plastic and Reconstructive Surgery, ‘Sf. Spiridon’ Clinical Hospital, 700111 Iasi, Romania
| | - Florin Anghelina
- Department of Otorhinolaryngology and Head and Neck Surgery, Dolj County Hospital, 200349 Craiova, Romania
| | - Petronela Zaharia
- Department of Otorhinolaryngology and Head and Neck Surgery, ‘Sf. Spiridon’ Clinical Hospital, 700111 Iasi, Romania
| | - Cătălina Pietroșanu
- Department of Otorhinolaryngology and Head and Neck Surgery, ‘Prof. Dr. D. Hociota’ Institute of Phonoaudiology and Functional ENT Surgery, 061344 Bucharest, Romania
| | - Valentin Calu
- Department of Surgery, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania
| | - Valeriu Ardeleanu
- Doctoral School, Faculty of Medicine, ‘Ovidius’ University, 900527 Constanta, Romania
| | - Felicia Manole
- Faculty of Medicine and Pharmacy, University of Oradea, 411073 Oradea, Romania
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Pacini L, Cabal VN, Hermsen MA, Huang PH. EGFR Exon 20 Insertion Mutations in Sinonasal Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:394. [PMID: 35053553 PMCID: PMC8774177 DOI: 10.3390/cancers14020394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/27/2022] Open
Abstract
Recurrent epidermal growth factor receptor (EGFR)-activating mutations have been identified in a rare form of head and neck cancer known as sinonasal squamous cell carcinoma (SNSCC), a malignant disease with a 5-year mortality rate of ~40%. Interestingly, the majority of EGFR mutations identified in patients with primary SNSCC are exon 20 insertions (Ex20ins), which is in contrast to non-small-cell lung cancer (NSCLC), where the EGFR exon 19 deletion and L858R mutations predominate. These studies demonstrate that EGFR Ex20ins mutations are not exclusive to lung cancer as previously believed, but are also involved in driving SNSCC pathogenesis. Here we review the landscape of EGFR mutations in SNSCC, with a particular focus on SNSCC associated with inverted sinonasal papilloma (ISP), a benign epithelial neoplasm. Taking lessons from NSCLC, we also discuss potential new treatment options for ISP-associated SNSCC harbouring EGFR Ex20ins in the context of targeted therapies, drug resistance and precision cancer medicine. Moving forward, further basic and translational work is needed to delineate the biology of EGFR Ex20ins in SNSCC in order to develop more effective treatments for patients with this rare disease.
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Affiliation(s)
- Laura Pacini
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton SM2 5NG, UK;
| | - Virginia N. Cabal
- Department Head and Neck Cancer, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Centro de Investigación Biomédica en Red (CIBER-ONC), 33011 Oviedo, Spain; (V.N.C.); (M.A.H.)
| | - Mario A. Hermsen
- Department Head and Neck Cancer, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Centro de Investigación Biomédica en Red (CIBER-ONC), 33011 Oviedo, Spain; (V.N.C.); (M.A.H.)
| | - Paul H. Huang
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton SM2 5NG, UK;
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Skull Base pathology – a diagnostic conundrum. The Journal of Laryngology & Otology 2021; 136:1135-1138. [DOI: 10.1017/s0022215121004187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10
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Sharma A, Tang AL, Takiar V, Wise-Draper TM, Langevin SM. Human Papillomavirus and Survival of Sinonasal Squamous Cell Carcinoma Patients: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13153677. [PMID: 34359578 PMCID: PMC8345036 DOI: 10.3390/cancers13153677] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/05/2021] [Accepted: 07/17/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary Human papillomavirus (HPV) has been associated with multiple cancers in the anogenital and upper aerodigestive tracts. In the head and neck region, HPV-positive cancers are common in oropharynx, with rising incidence and a well-established association with more favorable patient outcomes. However, the relationship with prognosis of sinonasal squamous cell carcinoma (SNSCC) has been much less often studied and is presently unclear. To better elucidate this relationship, we performed a systematic review and meta-analysis of the biomedical literature to determine the aggregate effect across studies. In doing so, we observed significantly better overall survival associated with HPV-positive SNSCC. Therefore, we conclude that HPV testing may be useful for determining patient prognosis and potentially guiding treatment decisions. Abstract Human papillomavirus (HPV) is detectable in a subset of sinonasal squamous cell carcinoma (SNSCC), but the impact on patient outcomes is presently unclear due to a modest number of studies with limited statistical power. Therefore, we conducted a systematic review and meta-analysis to better clarify this relationship. A PubMed search was conducted to identify all studies reporting on overall (OS) or disease-free survival (DFS) for SNSCC by HPV status. Hazard ratios (HR) and corresponding 95% confidence intervals (CI) were extracted or, when not provided, indirectly estimated from each manuscript. Summary survival curves for 5-year OS and estimating survival probability by HPV status at pre-specified time intervals from study-specific Kaplan-Meier curves generated 2-year DFS. Log HRs and log CIs were combined across studies to generate summary estimates and a corresponding 95% CIs for OS and DFS. We identified ten unique studies reporting on OS and four for DFS. We observed a significant association between HPV and OS (summary HR = 0.51, 95% CI: 0.38–0.70) with relatively low heterogeneity between studies. These results indicate that HPV is a significant predictor of more favorable survival for SNSCC, and thus may be a useful biomarker for prognostication and, potentially, treatment modulation.
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Affiliation(s)
- Anish Sharma
- Medical Sciences Program, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Alice L. Tang
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
- University of Cincinnati Cancer Center, Cincinnati, OH 45267, USA; (V.T.); (T.M.W.-D.)
| | - Vinita Takiar
- University of Cincinnati Cancer Center, Cincinnati, OH 45267, USA; (V.T.); (T.M.W.-D.)
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Cincinnati VA Medical Center, Cincinnati, OH 45220, USA
| | - Trisha M. Wise-Draper
- University of Cincinnati Cancer Center, Cincinnati, OH 45267, USA; (V.T.); (T.M.W.-D.)
- Department of Internal Medicine, Division of Hematology & Oncology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Scott M. Langevin
- University of Cincinnati Cancer Center, Cincinnati, OH 45267, USA; (V.T.); (T.M.W.-D.)
- Department of Environmental & Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Correspondence:
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Abstract
Sinonasal malignancies rare and pathologically diverse and make up <1% of all malignancies. Due to their anatomical location, they can cause significant morbidity with involvement of surrounding critical structures. They often present at a late stage with insidious onset of symptoms. Treatment of sinonasal malignancies is challenging and they often require a multimodality approach with surgery, radiation, and chemotherapy. Outcomes are poor with 5-year overall survival around 32%, but this varies greatly depending on histologic subtype. There is an urgent need for more randomized controlled trials to better define the appropriate therapeutic regimens and to improve clinical outcomes.
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Affiliation(s)
- Melissa A Taylor
- Department of Internal Medicine, Emory University, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303, USA
| | - Nabil F Saba
- Hematology Medical Oncology and Otolaryngology, Head and Neck Oncology Program, Winship Cancer Institute of Emory University, 1365 Clifton Road # C2110, Atlanta, GA 30322, USA.
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12
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Malignant Sinonasal Tumors: Update on Histological and Clinical Management. ACTA ACUST UNITED AC 2021; 28:2420-2438. [PMID: 34287240 PMCID: PMC8293118 DOI: 10.3390/curroncol28040222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 02/03/2023]
Abstract
Tumors of nasal cavity and paranasal sinuses (TuNSs) are rare and heterogeneous malignancies, presenting different histological features and clinical behavior. We reviewed the literature about etiology, biology, and clinical features of TuNSs to define pathologic features and possible treatment strategies. From a diagnostic point of view, it is mandatory to have high expertise and perform an immunohistochemical assessment to distinguish between different histotypes. Due to the extreme rarity of these neoplasms, there are no standard and evidence-based therapeutic strategies, lacking prospective and large clinical trials. In fact, most studies are retrospective analyses. Surgery represents the mainstay of treatment of TuNSs for small and localized tumors allowing complete tumor removal. Locally advanced lesions require more demolitive surgery that should be always followed by adjuvant radio- or chemo-radiotherapy. Recurrent/metastatic disease requires palliative chemo- and/or radiotherapy. Many studies emphasize the role of specific genes mutations in the development of TuNSs like mutations in the exons 4-9 of the TP53 gene, in the exon 9 of the PIK3CA gene and in the promoter of the TERT gene. In the near future, this genetic assessment will have new therapeutic implications. Future improvements in the understanding of the etiology, biology, and clinical features of TuNSs are warranted to improve their management.
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Nassrallah S, Neagoş CM, Mocan SL, Neagoş A. Evaluation of the incidence of inflammatory and tumor pathology of nose and nasal sinus region. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:1295-1300. [PMID: 34171077 PMCID: PMC8343604 DOI: 10.47162/rjme.61.4.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Inflammatory and nasal-sinus tumor pathology is a field of great interest in rhinology worldwide. The aim of the paper is to determine the prevalence of nasal and nasal-sinus inflammatory diseases, as well as nasal and nasosinusal rhinosinusitis tumors, in association or not with inflammatory diseases, using histopathological (HP) examination. It is also desired to identify the association of chronic inflammatory pathology with the tumor one, considering inflammation and immunodeficiency as local susceptibility factors. A retrospective study was performed on a group of 254 patients hospitalized between 2018–2019 in Department of Otorhinolaryngology, Emergency County Hospital, Târgu Mureş, Romania. Based on the clinical and HP examination, the distribution by inflammatory pathologies was made as follows: 175 nasal polyposis, 108 chronic rhinitis, 39 sinusitis – strictly affecting the sinus and 28 chronic polyposis rhinosinusitis – nasal and sinus association. Considering the evaluation of the incidence of benign tumor pathology, the following were found: out of the total examined cases, 4% squamous papilloma, 4% exophytic papilloma, 44% Schneiderian papilloma, 4% benign fibrous histiocytoma, 18% hemangioma, 4% hamartoma, and 4% osteoma were identified. The incidence of malignant tumors is 26% squamous cell carcinoma, 12% intestinal adenocarcinoma, 2% nonintestinal type adenocarcinoma, 2% large B-cell lymphoma, 2% plasma cell, 2% olfactory neuroblastoma, 7% malignant melanoma, 16% basal cell carcinoma. The paper draws attention to the increased incidence of tumor and inflammatory pathology both individually and in combination, considering the involvement of the clinical correlation with the HP result completed, if necessary, with immunohistochemical examinations, for a precise diagnosis.
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Affiliation(s)
- Salah Nassrallah
- Department of Otorhinolaryngology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Romania;
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14
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Nakajima K, Iwata H, Hattori Y, Nomura K, Hashimoto S, Toshito T, Hayashi K, Kuroda Y, Fukano H, Ogino H, Shibamoto Y. Spot Scanning Proton Therapy for Sinonasal Malignant Tumors. Int J Part Ther 2021; 8:189-199. [PMID: 34285946 PMCID: PMC8270097 DOI: 10.14338/ijpt-d-20-00043.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/12/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Treatment of sinonasal malignant tumors is challenging, and evidence to establish a standard treatment is limited. Our objective was to evaluate the efficacy and safety of spot scanning proton therapy (SSPT) for sinonasal malignant tumors. Patients and Methods We retrospectively analyzed patients with sinonasal malignant tumors (T1-4bN0-2M0) who underwent SSPT between May 2014 and September 2019. The prescription dose was typically either 60 GyRBE in 15 fractions or 60.8 GyRBE in 16 fractions for mucosal melanoma and 70.2 GyRBE in 26 fractions for other histologic subtypes. Endpoints included local control (LC), progression-free survival, overall survival (OS), and incidence of toxicity. Prognostic factors were analyzed using the Kaplan-Meier method and log-rank test. Results Of 62 enrolled patients, the common histologic subtypes were mucosal melanoma (35%), squamous cell carcinoma (27%), adenoid cystic carcinoma (16%), and olfactory neuroblastoma (10%). Locally advanced stages were common (T3 in 42% and T4 in 53%). Treatment-naïve tumors and postsurgical recurrent tumors accounted for 73% and 27%, respectively. No patient had previous radiotherapy. The median follow-up was 17 months (range, 6-66) for all patients and 21.5 months (range, 6-66) for survivors. The 2-year LC, progression-free survival, and OS rates of all patients were 92%, 50%, and 76%, respectively. Univariate analysis revealed histology as a prognostic factor for OS, being higher in adenoid cystic carcinoma and olfactory neuroblastoma than in other tumors. Sixteen grade ≥3 late toxicities were observed in 12 patients (19%), including 11 events resulting in visual impairment; the most common was cataract. There was 1 grade 4 toxicity, and there were no grade 5 toxicities. Conclusion SSPT was well tolerated and yielded good LC for sinonasal malignant tumors. Although we consider SSPT to be a leading treatment modality, further studies are required to establish its status as a standard treatment.
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Affiliation(s)
- Koichiro Nakajima
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan.,Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan.,Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yukiko Hattori
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Kento Nomura
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan.,Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shingo Hashimoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshiyuki Toshito
- Department of Proton Therapy Physics, Nagoya Proton Therapy Center, Nagoya, Japan
| | - Kensuke Hayashi
- Department of Proton Therapy Technology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Yo Kuroda
- Department of Otorhinolaryngology, Nagoya City West Medical Center, Nagoya, Japan
| | - Hideo Fukano
- Department of Oral and Maxillofacial Surgery, Nagoya City West Medical Center, Nagoya, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan.,Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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15
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Sommer F. Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base. Laryngorhinootologie 2021; 100:S1-S44. [PMID: 34352902 PMCID: PMC8354577 DOI: 10.1055/a-1331-2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.
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Affiliation(s)
- Fabian Sommer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinik Ulm
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16
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Yeung JT, Caminer DM, Young IM, Sughrue ME, Teo C. Radical Exenteration of the Skull Base for End-Stage, Locally Advanced Sinonasal Malignancies: Challenging the Dictum of Unresectability. World Neurosurg 2021; 150:e102-e107. [PMID: 33647490 DOI: 10.1016/j.wneu.2021.02.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The role of surgery is not well defined in locally advanced sinonasal cancers with intracranial involvement after all medical options have been exhausted. We hypothesize that patients whose tumors are deemed unresectable and referred to palliative care may benefit from radical salvage surgery. METHODS We performed a single-center retrospective review of patients with malignant, locally advanced (stage T4b) sinonasal cancers with intracranial involvement from 2000 to 2020, inclusive. Data were collected on the patient demographics, details of chemotherapy, radiation, histology, perioperative complications, surgical approaches, and survival. We compared the survival outcomes of patients with different duration of disease before presentation. RESULTS We identified 17 patients who had undergone salvage surgical resection of treatment-recalcitrant, locally advanced sinonasal tumors. Almost all patients had undergone prior surgery, radiotherapy, and chemotherapy. Perioperative complications occurred in 6 of 17 patients with 1 death. Patients with clinically less aggressive disease had significantly longer progression-free and overall survival compared with the more aggressive group. CONCLUSIONS Salvage surgery for locally advanced sinonasal cancers with intracranial invasion that is recalcitrant to all other therapies should be considered for patients who otherwise have no other treatment options.
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Affiliation(s)
- Jacky T Yeung
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
| | - David M Caminer
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia; Department of Plastic Surgery, St. Vincent's Hospital, Sydney, Australia
| | | | - Michael E Sughrue
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
| | - Charles Teo
- Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia.
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17
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Lie G, Wilson A, Campion T, Adams A. What's that smell? A pictorial review of the olfactory pathways and imaging assessment of the myriad pathologies that can affect them. Insights Imaging 2021; 12:7. [PMID: 33411049 PMCID: PMC7788544 DOI: 10.1186/s13244-020-00951-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/07/2020] [Indexed: 12/02/2022] Open
Abstract
The olfactory pathway is composed of peripheral sinonasal and central sensorineural components. The wide variety of different pathologies that can affect the olfactory pathway reflect this complex anatomical relationship. Localising olfactory pathology can present a challenge to the reporting radiologist. This imaging review will illustrate the normal anatomy of the olfactory system and describe a systematic approach to considering olfactory dysfunction. Key concepts in image interpretation will be demonstrated using examples of olfactory pathway pathologies.
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Affiliation(s)
- Geoffrey Lie
- Radiology Department, Royal London and St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
| | - Alexander Wilson
- Radiology Department, Royal London and St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Thomas Campion
- Radiology Department, Royal London and St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Ashok Adams
- Radiology Department, Royal London and St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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18
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Reyes C, Patel M, Solares CA. Sinonasal Malignancy and Orbital Exenteration Sparing Cancer Surgery. J Neurol Surg B Skull Base 2020; 81:369-375. [PMID: 33072478 DOI: 10.1055/s-0040-1713937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This article reviews the most common locations and natural history of sinonasal carcinomas. It also reviews surgical indications and current evidence regarding adjuvant and neoadjuvant therapies. In the past, orbital clearance was generally done for ethmoid and maxillary cancers, even without a marked neoplastic infiltration; however, such indications have changed in the recent years due to advances in our understanding of the disease, as well as new chemotherapeutic and radiotherapy protocols. Surgical resection of tumors close to the orbit exhibits the challenging task of balancing treatment goals and patient's desires.
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Affiliation(s)
- Camilo Reyes
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Augusta University, Augusta, Georgia, United States
| | - Mihir Patel
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute at Emory University, Emory University, Atlanta, Geogia, United States
| | - C Arturo Solares
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute at Emory University, Emory University, Atlanta, Geogia, United States
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19
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Alpuim Costa D, Monteiro A, André T, Esteves S, Sargento I, Ferreira M, Alexandre T, Clara A, Freire J, Moreira A. A Potential Link Between Prolonged Cork Exposure and Intestinal-Type Sinonasal Adenocarcinoma - Special Findings of a Retrospective Cohort Analysis. Front Oncol 2020; 10:565036. [PMID: 33072596 PMCID: PMC7531325 DOI: 10.3389/fonc.2020.565036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/24/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction intestinal-type sinonasal adenocarcinoma (ITAC) is a rare epithelium tumor of the nasal cavities and paranasal sinuses. Exposure to wood and leather dusts is a strong etiological factor related to its development. Prolonged cork exposure has rarely been associated. Materials and Methods thirty-seven-year (1981–2018) retrospective cohort analysis of all consecutive patients with sinonasal cancer (SNC) followed at our institution. Medical records were reviewed to determine patient demographics, occupational/environmental exposure, location and extent of the tumor, stage, histopathology findings, treatment strategies, and oncologic outcomes. Survival analysis was done using Kaplan–Meier method. Results we evaluated 379 patients with SNC, including 39 (10.3%) ITAC. Patient median age was 73 years (range 49–87), 56% male and 69% with identified professional occupational exposure (54% for cork; 69.2% considering only those for which an agent has been identified). Seventy-two percent had locally advanced disease (stage III or IVA–B). The initial treatment was surgery in 77%, and 54% received adjuvant radiotherapy. The median time to progression, progression-free survival, and overall-survival was 2.36 years (95% CI 1.54–8.70), 1.96 years (95% CI 1.43–3.74), and 3.51 years (95% CI 2.33–10.02), respectively. Conclusion ITAC is an uncommon malignancy that grows silently, which contributes to delayed diagnosis, advanced stage and low survival rates. In our cohort, we observed a high prevalence of cork occupational exposure. This finding may lead to the implementation of protection measures and suggest a potential link to be further studied.
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Affiliation(s)
| | - Ana Monteiro
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Teresa André
- Department of Medical Oncology, Hospital Central do Funchal, Madeira, Portugal
| | - Susana Esteves
- Department of Clinical Trials, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Isabel Sargento
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Margarida Ferreira
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Teresa Alexandre
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Ana Clara
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - João Freire
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - António Moreira
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal.,Department of Clinical Trials, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
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20
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Levitan I, Fichman S, Laviv Y. Fulminant presentation of a SMARCB1-deficient, anterior cranial fossa tumor in adult. Surg Neurol Int 2020; 11:195. [PMID: 32754366 PMCID: PMC7395541 DOI: 10.25259/sni_171_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/25/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Malignant atypical teratoid rhabdoid tumor (ATRT) usually develops in children. ATRTs are rare in adults, with only one case in the literature describing involvement of the anterior skull base. These primary intracranial tumors are characterized molecularly as SMARCB1 (INI1) deficient. Different types of such SMARCB1-deficient tumors exist in adulthood, usually in the form of extracranial tumors. Very few cases of such a new entity, named SMARCB1-deficient sinonasal carcinoma have been described with intracranial penetration and involvement of the anterior cranial fossa. Case Description: A 36-year-old male presented with acute cognitive deterioration. Over few hours, he developed a fulminant herniation syndrome. Imaging showed a tumor in the anterior cranial fossa surrounded by massive brain edema. The tumor has destroyed the frontal bone with involvement of the nasal cavities and paranasal sinuses. The patient underwent emergent decompressive craniectomy and tumor debulking but could not be saved. Pathological analysis revealed a highly cellular tumor without rhabdoid cells but with areas of necrosis. Further immunohistochemical stains revealed that neoplastic cells were diffusely and strongly positive for epithelial membrane antigen and P63 and negative for SMARCB1 (i.e., loss of expression), confirming the diagnosis of sinonasal carcinoma. Conclusion: To the best of our knowledge, this is the first report of a fulminant presentation of a SMARCB1- deficient tumor in young adult, involving the anterior cranial fossa and the paranasal sinuses. The main differential diagnosis of aggressive, primary, intracranial SMARCB1-deficient tumors in adults includes ATRT, SMARCB1- deficient sinonasal carcinoma, rhabdoid meningioma, and rhabdoid glioblastoma. Atypical tumors involving the anterior skull base without a clear histopathological pattern should therefore be checked for SMARCB1 expression.
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Affiliation(s)
- Idan Levitan
- Departments of Neurosurgery, Rabin Medical Center, Petha Tiqva, Israel
| | - Suzana Fichman
- Departments of Pathology, Rabin Medical Center, Petha Tiqva, Israel
| | - Yosef Laviv
- Departments of Neurosurgery, Rabin Medical Center, Petha Tiqva, Israel
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21
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Pasalic D, Ludmir EB, Allen PK, Thaker NG, Chapman BV, Hanna EY, Su SY, Ferrarotto R, Glisson BS, Reddy JP, Brandon Gunn G, Fuller CD, Phan J, Rosenthal DI, Morrison WH, Garden AS, Frank SJ. Patient-reported outcomes, physician-reported toxicities, and treatment outcomes in a modern cohort of patients with sinonasal cancer treated using proton beam therapy. Radiother Oncol 2020; 148:258-266. [DOI: 10.1016/j.radonc.2020.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/20/2020] [Accepted: 05/07/2020] [Indexed: 02/03/2023]
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22
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Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
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23
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Ranasinghe VJ, Stubbs VC, Reny DC, Fathy R, Brant JA, Newman JG. Predictors of nodal metastasis in sinonasal squamous cell carcinoma: A national cancer database analysis. World J Otorhinolaryngol Head Neck Surg 2020; 6:137-141. [PMID: 32596660 PMCID: PMC7296471 DOI: 10.1016/j.wjorl.2020.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/19/2020] [Indexed: 02/03/2023] Open
Abstract
Objective We present the largest population based study of sinonasal squamous cell carcinoma (SCC) to identify risk factors for presentation with nodal metastasis. Methods The National Cancer Database (NCDB) was used for this study. Location codes corresponding to the nasal cavity and paranasal sinuses and histology codes representing SCC malignancy were queried. Logistic regression analysis was performed to identify factors associated with presentation with nodal metastasis. Results 6448 cases met inclusion criteria. Nodal metastasis at presentation was seen in 13.2% of patients, with the sinus subsite (19.3%) being a significant risk factor for nodal metastasis at presentation when compared to the nasal cavity (7.9%). Logistic regression analysis showed black, uninsured and Medicaid patients were more likely than white and privately insured patients, respectively, to present with nodal metastasis. Conclusions In sinonasal SCC, the sinus subsite has a significantly increased risk of nodal metastasis compared to the nasal cavity. Black race, uninsured and Medicaid patients are more likely to have nodal metastasis at presentation.
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Affiliation(s)
- Viran J Ranasinghe
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Vanessa C Stubbs
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Danielle C Reny
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Ramie Fathy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jason A Brant
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Jason G Newman
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States
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24
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Sun Q, Zhang WB, Gao M, Yu S, Mao C, Guo CB, Yu GY, Peng X. Does the Brown classification of maxillectomy defects have prognostic prediction for patients with oral cavity squamous cell carcinoma involving the maxilla? Int J Oral Maxillofac Surg 2020; 49:1135-1142. [PMID: 32081582 DOI: 10.1016/j.ijom.2020.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/15/2019] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
The aim of this study was to investigate the correlation between the maxillectomy defect, T stage, and prognosis of patients with maxillary squamous cell carcinoma (SCC). The Brown classification system was used to appraise the maxillectomy defects due to maxillary SCC. The clinical data of 137 patients with maxillary SCC during the period 2000-2010 were reviewed; 105 patients were followed up. Preoperative T stage and postoperative maxillectomy class were recorded. The relationship between the maxillectomy defect class and T stage of maxillary SCC was analysed. Correlations between the maxillectomy defect class, local recurrence rate, and survival rate were assessed using IBM SPSS Statistics v19.0. The most common maxillectomy defect class was IIb (54.7%, 75/137). The maxillectomy defect class was significantly associated with the T stage (P < 0.001). Both T stage and the maxillectomy defect class were significantly associated with the survival rate of patients with maxillary SCC (both P< 0.001). In conclusion, the class of the maxillectomy defect was found to be associated with the T stage. Both of these were prognostic factors for patients with maxillary SCC. The class of the maxillectomy defect is suitable for clinical application in predicting the prognosis compared with T stage.
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Affiliation(s)
- Q Sun
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - W-B Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - M Gao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - S Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - C Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - C-B Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - G-Y Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - X Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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25
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Sadler KA, Hanna C, Melia L, White J. Very unusual case of a primary sinonasal germ cell tumour. BMJ Case Rep 2020; 13:13/2/e232288. [PMID: 32060110 DOI: 10.1136/bcr-2019-232288] [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: 11/03/2022] Open
Abstract
Sinonasal malignancies are a very rare diagnosis. We present a unique case of a 32-year-old man who presented with symptoms of worsening sinusitis and periorbital cellulitis. Investigation found a sinonasal malignancy and pathology confirmed this to be a primary germ cell tumour. The patient was managed with chemotherapy, surgery and consolidation radiotherapy and has remained well to date. This case report outlines an unusual presentation and diagnostic challenge for the primary care physician, ear, nose and throat surgeon, pathologist and oncologist with review of the surrounding literature.
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Affiliation(s)
- Katie Ann Sadler
- Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK.,University of Glasgow Faculty of Medicine, Glasgow, UK
| | - Catherine Hanna
- University of Glasgow Faculty of Medicine, Glasgow, UK.,Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Louise Melia
- ENT Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jeff White
- Beatson West of Scotland Cancer Centre, Glasgow, UK
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26
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Faisal M, Seemann R, Lill C, Hamzavi S, Wutzl A, Erovic BM, Janik S. Elective neck treatment in sinonasal undifferentiated carcinoma: Systematic review and meta-analysis. Head Neck 2020; 42:1057-1066. [PMID: 31922316 PMCID: PMC7217044 DOI: 10.1002/hed.26077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/11/2019] [Accepted: 12/31/2019] [Indexed: 12/14/2022] Open
Abstract
Sinonasal undifferentiated carcinomas (SNUCs), being an aggressive malignancy with dismal survival outcome, have given limited consideration regarding management of regional failures. A total of 12 studies, published between 1999 and 2019, met inclusion criteria. We performed a meta‐analysis assessing regional (neck) relapse after elective neck treatment compared to observation in clinically node negative (N0) necks. Clinical data of 255 patients were used for meta‐analysis. Among them, 83.4% of patients presented with T4 tumors and 14.1% had positive neck nodes. Elective neck treatment was applied in 49.5% of analyzed patients. Regional relapses occurred in 3.7% of patients who have undergone elective neck treatment compared to 26.4% in patients who had not. Elective neck treatment significantly reduced the risk of regional recurrence (odds ratio 0.20; 95% confidence interval 0.08‐0.49; P = .0004). The meta‐analysis indicates that elective neck treatment could significantly reduce the risk of regional failures in patients with SNUCs.
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Affiliation(s)
- Muhammad Faisal
- Department of Otorhinolaryngology, Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria.,Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Rudolf Seemann
- Department of Otorhinolaryngology, Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
| | - Claudia Lill
- Department of Otorhinolaryngology, Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
| | - Sasan Hamzavi
- Department of Otorhinolaryngology, Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
| | - Arno Wutzl
- Department of Otorhinolaryngology, Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
| | - Boban M Erovic
- Department of Otorhinolaryngology, Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, Vienna, Austria
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Valentini V, Giovannetti F, Cassoni A, Terenzi V, Priore P, Raponi I, Bosco S, Alesini F, Mezi S, Musio D, Tombolini V. Sinonasal Undifferentiated Carcinoma in a Patient Previously Treated for an Intestinal-Type Adenocarcinoma: Metachronous Neoplasms or Recurrence of a Different Tumor Type? Indian J Otolaryngol Head Neck Surg 2019; 71:1779-1781. [PMID: 31763244 DOI: 10.1007/s12070-017-1126-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/04/2017] [Indexed: 11/24/2022] Open
Abstract
A case of a sinonasal undifferentiated carcinoma occurring 2 years after a successfully surgically treated intestinal-type adenocarcinoma has never been reported. Treatment modality of paranasal sinus cancer strictly depends on histology so it is important to recognize a different tumor type in the follow-up of these patients.
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Affiliation(s)
- Valentino Valentini
- 1Odontostomatological Science and Maxillo-Facial Surgery Department, Maxillo-Facial Surgery, "Sapienza" University of Rome, Policlinico Umberto I. Viale del Policlinico 155, 00100 Rome, Italy
| | - Filippo Giovannetti
- 1Odontostomatological Science and Maxillo-Facial Surgery Department, Maxillo-Facial Surgery, "Sapienza" University of Rome, Policlinico Umberto I. Viale del Policlinico 155, 00100 Rome, Italy
| | - Andrea Cassoni
- 1Odontostomatological Science and Maxillo-Facial Surgery Department, Maxillo-Facial Surgery, "Sapienza" University of Rome, Policlinico Umberto I. Viale del Policlinico 155, 00100 Rome, Italy
| | - Valentina Terenzi
- 1Odontostomatological Science and Maxillo-Facial Surgery Department, Maxillo-Facial Surgery, "Sapienza" University of Rome, Policlinico Umberto I. Viale del Policlinico 155, 00100 Rome, Italy
| | - Paolo Priore
- 1Odontostomatological Science and Maxillo-Facial Surgery Department, Maxillo-Facial Surgery, "Sapienza" University of Rome, Policlinico Umberto I. Viale del Policlinico 155, 00100 Rome, Italy
| | - Ingrid Raponi
- 1Odontostomatological Science and Maxillo-Facial Surgery Department, Maxillo-Facial Surgery, "Sapienza" University of Rome, Policlinico Umberto I. Viale del Policlinico 155, 00100 Rome, Italy
| | - Sandro Bosco
- 2Molecular Medicine Department, "Sapienza" University of Rome, Viale del Policlinico 155, 00100 Rome, Italy
| | - Francesco Alesini
- 2Molecular Medicine Department, "Sapienza" University of Rome, Viale del Policlinico 155, 00100 Rome, Italy
| | - Silvia Mezi
- 3Medical Oncology, Policlinico Umberto I, Viale del Policlinico 155, 00100 Rome, Italy
| | - Daniela Musio
- 4Radiological, Oncological and Pathological Science Department, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00100 Rome, Italy
| | - Vincenzo Tombolini
- 4Radiological, Oncological and Pathological Science Department, "Sapienza" University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00100 Rome, Italy
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28
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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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29
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Hermsen MA, Riobello C, García-Marín R, Cabal VN, Suárez-Fernández L, López F, Llorente JL. Translational genomics of sinonasal cancers. Semin Cancer Biol 2019; 61:101-109. [PMID: 31560943 DOI: 10.1016/j.semcancer.2019.09.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/22/2019] [Indexed: 02/06/2023]
Abstract
The sinonasal cavities harbor a wide variety of histologically distinct cancers, the majority very aggressive with 5-year survival rates between 30-60% and local recurrence as the main cause of death. This is a complex anatomic area, close to structures such the eyes and the brain, which is of special relevance for surgery and postoperative radiotherapy. The low incidence of these rare tumors hampers accumulation of experience with diagnosis and clinical managment as well as knowledge on recurrent genetic aberrations or testing of new treatment strategies. However, recent years have seen a growing number of publications on genetic aberrations providing data that can aid or fine-tune classification and provide molecular targets for treatment with specific inhibitors. In addition, new sinonasal cancer models are created that enable preclinical testing of candidate inhibitor drugs. With more and more novel targeted therapies being developed, options for personalized treatment of sinonasal cancer patients are now opening up.
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Affiliation(s)
- Mario A Hermsen
- Dept. Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
| | - Cristina Riobello
- Dept. Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Rocío García-Marín
- Dept. Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Virginia N Cabal
- Dept. Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Laura Suárez-Fernández
- Dept. Head and Neck Oncology, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Fernando López
- Dept. Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José L Llorente
- Dept. Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
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30
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König M, Osnes T, Bratland Å, Jebsen P, Meling TR. Treatment of Sinonasal Adenocarcinoma: A Population-Based Prospective Cohort Study. J Neurol Surg B Skull Base 2019; 81:627-637. [PMID: 33381366 DOI: 10.1055/s-0039-1694050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022] Open
Abstract
Objectives Sinonasal adenocarcinoma (AC) is a potentially curable disease despite being an aggressive malignancy. Long-term survival can be achieved with early diagnosis and adequate multidisciplinary treatment. Our goal was to evaluate outcomes for patients with AC treated at our institution. Design In a population-based consecutive prospective cohort, we conducted an analysis of all patients treated for surface epithelial AC between 1995 and 2018. Results Twenty patients were included, and follow-up was 100%. The mean follow-up time was 89 months for the entire cohort (112 months for patients with no evidence of disease). Intestinal-type AC was found in 65%, whereas nonintestinal-type AC was found in 35% of all cases; 75% had stage T3/4 disease. Tumor grade was intermediate/high in 65%. Eighteen patients underwent treatment with curative intent (craniofacial resection [CFR] in 61%, transfacial approach in 39%, adjuvant radiotherapy in 89%), achieving negative margins in 56% of cases. Overall survival (OS) rates were 90, 68, and 54% after 2, 5, and 10 years of follow-up, respectively, and the corresponding disease-specific survival (DSS) rates were 90, 73, and 58%. Age over 60 years, tumor with a maxillary origin, and microscopic bone invasion were negative prognostic factors. Radical CFR was correlated with better OS and DSS. Conclusion The high probability of achieving radicality with CFR, the low complication rate, the acceptable toxicity of modern irradiation modalities, and the promising survival rates indicate that this strategy might be considered a safe and an effective option for treating patients with very advanced sinonasal AC.
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Affiliation(s)
- Marton König
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Terje Osnes
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Åse Bratland
- Department of Oncology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Peter Jebsen
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Torstein R Meling
- Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Service de Neurochirurgie, Département des Neurosciences Cliniques, Hopitaux Universitaires de Genève, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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31
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Yu NY, Gamez ME, Hartsell WF, Tsai HK, Laramore GE, Larson GL, Simone CB, Rossi C, Katz SR, Buras MR, Golafshar MA, Vargas CE, Patel SH. A Multi-Institutional Experience of Proton Beam Therapy for Sinonasal Tumors. Adv Radiat Oncol 2019; 4:689-698. [PMID: 31673662 PMCID: PMC6817523 DOI: 10.1016/j.adro.2019.07.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/26/2019] [Accepted: 07/08/2019] [Indexed: 12/29/2022] Open
Abstract
Purpose To report the outcomes of sinonasal tumors treated with proton beam therapy (PBT) on the Proton Collaborative Group registry study. Methods and Materials Sixty-nine patients with sinonasal tumors underwent curative intent PBT between 2010 and 2016. Patients who received de novo irradiation (42 patients) were analyzed separately from those who received reirradiation (27 patients) (re-RT). Median age was 53.1 years (range, 15.7-82.1; de novo) and 57.4 years (range, 31.3-88.0; re-RT). The most common histology was squamous cell carcinoma in both groups. Median PBT dose was 58.5 Gy (RBE) (range, 12-78.3; de novo) and 60.0 Gy (RBE) (range 18.2-72.3; re-RT), and median dose per fraction was 2.0 Gy (RBE) for both cohorts. Survival estimates for patients who received de novo irradiation and those who received re-RT were calculated using the Kaplan-Meier method. Results Median follow-up for surviving patients was 26.4 months (range, 3.5-220.5). The 3-year overall survival (OS), freedom from distant metastasis, freedom from disease progression, and freedom from locoregional recurrence (FFLR) for de novo irradiation were 100%, 84.0%, 77.3%, and 92.9%, respectively. With re-RT, the 3-year OS, freedom from distant metastasis, FFDP, and FFLR were 76.2%, 47.4%, 32.1%, and 33.8%, respectively. In addition, 12 patients (17.4%) experienced recurrent disease. Re-RT was associated with inferior FFLR (P = .04). On univariate analysis, squamous cell carcinoma was associated with inferior OS (P < .01) for patients receiving re-RT. There were 11 patients with acute grade 3 toxicities. Late toxicities occurred in 15% of patients, with no grade ≥3 toxicities. No patients developed vision loss or symptomatic brain necrosis. Conclusions As one of the largest studies of sinonasal tumors treated with PBT, our findings suggest that PBT may be a safe and efficacious treatment option for patients with sinonasal tumors.
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Affiliation(s)
- Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - William F Hartsell
- Department of Radiation Oncology, Northwestern Medicine Chicago Proton Center, Warrenville, Illinois
| | - Henry K Tsai
- Department of Radiation Oncology, ProCure Proton Therapy Center, Somerset, New Jersey
| | - George E Laramore
- Department of Radiation Oncology, Seattle Cancer Care Alliance Proton Therapy Center, Seattle, Washington
| | - Gary L Larson
- Department of Radiation Oncology, ProCure Proton Therapy Center, Oklahoma City, Oklahoma
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Maryland Proton Treatment Center, Baltimore, Maryland
| | - Carl Rossi
- Department of Radiation Oncology, California Protons Cancer Therapy Center, San Diego, California
| | - Sanford R Katz
- Department of Radiation Oncology, Willis-Knighton Cancer Center, Shreveport, Louisiana
| | - Matthew R Buras
- Division of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona
| | | | - Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
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Ozturk K, Gencturk M, Caicedo-Granados E, Li F, Cayci Z. Appropriate timing of surveillance intervals with whole-body 18F-FDG PET/CT following treatment for sinonasal malignancies. Eur J Radiol 2019; 118:75-80. [PMID: 31439262 DOI: 10.1016/j.ejrad.2019.07.004] [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: 10/09/2018] [Revised: 06/10/2019] [Accepted: 07/03/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the ideal timing of posttreatment whole-body 18F-FDG PET/CT examination as routine surveillance to determine local recurrence (R), lymph node metastasis (LM), and distant metastasis (DM) of sinonasal malignancies and to investigate the effect of 18F-FDG PET/CT on survival. METHODS An overall 80 patients who had undergone a total of 197 posttreatment whole-body 18F-FDG PET/CT examinations for sinonasal malignancy were retrospectively examined after institutional review board approval. Patients were grouped regarding the time intervals (<1 month, 1-3 months, 3-6 months, 6-12 months, 12-18 months and >18 months) after the conclusion of treatment. Differences in diagnostic accuracy due to different follow-up intervals were calculated by receiver operator curves (ROC) and a Cox proportional hazards model was used to assess the prognostic value of surveillance 18F-FDG PET/CT. RESULTS Considering the time intervals of posttreatment 18F-FDG PET/CT scans, the negative predictive value and positive predictive value of the 18F-FDG PET/CT examinations to predict overall recurrence in 1-3 months (100 and 100%, respectively) and >18 months (100 and 95%, respectively) were higher than for recurrence detection in <1 month (50 and 100%, respectively), 3-6 months (81 and 93%, respectively), 6-12 months (79 and 87%, respectively), and 12-18 months (75 and 80%, respectively) (p < 0.05). Positive findings on 18F-FDG PET/CT scans were also independent predictors of poorer overall survival (OS) (p < 0.05). CONCLUSIONS Whole-body 18F-FDG PET/CT is capable of identifying recurrences following treatment, using an optimal time interval for scanning of 1-3 months and >18 months after therapy.
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Affiliation(s)
- Kerem Ozturk
- Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA.
| | - Mehmet Gencturk
- Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA.
| | - Emiro Caicedo-Granados
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA.
| | - Faqian Li
- Department of Pathology and Laboratory Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.
| | - Zuzan Cayci
- Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA.
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Rigante M, Loperfido A, Paludetti G. Oncogenic Osteomalacia with Elevated Fibroblast Growth Factor 23: A Rare Case of Paranasal Sinus Tumor Onset. Cureus 2019; 11:e4919. [PMID: 31423395 PMCID: PMC6692094 DOI: 10.7759/cureus.4919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tumor-induced osteomalacia, also known as oncogenic osteomalacia, is a rare, acquired paraneoplastic disease characterized by hypophosphatemia and renal phosphate wasting. We report on the case of a 52-year-old-man admitted to our hospital for bone and muscular pains and difficulty in walking. He underwent a computed tomography (CT) scan of the legs that documented fractures in the right tibia, femur, and fifth metatarsus. Laboratory findings showed hypophosphatemia and elevated levels of parathyroid hormone (PTH). The first diagnosis was osteomalacia, treated with calcium and vitamin D, without any benefit. So he underwent a whole body CT scan, showing a small expansive lesion occupying the left frontal sinus. Furthermore, we found high serum levels of fibroblast growth factor 23 (FGF23) using the enzyme-linked immune sorbent assay (ELISA) assay. The patient underwent endoscopic surgical resection of the frontal tumor with complete clinical remission and the histopathological diagnosis of an ossifying fibromyxoid tumor. This is a rare case of oncogenic osteomalacia due to a paranasal sinus tumor. The main symptoms are not associated with nasal sinus involvement but with over-expressed FGF23. To conclude, physicians should never underestimate the chance of paraneoplastic syndrome in the head and neck district, even if such an occurrence is uncommon in this location. The clinical symptoms may be aspecific and not related to nose problems, making the differential diagnosis very difficult.
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Affiliation(s)
- Mario Rigante
- Otolaryngology Institute-Department of Head and Neck, Fondazione Policlinico Universitario A. Gemelli Irccs Università Cattolica Del Sacro Cuore, Rome, ITA
| | - Antonella Loperfido
- Otolaryngology Institute-Department of Head and Neck, Fondazione Policlinico Universitario A. Gemelli Irccs Università Cattolica Del Sacro Cuore, Rome, ITA
| | - Gaetano Paludetti
- Otolaryngology Institute-Department of Head and Neck, Fondazione Policlinico Universitario A. Gemelli Irccs Università Cattolica Del Sacro Cuore, Rome, ITA
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Shay A, Ganti A, Raman A, Kuhar HN, Auger SR, Eggerstedt M, Patel T, Kuan EC, Batra PS, Tajudeen BA. Survival in low-grade and high-grade sinonasal adenocarcinoma: A national cancer database analysis. Laryngoscope 2019; 130:E1-E10. [PMID: 31081940 DOI: 10.1002/lary.28052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/03/2019] [Accepted: 04/18/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to investigate survival differences between low-grade and high-grade sinonasal adenocarcinoma (SNAC) by examining demographics, tumor characteristics, and treatment modalities. STUDY DESIGN Retrospective database analysis. METHODS The National Cancer Database was queried for patients with SNAC between 2004 and 2015. Univariate and multivariate analyses were performed for all cases of SNAC. Subsequent analysis focused on low-grade (grade 1 and grade 2) and high-grade (grade 3 and grade 4) SNAC. RESULTS A total of 1,288 patients with SNAC were included in the main cohort and divided into low grade (n = 601) and high grade (n = 370). The 5-year overall survival for all patients, low-grade, and high-grade was 54%, 64%, and 38%, respectively. Prognostic factors associated with decreased survival for the main cohort include advanced age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.03-1.06), Charlson-Deyo score (HR: 1.37; 95% CI: 1.05-1.78), grade 2 (HR: 2.21; 95% CI: 1.26-3.86], grade 3 (HR: 3.67; 95% CI: 2.09-6.45), and grade 4 (HR: 3.31; 95% CI: 1.38-7.91). Radiotherapy was associated with improved overall survival for high-grade SNAC (HR: 0.41; 95% CI: 0.24-0.70) but not for low-grade SNAC (HR: 1.05; 95% CI: 0.59-1.85). CONCLUSIONS This investigation is the largest to date analyzing the association of treatment modalities with overall survival in SNAC. Surgery remains paramount to treatment, with radiotherapy offering additional survival benefit for high-grade SNAC. Administration of chemotherapy was not associated with improved survival. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E1-E10, 2020.
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Affiliation(s)
- Aryan Shay
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Ashwin Ganti
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Anish Raman
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Hannah N Kuhar
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Samuel R Auger
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Michael Eggerstedt
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois
| | - Tirth Patel
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, U.S.A
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois
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Ozturk K, Gencturk M, Caicedo-Granados E, Li F, Cayci Z. Prediction of survival with combining quantitative 18 F-FDG PET/CT and DW-MRI parameters in sinonasal malignancies. Head Neck 2019; 41:3080-3089. [PMID: 31041831 DOI: 10.1002/hed.25799] [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: 11/12/2018] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We aimed to establish the prognostic value of 18 F-fluoro-deoxy-glucose positron emission/CT (18 F-FDG PET/CT) and diffusion-weighted (DW) MRI in determining overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) of sinonasal malignancies. METHODS Sixty-eight patients with sinonasal cancer who underwent both pretreatment 18 F-FDG PET/CT scan and head-neck MRI from January 2009 through August 2017 were retrospectively reviewed. Kaplan-Meier survival analysis of 18 F-FDG PET/CT and DW-MRI parameters were performed for OS, PFS, and DMFS. RESULTS Cox regression analysis determined that all the quantitative 18 F-FDG PET/CT and DW-MRI parameters were independently correlated with PFS, DMFS, and OS (P < .05). After controlling for imaging variables, perineural invasion (P = .02) and ill-defined margin (P = .02) were found to be significantly correlated with shorter OS; while the perineural invasion was significantly correlated with shorter PFS (P = .02). CONCLUSIONS The pretreatment DW-MRI and 18 F-FDG PET/CT parameters could be substantial surrogate markers for sinonasal malignancies.
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Affiliation(s)
- Kerem Ozturk
- Department of Radiology, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Mehmet Gencturk
- Department of Radiology, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Emiro Caicedo-Granados
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Faqian Li
- Department of Pathology and Laboratory Medicine, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | - Zuzan Cayci
- Department of Radiology, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
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Trieu V, Aulet RM, Ciolino A, Rimash T. SMARCB1-Deficient Sinonasal Carcinoma: A Case Report and Discussion of the Clinical Implications. Ann Otol Rhinol Laryngol 2019; 128:676-680. [PMID: 30873845 DOI: 10.1177/0003489419836668] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE SMARCB1-deficient sinonasal tract carcinomas are an emerging subset of rare tumors recently described in the literature, with less than 100 reported cases. Given the aggressive nature of this tumor, timely diagnosis is especially important. We present a case report of a SMARCB1-deficient carcinoma of the sinonasal tract. METHODS Case report with review of the literature. RESULTS The patient was a 53-year-old male with computed tomography (CT)-proven mass of the right ethmoid and sphenoid sinuses. Rigid nasal endoscopy revealed a purple mass completely obstructing the right nasal cavity that extended inferiorly from the posterior ethmoids and sphenoid sinuses. Initial biopsy in the emergency room was nondiagnostic due to extensive tumor necrosis. Magnetic resonance imaging (MRI) revealed T2 hypointense enhancing mass centered in the right posterior ethmoids with invasion into the right orbital apex, classifying it as a T4b tumor. The patient underwent repeat biopsy with frozen section and tumor debulking. Immunohistochemical analysis of subsequent biopsy revealed complete loss of INI-1 and negative staining for other pertinent markers, alluding to the diagnosis of SMARCB1-deficient sinonasal tract carcinoma. CONCLUSION Tumor necrosis may be problematic in obtaining a diagnosis for SMARCB1-deficient sinonasal carcinomas. Thus, sampling various regions of the tumor during initial biopsy can prevent delays in diagnosis and treatment.
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Affiliation(s)
- Vanessa Trieu
- 1 Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Ricardo Mario Aulet
- 2 Division of Otolaryngology, University of Vermont Medical Center, Burlington, VT, USA
| | - Allison Ciolino
- 3 Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Tamara Rimash
- 2 Division of Otolaryngology, University of Vermont Medical Center, Burlington, VT, USA
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Application of diffusion-weighted MR imaging with ADC measurement for distinguishing between the histopathological types of sinonasal neoplasms. Clin Imaging 2019; 55:76-82. [PMID: 30769222 DOI: 10.1016/j.clinimag.2019.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/20/2019] [Accepted: 02/06/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate the potential contribution of quantitative DWI parameters including ADCmean and ADCratio values to help in distinguishing the histopathological types of sinonasal neoplasms. METHODS This retrospective study included 83 patients (50 males, 33 females; mean age 61 years) with pathologically proven untreated sinonasal neoplasms who have undergone diffusion-weighted MRI imaging from February 2010 to August 2017. Diffusion-weighted MRI was performed on a 3 T unit with b factors of 0 and 1000 s/mm2, and ADC maps were generated. Mean ADC values of sinonasal tumors and ADC ratios (ADCmean of the tumor to ADCmean of pterygoid muscles) were compared with the histopathological diagnosis by utilizing the Kruskal-Wallis non-parametric test. RESULTS Mean ADCmean and ADCratio were 0.8 (SD, ±0.4) × (10-3 mm2/s) and 1.2 (SD, ±0.5), respectively, and each parameter was significantly different between histopathological types (p < 0.05). Mean ADCmean and ADCratio were higher in adenoid cystic carcinoma (ACC) than in SCC, lymphoma, neuroendocrine carcinoma and sinonasal undifferentiated carcinoma (SNUC) (p < 0.05). Optimized ADCmean thresholds of 0.79, 0.81, 0.74 and 0.78 (10-3 mm2/s) achieved maximal discriminatory accuracies of 100%, 79%, 100% and 89% for ACC/SNUC, ACC/SCC, ACC/neuroendocrine carcinoma, and ACC/lymphoma, respectively. CONCLUSIONS The optimized ADCmean threshold of 0.80 (10-3 mm2/s) could be used to differentiate ACC from non-ACC sinonasal neoplasms with maximal discriminatory accuracy (82%) and sensitivity of 100%. However, there is considerable overlapping of the ADCmean and ADCratio values among non-ACC sinonasal neoplasms hence surgical biopsy is still needed.
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Frederic-Moreau T, Piram L, Bellini R, Martin F, Miroir J, Saroul N, Pham Dang N, Lapeyre M, Biau J. Postoperative volumetric modulated arc therapy for sinonasal cancer: Improved survival compared with 3D conformal radiation therapy. Head Neck 2018; 41:448-455. [PMID: 30549346 DOI: 10.1002/hed.25410] [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: 02/20/2018] [Revised: 07/11/2018] [Accepted: 09/12/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Prospective evaluation of the results of volumetric modulated arc therapy (VMAT) for sinonasal cancer compared to 3D conformal radiation therapy (3DCRT). MATERIALS AND METHODS We prospectively evaluated 34 patients (pts) treated with postoperative VMAT with simultaneous integrated boost (SIB; RapidArc) from 2011 to 2015. These pts were retrospectively compared with 24 pts treated with 3DCRT from 2003 to 2011. The two sets were not significantly different on sex, mean age, tumor site, stage, histology. Efficacy and toxicity were evaluated. RESULTS Median follow-up was 45 months (range: 6-143 months). Three-year overall survival was 85.2% in VMAT-SIB versus 65.2% in 3DCRT (P = .02). Three-year local control was 81.2% in VMAT-SIB versus 62.5% in 3DCRT (P = .04). There was a reduction of acute (<0.09) and late (0.03) ocular toxicity of grade ≥ 2 for pts with VMAT-SIB. CONCLUSION VMAT significantly improved local control and overall survival in sinonasal cancer with lower rate of toxicity.
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Affiliation(s)
| | - Lucie Piram
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Romain Bellini
- Department of Radiology, Centre Jean Perrin, Clermont-Ferrand, France
| | - Fanny Martin
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Jessica Miroir
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Nicolas Saroul
- Department of Head and Neck Surgery, CHU, Clermont-Ferrand, France
| | | | - Michel Lapeyre
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Julian Biau
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France.,University Clermont Auvergne, INSERM, U1240 IMoST, Clermont-Ferrand, France
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Utility of FDG PET/CT in the Characterization of Sinonasal Neoplasms: Analysis of Standardized Uptake Value Parameters. AJR Am J Roentgenol 2018; 211:1354-1360. [PMID: 30300005 DOI: 10.2214/ajr.18.19501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We aimed to evaluate the contribution of different standardized uptake value (SUV) parameters generated from pretreatment 18F-FDG PET/CT in the characterization of sinonasal neoplasms with histopathologic correlations. MATERIALS AND METHODS This retrospective study included 97 consecutive patients (58 men, 39 women; age range, 20-93 years; mean age, 62 years) with pathologically proven untreated sinonasal neoplasms who underwent FDG PET/CT from February 2010 to August 2017. Semiquantitative analysis of primary tumors were performed to evaluate the maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and the ratio of the SUVmax of the primary tumor to the SUVmean of mediastinal blood pool, which we refer to here as " SUVratio." Various sinonasal tumor histopathologic subgroups (n = 14) were analyzed. The Kruskal-Wallis test was used to compare the SUVmax, SUVmean, and SUVratio with the histopathologic diagnosis. RESULTS Mean values of SUVmax, SUVmean, and SUVratio for the sinonasal neoplasms were 16.6 ± 9.7 (SD), 8.6 ± 5.1, and 5.9 ± 3.7, respectively, and each parameter was significantly different between histopathologic types (p < 0.05). Mean values of SUVmax, SUVmean, and SUVratio were higher in sinonasal undifferentiated carcinoma (SNUC) than in olfactory neuroblastoma, metastasis, and adenoid cystic carcinoma (p < 0.05). Mean values of SUVmax and SUVmean were higher in squamous cell carcinoma (SCC) than in olfactory neuroblastoma and metastasis (p < 0.05). Also, mean SUVmax was higher in SCC and SNUC than in poorly differentiated carcinoma (p < 0.05). Mean SUVratio was higher in SCC than in small cell carcinoma, olfactory neuroblastoma, and adenoid cystic carcinoma (p < 0.05). CONCLUSION We conclude that different SUV parameters from FDG PET/CT can be used as so-called "metabolic biopsy" to categorize sinonasal neoplasms into different histopathologic subgroups because it can help in the characterization of some of the more common subgroups of sinonasal neoplasms. However, we found that there is overlap in FDG uptake values among some of the rare histologic subgroups; hence, surgical biopsy is still needed for differentiation of histologic subtypes of aggressive sinonasal masses.
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Jain S, Li Y, Kuan EC, Tajudeen BA, Batra PS. Prognostic Factors in Paranasal Sinus Squamous Cell Carcinoma and Adenocarcinoma: A SEER Database Analysis. J Neurol Surg B Skull Base 2018; 80:258-263. [PMID: 31143568 DOI: 10.1055/s-0038-1669420] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 07/07/2018] [Indexed: 12/12/2022] Open
Abstract
Background Outcome studies on sinonasal malignancy are limited to retrospective case series, often with inclusion of diverse histology and short follow-up. The objective of this study was to identify key predictive variables that independently impact survival for paranasal sinus squamous cell carcinoma (SCC) and adenocarcinoma (AC) and to compare these variables in the context of these two distinct clinicopathologic entities. Methods: Analysis was conducted using the Surveillance, Epidemiology, and End Results database from 1973 to 2012 to identify key variables that impact survival for SCC and AC. Results A total of 3,714 cases were included. There were 2,895 SCC cases and 819 AC cases. The mean age at diagnosis was 64.1 years. The male to female ratio for SCC and AC was 1.85 and 1.04, respectively. Patients with SCC and AC were most often diagnosed with stage IV disease in 61.8 and 63.4% of cases, respectively. The majority of patients received combined surgery and radiation (52% for SCC and 43.1% for AC). For SCC, increased age ( p < 0.001) and stage ( p < 0.001) were negative predictors, and surgery improved survival ( p < 0.001) on multivariate analysis. For AC, prognostic factors associated with worse survival include increased age ( p < 0.001) and grade ( p < 0.001) on multivariate analysis. Overall survival was significantly higher in AC compared with SCC at 5 years ( p = 0.001). Conclusion SCC and AC of the paranasal sinuses are both aggressive malignancies with poor survival. For both histological subtypes, increased age predicts worse survival and grade also closely links to survival in AC. These data have important potential implications for treatment planning and pretreatment counseling.
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Affiliation(s)
- Sumit Jain
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois, United States
| | - Yan Li
- Department of Otolaryngology, Rush University, Chicago, Illinois, United States
| | - Edward C Kuan
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology - Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Pete S Batra
- Department of Otorhinolaryngology - Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, United States
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Allard FD, Bell D, Stelow EB. Cytopathologic features of SMARCB1 (INI-1)-deficient sinonasal carcinoma. Cancer Cytopathol 2018; 126:567-574. [DOI: 10.1002/cncy.22020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/15/2018] [Accepted: 04/27/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Felicia D. Allard
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Diana Bell
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Edward B. Stelow
- Department of Pathology; University of Virginia; Charlottesville Virginia
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Chmelarova M, Laco J, Kovarikova H, Baranova I, Dundr P, Nemejcova K, Michalek J, Vosmik M, Palicka V. Elevated DNA methylation in malignant tumors of the sinonasal tract and its association with patient survival. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:232-238. [PMID: 29581595 DOI: 10.5507/bp.2018.012] [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: 11/27/2017] [Accepted: 03/21/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Epigenetic modifications have been recognized as an important mechanism underlying carcinoma progression. DNA methylation plays an important role in cancer biology and represents potentially heritable changes in gene expression that do not involve DNA sequence. The aim of this study was to investigate promoter methylation of selected genes in sinonasal carcinoma by comparison with noncancerous sinonasal tissue. METHODS To search for epigenetic events (methylation in 25 tumor suppressor genes) we used MS-MLPA (Methylation-specific multiplex ligation-dependent probe amplification) to compare methylation status of 59 formalin fixed, paraffin embedded tissue samples of sinonasal carcinomas with 18 control samples. The most important changes in methylation were confirmed using MSP (Methylation specific PCR). Detected alterations in methylation were compared with clinicopathological characteristics. RESULTS Using a 20% cut-off for methylation (MS-MLPA), we found significantly higher methylation in GATA5 (P=0.0005), THSB1 (P=0.0002) and PAX5 (P=0.03) genes in the sinonasal cancer group compared to the control group. Methylation in five or more genes was associated with impaired overall survival (P=0.017). CONCLUSION These findings provide evidence that alterations in methylation profile may be one of the major mechanisms in sinonasal carcinogenesis. In addition, changes in methylation could potentially be used as prognostic factors of sinonasal carcinoma and may have implications for future individualized therapy based on epigenetic changes.
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Affiliation(s)
- Marcela Chmelarova
- Institute for Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
| | - Jan Laco
- The Fingerland Department of Pathology, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
| | - Helena Kovarikova
- Institute for Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
| | - Ivana Baranova
- Institute for Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
| | - Pavel Dundr
- Department of Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Kristyna Nemejcova
- Department of Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Jaroslav Michalek
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Milan Vosmik
- Department of Oncology and Radiotherapy, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
| | - Vladimir Palicka
- Institute for Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Czech Republic
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Binazzi A, Corfiati M, Di Marzio D, Cacciatore AM, Zajacovà J, Mensi C, Galli P, Miligi L, Calisti R, Romeo E, Franchi A, Marinaccio A. Sinonasal cancer in the Italian national surveillance system: Epidemiology, occupation, and public health implications. Am J Ind Med 2018; 61:239-250. [PMID: 29114957 DOI: 10.1002/ajim.22789] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Sinonasal cancer (SNC) is a rare tumor with predominant occupational etiology associated with exposures to specific carcinogens. The aim of this study is to describe SNC cases recorded in Italy in the period 2000-2016. METHODS Clinical information, occupational history, and lifestyle habits of SNC cases collected in the Italian Sinonasal Cancer Register were examined. Age-standardized rates were estimated. RESULTS Overall, 1529 cases were recorded. The age-standardized incidence rates per 100 000 person-years were 0.65 in men and 0.26 in women. Occupational exposures were predominant among the attributed exposure settings, primarily to wood and leather dusts. Other putative causal agents included chrome, solvents, tannins, formaldehyde, textile dusts, and pesticides. Many cases had unknown exposure. CONCLUSIONS Epidemiological surveillance of SNC cases and their occupational history is fundamental for monitoring the occurrence of the disease in exposed workers in industrial sectors generally not considered at risk of SNC as well as in non-occupational settings.
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Affiliation(s)
- Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology, Hygiene; National Institute for Insurance Against Accidents at Work (INAIL); Rome Italy
| | - Marisa Corfiati
- Department of Occupational and Environmental Medicine, Epidemiology, Hygiene; National Institute for Insurance Against Accidents at Work (INAIL); Rome Italy
| | - Davide Di Marzio
- Department of Occupational and Environmental Medicine, Epidemiology, Hygiene; National Institute for Insurance Against Accidents at Work (INAIL); Rome Italy
| | - Anna M. Cacciatore
- Sinonasal Cancer Registry of Piedmont; Occupational Health and Safety Department; ASL CN1; Cuneo Italy
| | - Jana Zajacovà
- Sinonasal Cancer Registry of Piedmont; Occupational Health and Safety Department; ASL CN1; Cuneo Italy
| | - Carolina Mensi
- Sinonasal Cancer Registry of Lombardy; Department of Preventive Medicine; Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico; Milan Italy
| | - Paolo Galli
- Sinonasal Cancer Registry of Emilia-Romagna; Department of Public Health; Unit of Workplace Prevention and Safety; AUSL Imola Italy
| | - Lucia Miligi
- Sinonasal Cancer Registry of Tuscany; Cancer Prevention and Research Institute (ISPO); Environmental and Occupational Epidemiology Unit; Florence Italy
| | - Roberto Calisti
- Sinonasal Cancer Registry of Marche; Department of Prevention; SPreSAL; Civitanova Marche Italy
| | - Elisa Romeo
- Sinonasal Cancer Registry of Lazio; Department of Epidemiology; ASL RM1; Rome Italy
| | - Alessandro Franchi
- Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology, Hygiene; National Institute for Insurance Against Accidents at Work (INAIL); Rome Italy
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Kawaguchi M, Kato H, Tomita H, Mizuta K, Aoki M, Hara A, Matsuo M. Imaging Characteristics of Malignant Sinonasal Tumors. J Clin Med 2017; 6:jcm6120116. [PMID: 29211048 PMCID: PMC5742805 DOI: 10.3390/jcm6120116] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/01/2017] [Accepted: 12/04/2017] [Indexed: 12/13/2022] Open
Abstract
Malignancies of the nasal cavity and paranasal sinuses account for 1% of all malignancies and 3% of malignancies of the upper aerodigestive tract. In the sinonasal tract, nearly half of all malignancies arise in the nasal cavity, whereas most of the remaining malignancies arise in the maxillary or ethmoid sinus. Squamous cell carcinoma is the most common histological subtype of malignant tumors occurring in this area, followed by other epithelial carcinomas, lymphomas, and malignant soft tissue tumors. Although many of these tumors present with nonspecific symptoms, each tumor exhibits characteristic imaging features. Although complex anatomy and various normal variants of the sinonasal tract cause difficulty in identifying the origin and extension of large sinonasal tumors, the invasion of vital structures such as the brain, optic nerves, and internal carotid artery affects patients’ prognosis. Thus, diagnostic imaging plays a key role in predicting the histological subtype and in evaluating a tumor extension into adjacent structures. This article describes the computed tomography and magnetic resonance imaging findings for malignant sinonasal tumors.
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Affiliation(s)
- Masaya Kawaguchi
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
- Department of Tumor Pathology, Gifu University School of Medicine, Gifu 501-1194, Japan.
| | - Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Hiroyuki Tomita
- Department of Tumor Pathology, Gifu University School of Medicine, Gifu 501-1194, Japan.
| | - Keisuke Mizuta
- Department of Otolaryngology, Gifu University School of Medicine, Gifu 501-1194, Japan.
| | - Mitsuhiro Aoki
- Department of Otolaryngology, Gifu University School of Medicine, Gifu 501-1194, Japan.
| | - Akira Hara
- Department of Tumor Pathology, Gifu University School of Medicine, Gifu 501-1194, Japan.
| | - Masayuki Matsuo
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
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Kılıç S, Kılıç SS, Kim ES, Baredes S, Mahmoud O, Gray ST, Eloy JA. Significance of human papillomavirus positivity in sinonasal squamous cell carcinoma. Int Forum Allergy Rhinol 2017; 7:980-989. [PMID: 28859244 DOI: 10.1002/alr.21996] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 06/29/2017] [Accepted: 07/07/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The role of human papillomavirus (HPV) in sinonasal squamous cell carcinoma (SNSCC) is not well understood. METHODS The National Cancer Database was queried for cases of SNSCC with known HPV status. Demographics, socioeconomic variables, TNM stage, histology, grade, treatment modalities, and overall survival (OS) through 5 years were compared between HPV-positive and HPV-negative tumors. Cox proportional hazard regression analyses were performed. RESULTS Seven hundred seventy (770) cases were identified; 526 were HPV-negative (68.3%) and 244 (31.7%) were HPV-positive. Patients with HPV-positive tumors were younger (58.0 vs 63.7 years, p < 0.0001). Nasal cavity (49.4%) tumors were more likely to be HPV-positive (p < 0.05) than maxillary (18.8%), ethmoid (18.8%), and frontal (18.2%) sinus tumors. Large cell nonkeratinizing (42.4%), papillary (42.1%), and basaloid (56.5%) tumors were more likely than keratinizing (25.2%) tumors to be HPV-positive (p < 0.05). Well-differentiated (grade I) tumors (9.0%) were less likely than higher grade tumors to be HPV-positive (p < 0.05). Gender, race, facility type, insurance type, median income, education level, Charlson-Deyo comorbidity score, overall stage, T stage, N stage, M stage, tumor size, treatment modality, surgical approach, and surgical margins did not vary by HPV status (p ≥ 0.05). HPV-positive tumors had higher OS than HPV-negative tumors (p < 0.0001). At 5 years, OS was 68.1% and 51.5% for HPV-positive and HPV-negative tumors, respectively. On multivariate analyses, HPV positivity remained a favorable prognostic factor (hazard ratio, 0.49; 95% confidence interval, 0.34-0.70). CONCLUSION HPV positivity is more common in nasal cavity SCC and nonkeratinizing SNSCC. It is also a favorable prognostic factor in SNSCC. Future studies on SNSCC should take HPV positivity into consideration.
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Affiliation(s)
- Suat Kılıç
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Sarah S Kılıç
- Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ
| | - Emilie S Kim
- 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
| | - Omar Mahmoud
- Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - 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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Carey RM, Parasher AK, Workman AD, Yan CH, Glicksman JT, Chen J, Palmer JN, Adappa ND, Newman JG, Brant JA. Disparities in sinonasal squamous cell carcinoma short- and long-term outcomes: Analysis from the national cancer database. Laryngoscope 2017; 128:560-567. [DOI: 10.1002/lary.26804] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/05/2017] [Accepted: 06/26/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Ryan M. Carey
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
| | - Arjun K. Parasher
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
- Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
| | - Alan D. Workman
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
- Perelman School of Medicine; Philadelphia Pennsylvania U.S.A
| | - Carol H. Yan
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
| | - Jordan T. Glicksman
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
| | - Jinbo Chen
- University of Pennsylvania and the Department of Biostatistics and Epidemiology; Philadelphia Pennsylvania U.S.A
| | - James N. Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
| | - Nithin D. Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
| | - Jason G. Newman
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery; Philadelphia Pennsylvania U.S.A
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SMARCB1 (INI-1)-deficient Sinonasal Carcinoma: A Series of 39 Cases Expanding the Morphologic and Clinicopathologic Spectrum of a Recently Described Entity. Am J Surg Pathol 2017; 41:458-471. [PMID: 28291122 DOI: 10.1097/pas.0000000000000797] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To more fully characterize the clinical and pathologic spectrum of a recently described tumor entity of the sinonasal tract characterized by loss of nuclear expression of SMARCB1 (INI1), we analyzed 39 SMARCB1-deficient sinonasal carcinomas collected from multiple medical centers. The tumors affected 23 males and 16 females with an age range of 19 to 89 years (median, 52). All patients presented with locally advanced disease (T3, n=5; T4, n=27) involving the sinuses (mainly ethmoid) with variable involvement of the nasal cavity. Thirty patients received surgery and/or radiochemotherapy with curative intent. At last follow-up, 56% of patients died of disease 0 to 102 months after diagnosis (median, 15), 2 were alive with disease, and 1 died of an unrelated cause. Only 9 patients (30%) were alive without disease at last follow-up (range, 11 to 115 mo; median, 26). The original diagnosis of retrospectively identified cases was most often sinonasal undifferentiated carcinoma (n=14) and nonkeratinizing/basaloid squamous cell carcinoma (n=5). Histologically, most tumors displayed either a predominantly basaloid (61%) or plasmacytoid/rhabdoid morphology (36%). The plasmacytoid/rhabdoid form consisted of sheets of tumor cells with abundant, eccentrically placed eosinophilic cytoplasm, whereas similar cells were typically rare and singly distributed in the basaloid variant. Glandular differentiation was seen in a few tumors. None of the cases showed squamous differentiation or surface dysplasia. By immunohistochemistry, the tumors were positive for pancytokeratin (97%), CK5 (64%), p63 (55%), and CK7 (48%); and they were negative for NUT (0%). Epstein-Barr virus and high-risk human papillomavirus was not detected by in situ hybridization. Immunohistochemical loss of SMARCB1 (INI1) expression was confirmed for all 39 tumors. Investigation of other proteins in the SWI/SNF complex revealed co-loss of SMARCA2 in 4 cases, but none were SMARCA4 deficient or ARID1A deficient. Of 27 tumors with SMARCB1 fluorescence in situ hybridization analysis, 14 showed homozygous (biallelic) deletions and 7 showed heterozygous (monoallelic) deletions. SMARCB1-deficient sinonasal carcinoma represents an emerging poorly differentiated/undifferentiated sinonasal carcinoma that (1) cannot be better classified as another specific tumor type, (2) has consistent histopathologic findings (albeit with some variability) with varying proportions of plasmacytoid/rhabdoid cells, and (3) demonstrates an aggressive clinical course. This entity should be considered in any difficult-to-classify sinonasal carcinoma, as correct diagnosis will be mandatory for optimizing therapy and for further delineation of this likely underdiagnosed disease.
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López F, Grau JJ, Medina JA, Alobid I. Consenso español para el tratamiento de los tumores nasosinusales. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 68:226-234. [DOI: 10.1016/j.otorri.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 12/25/2022]
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He N, Chen X, Zhang L, Chen X, Huang Z, Zhong Q, Ma H, Feng L, Hou L, Fang J. Minimally invasive endoscopic resection for the treatment of sinonasal malignancy: the outcomes and risk factors for recurrence. Ther Clin Risk Manag 2017; 13:593-602. [PMID: 28496329 PMCID: PMC5422458 DOI: 10.2147/tcrm.s131185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose The role of minimally invasive endoscopic resection (MIER) in the treatment of sinonasal malignancy is controversial. Herein, we performed a retrospective review of a large case series of sinonasal malignancy patients treated with MIER aimed at evaluating the outcomes and identifying the risk factors for recurrence. Methods Patients with sinonasal malignancy who underwent MIER from March 2000 to May 2015 were enrolled, and their clinical data were collected. The clinical outcomes were evaluated by determining the 5-year overall survival (OS) and disease-free survival (DFS). The predictive factors for survival and potential independent risk factors for recurrence were explored. Results A total of 120 patients were enrolled, including 62 males and 58 females. The mean follow-up period was 51.4 (95% confidence interval: 44.0–59.1) months. The most frequent histological type was mucosal malignant melanoma. The positive margin rate was 19.2% (23/120). Seventy-one patients had the safety anatomic plane (SAP). Age ≥50 years, nodal metastasis, and not having the SAP were found to be predictive factors for survival, and absence of SAP was found to be an independent risk factor for recurrence. Conclusion Our study indicated that MIER is an effective and safe surgical procedure in appropriately selected patients. Tumor resection with a safety anatomic boundary is likely to lead to improved survival and decreased recurrence. However, a larger sample and long-term prospective observation are still required to establish the role of MIER in treatment of sinonasal malignancy.
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Affiliation(s)
- Ning He
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University.,Key Laboratory of Otorhinolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing.,Department of Otolaryngology & Head and Neck Oncology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi Zhuang Autonomous Region
| | - Xiaohong Chen
- Key Laboratory of Otorhinolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing
| | - Luo Zhang
- Key Laboratory of Otorhinolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing
| | - Xuejun Chen
- Key Laboratory of Otorhinolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing
| | - Zhigang Huang
- Key Laboratory of Otorhinolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing
| | - Qi Zhong
- Key Laboratory of Otorhinolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing
| | - Hongzhi Ma
- Key Laboratory of Otorhinolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing
| | - Ling Feng
- Key Laboratory of Otorhinolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing
| | - Lizhen Hou
- Key Laboratory of Otorhinolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing
| | - Jugao Fang
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University.,Key Laboratory of Otorhinolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing.,Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, People's Republic of China
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