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Agarwal S, van Zante A, Granados ML. Combined Neuroendocrine and Squamous Cell Carcinoma of the Sinonasal Tract: A Morphologic and Immunohistochemical Analysis and Review of Literature. Head Neck Pathol 2022; 16:1019-1033. [PMID: 35507300 PMCID: PMC9729485 DOI: 10.1007/s12105-022-01457-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/16/2022] [Indexed: 12/16/2022]
Abstract
Sinonasal malignancies constitute 3% of head and neck cancers, with squamous cell carcinoma (SCC) the most common histology. Neuroendocrine carcinomas (NEC) are rare, with a subset showing neuroendocrine carcinoma and a non-neuroendocrine component. The pathogenesis of these combined tumors is largely unknown, and TP53 driver mutations may play a role. A database search for combined NEC was performed across two institutions (UNM and UCSF) spanning 15 years. Excluding NUT midline carcinoma, 3 cases met inclusion criteria. All were morphologically NEC + SCC and underwent a comprehensive immunohistochemical evaluation. Tumors demonstrated two components histologically: moderately to poorly differentiated SCC and high-grade NEC. Divergent differentiation was confirmed with lineage-specific markers. Only one patient received neoadjuvant chemotherapy prior to surgery, with a remarkable response (a marked decrease in the size of the primary lesion and resolution of liver metastases). Immunohistochemical staining for p53 was increased in 2 of 3 cases (both components), suggesting a role in the carcinogenesis of these tumors. Aberrant expression of beta-catenin was not identified. One case tested positive for p16, which can be seen in high grade NECs due to inactivation of Rb gene. Additionally, both cases with a small cell NEC component expressed PD-L1, suggesting that immunotherapy may be an effective treatment. Findings in this study support the role of p53 mutation in a subset of combined NEC + SCC of the sinonasal tract. Recognition of this rare entity is essential for optimal management of these aggressive neoplasms.
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Affiliation(s)
- Shweta Agarwal
- Department of Pathology, University of New Mexico School of Medicine, University of New Mexico, MSC08 4640, Albuquerque, NM 87131 USA ,Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM USA
| | - Annemieke van Zante
- Department of Pathology, University of California San Francisco, San Francisco, CA USA
| | - Michaela L. Granados
- Department of Pathology, University of New Mexico School of Medicine, University of New Mexico, MSC08 4640, Albuquerque, NM 87131 USA
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Stephen N, Srinivas BH, Ravi S, Ganesh RN, Badhe BA, Toi P, Jinkala S, Sekar R, Alexander A, Narendhar, Pandjatcharam J. Neuroectodermal tumours of the sino-nasal tract: a clinicopathological study of 18 cases with a newly proposed revised classification and a brief review of literature. Eur Arch Otorhinolaryngol 2021; 279:1181-1191. [PMID: 34568968 DOI: 10.1007/s00405-021-07051-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
AIM Sino-nasal tract tumours constitute 3% of the head and neck malignancies. Among these tumours, neuroectodermal tumours are rare with histo-morphological and immunohistochemical overlap making them a challenge for the pathologist. We included Ewing's/PNET, olfactory neuroblastoma (OFN), mucosal malignant melanomas (MMM), Melanotic neuroectodermal tumour of infancy (MNTI), small-cell neuroendocrine carcinoma (SNEC), and the newest entity Adamantinoma like Ewing's sarcoma (ALES) as part of the neuroectodermally derived tumours of the sino-nasal tract. The last three entities were added to the existing ones, which also has been emphasized in this paper. METHODS AND RESULTS A comprehensive analysis was done on all neuroectodermally derived tumours from 2016 to 2020. A total of 18 cases were collected, which included OFN (10 cases), SNEC (2 cases), MMM (2 cases), Ewing's/PNET (2 cases), MNTI (1 case), and ALES (1 case). The most common presentation in NE tumours was nasal obstruction (80-100%). Except for OFN, all other tumours were confined to the nasal and paranasal sinuses. 4/10 cases of OFN showed orbital extension. Cervical lymph-node metastasis was seen in 50% of cases of SNEC and MMM groups. An array of relevant immune-histochemical markers were performed. The marker expression was very subtle among the groups. On follow-up, recurrence was seen in the OFN and MMM groups in 30 and 50%, respectively. Metastasis was seen in SNEC group (100%) and OFN group (10%). CONCLUSION As sino-nasal neuroectodermal tumours pose a diagnostic challenge and have different therapies and are prognostically different, the pathologist must be aware of the subtle morphological, immunohistochemical clues which have been dealt with in-depth in this study.
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Affiliation(s)
- Norton Stephen
- Pathology, Sri Venkateswara Medical College Hospital and Research Centre, Pondicherry, India
| | | | | | | | | | - Pampa Toi
- Pathology, JIPMER, Pondicherry, India
| | | | | | | | - Narendhar
- Radiotherapy, JIPMER, Pondicherry, India
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Inomata K, Yokoi H, Fujiwara M, Kimura Y, Matsumoto Y, Naito S, Ohara A, Okano N, Kamma H, Saito K. Case of thyroid transcription factor-1-positive neuroendocrine carcinoma of the sphenoid sinus with bone metastases. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Klymenko O, Buchberger AMS, Wollenberg B, Wolff KD, Kehl V, Combs SE, Pickhard A, Pigorsch SU. Radiooncological View on Therapy Outcome after Multidisciplinary Treatment of Sinonasal Tumors. Cancers (Basel) 2021; 13:cancers13102364. [PMID: 34068905 PMCID: PMC8157068 DOI: 10.3390/cancers13102364] [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: 02/22/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Tumors of the nasal cavity and paranasal sinus are rare. Most are discovered at a locally advanced stage and require multimodal treatment consisting of surgery and radiotherapy with concomitant chemotherapy. Tumor localization between the eyes and near the brain makes treatment planning difficult due to the necessary consideration of both critical normal tissue with high protection priority and the curative aim of the best radiotherapy dose deposit. Thus, it is noteworthy how tumor volumes impact the five-year survival outcome. Therefore, we investigated initial tumor volumes before any therapy. Patients with larger mean initial tumor volumes of more than 75 cm3 had worse outcomes. There was no additional benefit of upfront surgery. Especially for patients with large tumor burdens of the nasal cavity or paranasal sinus, an interdisciplinary case discussion with the patient is essential in the process of shared decision-making. Abstract Purpose: We report the outcome of a mono-institutional retrospective study of sinonasal carcinoma with the primary focus on GTV (gross tumor volume) and the effect of radiotherapy. Methods: 53 patients with sinonasal carcinoma and that of the nasal cavity, paranasal sinus or both except lymphoma were included. All patients were treated between 1999 and 2017. For tumor volume delineation, all pre-therapeutic images were fused to the planning CT (computed tomography). Results: The median follow-up was 17 months [0.3–60], the median age 60 years, 35 males and 18 females were included. Squamous cell carcinoma (SCC) (60.4%) was the predominant histology, followed by adenocarcinoma (15.1%). The mean composite OS (overall survival) time was 33.3 ± 3.5 months. There was no significant difference in the 5 y composite OS between tumor localization or radiotherapy setting. The simultaneous integrated boost concept showed a trend towards improving five-year composite OS compared to the sequential boost concept. The only factor with a significant impact on the 5 y composite OS rate was the pre-therapeutic GTV (cutoff 75 cm3; p = 0.033). The GTV ≥ 100 cm3 has no effect on the 5 y composite OS rate for SCC. Conclusions: The pre-therapeutic GTV is a prognostic factor for five-year composite OS for the entire group of patients with sinonasal tumors, influencing the outcome after completion of all treatment strategies. The GTV seems to not influence five-year composite OS in SCC. For this rare tumor entity, an intensive, multidisciplinary discussion is essential to finding the best treatment option for the patient.
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Affiliation(s)
- Olena Klymenko
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, D-81675 Munich, Germany; (O.K.); (S.E.C.)
| | - Anna Maria Stefanie Buchberger
- Ear, Nose and Throat Department, Head and Neck Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, D-81675 Munich, Germany; (A.M.S.B.); (B.W.)
| | - Barbara Wollenberg
- Ear, Nose and Throat Department, Head and Neck Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, D-81675 Munich, Germany; (A.M.S.B.); (B.W.)
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, D-81675 Munich, Germany;
| | - Victoria Kehl
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich (TUM), Ismaninger Str. 22, D-81675 Munich, Germany; (V.K.); (A.P.)
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, D-81675 Munich, Germany; (O.K.); (S.E.C.)
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, D-85764 Neuherberg, Germany
| | - Anja Pickhard
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich (TUM), Ismaninger Str. 22, D-81675 Munich, Germany; (V.K.); (A.P.)
| | - Steffi U. Pigorsch
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, D-81675 Munich, Germany; (O.K.); (S.E.C.)
- Correspondence: ; Tel.: +49-089-4140-4501
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Yan O, Xie W, Teng H, Fu S, Chen Y, Liu F. Nomograms Forecasting Long-Term Overall and Cancer Specific Survival of Patients With Head and Neck Neuroendocrine Carcinoma. Front Oncol 2021; 11:619599. [PMID: 33659217 PMCID: PMC7917297 DOI: 10.3389/fonc.2021.619599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/08/2021] [Indexed: 02/05/2023] Open
Abstract
Background The purpose of this retrospective analysis was to build and validate nomograms to predict the cancer-specific survival (CSS) and overall survival (OS) of head and neck neuroendocrine carcinoma (HNNEC) patients. Methods A total of 493 HNNEC patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015, and 74 HNNEC patients were collected from the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital (HCH) between 2008 and 2020. Patients from SEER were randomly assigned into training (N=345) and internal validation (N=148) groups, and the independent data group (N=74) from HCH was used for external validation. Independent prognostic factors were collected using an input method in a Cox regression model, and they were then included in nomograms to predict 3-, 5-, and 10-year CSS and OS rates of HNNEC patients. Finally, we evaluated the internal and external validity of the nomograms using the consistency index, while assessing their prediction accuracy using calibration curves. A receiver operating curve (ROC) was also used to measure the performance of the survival models. Results The 3-, 5-, and 10-year nomograms of this analysis demonstrated that M classification had the largest influence on CSS and OS of HNNEC, followed by the AJCC stage, N stage, age at diagnosis, sex/gender, radiation therapy, and marital status. The training validation C-indexes for the CSS and OS models were 0.739 and 0.713, respectively. Those for the internal validation group were 0.726 and 0.703, respectively, and for the external validation group were 0.765 and 0.709, respectively. The area under the ROC curve (AUC) of 3-, 5-, and 10-year CSS and OS models were 0.81, 0.82, 0.82, and 0.78, 0.81, and 0.82, respectively. The C-indexes were all higher than 0.7, indicating the high accuracy ability of our model's survival prediction. Conclusions In this study, prognosis nomograms in HNNEC patients were constructed to predict CSS and OS for the first time. Clinicians can identify patients' survival risk better and help patients understand their survival prognosis for the next 3, 5, and 10 years more clearly by using these nomograms.
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Affiliation(s)
- Ouying Yan
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Wenji Xie
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Haibo Teng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Shengnan Fu
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Yanzhu Chen
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Feng Liu
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China.,Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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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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Takahashi Y, Gleber-Netto FO, Bell D, Roberts D, Xie TX, Abdelmeguid AS, Pickering C, Myers JN, Hanna EY. Identification of markers predictive for response to induction chemotherapy in patients with sinonasal undifferentiated carcinoma. Oral Oncol 2019; 97:56-61. [PMID: 31421472 DOI: 10.1016/j.oraloncology.2019.07.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/09/2019] [Accepted: 07/29/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Sinonasal undifferentiated carcinoma (SNUC) is a rare, highly aggressive cancer. Despite aggressive multimodal therapy, its prognosis remains poor. Because of its locally advanced nature and high propensity for distant metastasis, we frequently use induction chemotherapy before definitive therapy in patients with SNUC. However, about 30% of patients do not respond to induction chemotherapy, and lack of response is associated with a poor survival rate. Therefore, in this study, we performed gene expression analysis of SNUC samples to identify prognostic markers for induction chemotherapy response. MATERIALS AND METHODS Formalin-fixed, paraffin-embedded SNUC tumor samples from previously untreated patients harvested before induction chemotherapy were used. Gene expression was performed using an oncology gene expression panel. RESULTS We identified 34 differentially expressed genes that distinguish the responders from the non-responders. Pathway analysis using these genes revealed alteration of multiple pathways between the two groups. Of these 34 genes, 24 distinguished between these two groups. Additionally, 16 gene pairs were associated with response to induction therapy. CONCLUSION We identified genes predictive of SNUC response to induction chemotherapy and pathways potentially associated with treatment outcome. This is the first report of identification of predictive biomarkers for response of SNUC to induction chemotherapy, and it may help us develop therapeutic strategies to improve the treatment outcomes of non-responders.
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Affiliation(s)
- Yoko Takahashi
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Frederico O Gleber-Netto
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Diana Bell
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dianna Roberts
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Tong-Xin Xie
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ahmed S Abdelmeguid
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Curtis Pickering
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Takahashi Y, Gleber‐Netto FO, Bell D, Roberts D, Xie T, Abdelmeguid AS, Pickering C, Myers JN, Hanna EY. Identification of novel diagnostic markers for sinonasal undifferentiated carcinoma. Head Neck 2019; 41:2688-2695. [DOI: 10.1002/hed.25748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/24/2019] [Accepted: 03/11/2019] [Indexed: 01/09/2023] Open
Affiliation(s)
- Yoko Takahashi
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer Center Houston Texas
| | | | - Diana Bell
- Department of PathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Dianna Roberts
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Tong‐Xin Xie
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Ahmed S. Abdelmeguid
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer Center Houston Texas
- Department of Otolaryngology Head and Neck SurgeryFaculty of Medicine, Mansoura University Mansoura Egypt
| | - Curtis Pickering
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Jeffrey N. Myers
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Ehab Y. Hanna
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer Center Houston Texas
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Maharaj S, Mahomed F. Sinonasal non-small cell neuroendocrine carcinoma the validity of histological grading: Case report and a review of the literature. OTOLARYNGOLOGY CASE REPORTS 2019. [DOI: 10.1016/j.xocr.2018.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Franchi A, Bishop JA, Coleman H, Flucke U, Licitra LF, Pendás JLL, Stelow EB, Toner M, Weinreb I, Wenig BM, Thompson LDR. Data Set for the Reporting of Carcinomas of the Nasal Cavity and Paranasal Sinuses: Explanations and Recommendations of the Guidelines From the International Collaboration on Cancer Reporting. Arch Pathol Lab Med 2018; 143:424-431. [PMID: 30500298 DOI: 10.5858/arpa.2018-0404-sa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The International Collaboration on Cancer Reporting was established to internationally unify and standardize the pathologic reporting of cancers based on collected evidence, as well as to allow systematic multi-institutional intercountry data collection to guide cancer care in the future. This data set has been developed by the collaborative efforts of an international multidisciplinary panel of experts involved in the care of patients with carcinomas of the nasal cavity and paranasal sinuses (sinonasal tract). The nasal cavity and paranasal sinuses (including frontal, sphenoid, ethmoid, and maxillary sinuses) comprise a very complex anatomic area of the head and neck, affected by a sometimes bewildering array of neoplasms. Management of malignancies in this anatomic region involves complex surgery because of the anatomic confines and close proximity to many vital structures. Given a multidisciplinary approach, the standardized reporting of the carcinomas that develop in this anatomic region include both required (core) and recommended (noncore) elements in pathology reporting in order to be able to identify critical prognostic factors, often requiring clinical and radiologic correlation. A summary of the International Collaboration on Cancer Reporting guidelines and clinically relevant elements, along with additional explanatory notes, are provided, based on evidentiary support from the literature, set in the context of practical application.
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Affiliation(s)
- Alessandro Franchi
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Justin A Bishop
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Hedley Coleman
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Uta Flucke
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Lisa F Licitra
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - José Luis Llorente Pendás
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Edward B Stelow
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Mary Toner
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Ilan Weinreb
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Bruce M Wenig
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
| | - Lester D R Thompson
- From the Department of Translational Research, University of Pisa, Pisa, Italy (Dr Franchi); the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Dr Bishop); the Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia (Dr Coleman); the Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Flucke); the Head and Neck Medical Oncology Department, Fondazione International Collaboration on Cancer Reporting Istituto Nazionale dei Tumori, and University of Milan, Milan, Italy (Dr Licitra); the Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias, Centro de Investigación Biomédica en Red de Cancer, Hospital Universitario Central de Asturias, Oviedo, Spain (Dr Llorente Pendás); the Department of Pathology, University of Virginia, Charlottesville (Dr Stelow); St James and Dublin Dental Hospitals and Trinity College, Sir Patrick Dunne Research Laboratory, and St James Hospital, Dublin, Ireland (Dr Toner); the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Weinreb); the Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida (Dr Wenig); and the Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills (Dr Thompson)
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11
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Workman AD, Brody RM, Kuan EC, Baranov E, Brooks SG, Alonso-Basanta M, Newman JG, Rassekh CH, Chalian AA, Chiu AG, Weinstein GS, Feldman MD, Adappa ND, O'Malley BW, Palmer JN. Sinonasal Undifferentiated Carcinoma: A 15-Year Single Institution Experience. J Neurol Surg B Skull Base 2018; 80:88-95. [PMID: 30733906 DOI: 10.1055/s-0038-1668537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/12/2018] [Indexed: 01/03/2023] Open
Abstract
Objective Sinonasal undifferentiated carcinoma (SNUC) is an aggressive neoplasm, with conflicting existing literature regarding prognosis and treatment due to the rarity of disease. Characterization of optimal SNUC management is necessary for improved outcomes. Study Design Case series with planned data collection and analysis. Setting Hospital of the University of Pennsylvania and Pennsylvania Hospital. Participants Patients with pathologically confirmed SNUC treated within a 15-year period were identified, and records were obtained and evaluated for several demographic characteristics. Main Outcomes Measures Disease-specific survival from diagnosis was the primary endpoint, while disease recurrence was a secondary endpoint of the study. Results Twenty-seven patients with established SNUC were included in this cohort, with a median age of 55 years. Eighty-five percent of patients were surgically treated, and 85% of patients presented with stage IV disease. Two-year disease-specific survival was 66% and 5-year disease-specific survival was 46%. Ninety-six percent of patients received both chemotherapy and radiation as adjuvant treatment. Nodal disease at presentation and disease recurrence both significantly decreased patient survival ( p < 0.05). Conclusions The majority of patients at this institution presented with clinically advanced disease, and most were managed with a multimodal approach of surgical resection, chemotherapy, and radiation. Extent of disease at presentation and progression of disease following treatment are poor prognostic signs and may merit a more aggressive approach, while early detection and treatment may improve survival and decrease patient morbidity.
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Affiliation(s)
- Alan D Workman
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Robert M Brody
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Edward C Kuan
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Esther Baranov
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Steven G Brooks
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia,, Pennsylvania, United States
| | - Jason G Newman
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Christopher H Rassekh
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ara A Chalian
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Alexander G Chiu
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Otolaryngology - Head and Neck Surgery, University of Kansas, Kansas City, Kansas, United States
| | - Gregory S Weinstein
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Michael D Feldman
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Nithin D Adappa
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Bert W O'Malley
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - James N Palmer
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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12
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Maglietti F, Tellado M, Olaiz N, Michinski S, Marshall G. Minimally Invasive Electrochemotherapy Procedure for Treating Nasal Duct Tumors in Dogs using a Single Needle Electrode. Radiol Oncol 2017; 51:422-430. [PMID: 29333121 PMCID: PMC5765319 DOI: 10.1515/raon-2017-0043] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/02/2017] [Indexed: 12/21/2022] Open
Abstract
Background Nasal cavity tumors are usually diagnosed late, when they already have infiltrated adjacent tissues thus requiring very aggressive treatments with serious side effects. Here we use electrochemotherapy (ECT), a well demonstrated treatment modality for superficial tumors. Materials and methods In the case of deep-seated tumors, the main limitation of ECT is reaching the tumor with an appropriate electric field. To overcome this limitation we introduce the single needle electrode (SiNE), a minimally invasive device that can deliver an appropriate electric field with a simple procedure. Twenty-one canine patients with spontaneous tumors were selected, eleven were treated using the SiNE with ECT, and ten with surgery plus adjuvant chemotherapy as a control group. Results In the SiNE group, 27% achieved a complete response, 64% had a partial response, and 9% had a stable disease. This means that 91% of objective responses were obtained. The mean overall survival was 16.86 months (4–32 months, median 16.5 months), with a survival rate significantly higher (p = 0.0008) when compared with control group. The only side effect observed was the inflammation of the treated nasal passage, which was controlled with corticosteroid therapy for one week. One year after the treatment, 60% of the canine of the SiNE group vs. 10% of the control group remained alive, and after the 32 months follow-up, the survival rate were 30% and 0%, respectively. Conclusions ECT with the SiNE can be safely used in canine to treat nasal tumors with encouraging results.
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Affiliation(s)
- Felipe Maglietti
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física, Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Instituto de Física del Plasma (INFIP), Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Computación, Laboratorio de Sistemas Complejos, Buenos Aires, Argentina
| | - Matías Tellado
- Universidad de Buenos Aires, Facultad de Ciencias Veterinarias, Buenos Aires, Argentina
| | - Nahuel Olaiz
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física, Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Instituto de Física del Plasma (INFIP), Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Computación, Laboratorio de Sistemas Complejos, Buenos Aires, Argentina
| | - Sebastian Michinski
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física, Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Instituto de Física del Plasma (INFIP), Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Computación, Laboratorio de Sistemas Complejos, Buenos Aires, Argentina
| | - Guillermo Marshall
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física, Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Instituto de Física del Plasma (INFIP), Buenos Aires, Argentina.,CONICET-Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Computación, Laboratorio de Sistemas Complejos, Buenos Aires, Argentina
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13
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Morand GB, Anderegg N, Vital D, Ikenberg K, Huber GF, Soyka MB, Egger M, Holzmann D. Outcome by treatment modality in sinonasal undifferentiated carcinoma (SNUC): A case-series, systematic review and meta-analysis. Oral Oncol 2017; 75:28-34. [PMID: 29224819 DOI: 10.1016/j.oraloncology.2017.10.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/26/2017] [Accepted: 10/10/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Sinonasal undifferentiated carcinoma (SNUC) is an aggressive malignancy first described by Frierson et al. in 1986. As the tumor is very rare, current treatment recommendations are based on institutional case reports. We thus felt the need to perform a comprehensive systematic review and meta-analysis to investigate how treatment modalities are associated with survival. DESIGN Case-series, systematic review and meta-analysis METHODS: We searched the OvidMedline, OvidEmbase, Web of Science, Biosis, Scopus and the Cochrane Library database libraries. We extracted aggregate and individual patient data for statistical analysis. To study the association between treatment modalities and survival, we used random-effects meta-regression for the aggregate- and cox mixed-effects models. RESULTS 379 citations were found; 29 case series could be included in the final analysis, including a total number of 390 single patients (34.6% female). Median age at diagnosis was 52 years. 80.9% of patients presented with a T4 tumor and 16.0% with nodal metastasis at diagnosis. In individual patient data (IPD) meta-analysis, single modality (surgery alone or radiation alone) treatment was associated with reduced survival compared to double modality (surgery & radiation or chemoradiation) treatment (adjusted Hazard Ratio [aHR] 2.97, 95% ConfidenceInterval [1.41-6.27]) and compared to triple modality (surgery & radiation & chemotherapy) treatment (aHR 2.80 95%-CI 1.29-6.05 for triple vs. single modality). Triple modality treatment was not superior to double modality treatment. (aHR 1.06, 95%-CI 0.59-1.92). CONCLUSION Double and triple modality treatment are associated with improved survival over single modality but there is no evidence that triple modality is superior to double modality treatment.
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Affiliation(s)
- Grégoire B Morand
- Department for Otorhinolaryngology - Head and Neck Surgery, University Hospital and University of Zurich, Switzerland
| | - Nanina Anderegg
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Domenic Vital
- Department for Otorhinolaryngology - Head and Neck Surgery, University Hospital and University of Zurich, Switzerland
| | - Kristian Ikenberg
- Department of Surgical Pathology, University Hospital Zurich, Switzerland
| | - Gerhard F Huber
- Department for Otorhinolaryngology - Head and Neck Surgery, University Hospital and University of Zurich, Switzerland
| | - Michael B Soyka
- Department for Otorhinolaryngology - Head and Neck Surgery, University Hospital and University of Zurich, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - David Holzmann
- Department for Otorhinolaryngology - Head and Neck Surgery, University Hospital and University of Zurich, Switzerland.
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14
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Population-Based Results in the Management of Sinonasal and Ventral Skull Base Malignancies. Otolaryngol Clin North Am 2017; 50:481-497. [DOI: 10.1016/j.otc.2016.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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15
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Thompson LD. Small round blue cell tumors of the sinonasal tract: a differential diagnosis approach. Mod Pathol 2017; 30:S1-S26. [PMID: 28060373 DOI: 10.1038/modpathol.2016.119] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/08/2016] [Accepted: 05/15/2016] [Indexed: 01/02/2023]
Abstract
One of the most challenging diagnostic categories within tumors of the sinonasal tract is the small round blue cell tumors. Biopsies are usually small and limited, resulting in considerable diagnostic difficulty for practicing surgical pathologists. These tumors share several overlapping histologic and immunophenotypic findings while also showing considerable variation within and between cases. Specific tumor site of origin, imaging findings, and clinical findings must be combined with the histology and pertinent ancillary studies if the correct diagnosis is to be reached. Discrimination between neoplasms is critical as there are significant differences in therapy and overall outcome. It is important to have a well developed differential diagnosis for this category of tumors, where each of the diagnoses is considered, evaluated, and either confirmed or excluded from further consideration. In an undifferentiated tumor, showing a small round blue cell morphology, using the mnemonic 'MR SLEEP' helps to highlight tumors to consider: melanoma, mesenchymal chondrosarcoma, rhabdomyosarcoma, sinonasal undifferentiated carcinoma, squamous cell carcinoma (including NUT carcinoma), small cell osteosarcoma, lymphoma, esthesioneuroblastoma (olfactory neuroblastoma), Ewing sarcoma/primitive neuroectodermal tumor, pituitary adenoma, and plasmacytoma. A panel of pertinent immunohistochemistry studies, histochemistries and/or molecular tests should aid in reaching a diagnosis, especially when taking the pattern and intensity of reactions into consideration.
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Affiliation(s)
- Lester Dr Thompson
- Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, Woodland Hills, CA, USA
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16
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Soldatova L, Campbell RG, Carrau RL, Prevedello DM, Wakely P, Otto BA, Filho LFD. Sinonasal Carcinomas with Neuroendocrine Features: Histopathological Differentiation and Treatment Outcomes. J Neurol Surg B Skull Base 2016; 77:456-465. [PMID: 27857871 PMCID: PMC5112165 DOI: 10.1055/s-0036-1582432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/26/2016] [Indexed: 10/21/2022] Open
Abstract
Objectives Sinonasal cancers with neuroendocrine features share similar clinical, radiological, and histopathological features; however, these tumors often exhibit varying degrees of aggressive behavior presenting significant treatment challenges. The objective of this study was to report our experience with these rare malignancies and to present a review of current literature. Methods Following institutional review board approval, the records of all patients with biopsy-proven sinonasal malignancies over a 5-year period were reviewed. Results The study included 14 patients with olfactory neuroblastomas (ONBs), 7 patients with sinonasal undifferentiated carcinomas (SNUC), and 2 patients with sinonasal neuroendocrine carcinomas (SNEC). Histopathologic markers aided in final diagnosis, but showed variable specificity. In patients with sufficient follow-up, the 2-year disease-free survival rate was 81% (9/11) for ONB and 75% (3/4) for SNUC. Three patients developed a regional or distant recurrence (two with ONBs and one with SNUC). Two patients, one with SNEC and one with ONB, succumbed to brain radionecrosis related to proton radiation therapy. Conclusions Overlapping clinical and histopathological features in poorly differentiated sinonasal cancers with neuroendocrine features continue to present a diagnostic challenge. Individualized assessment and treatment strategies can improve the accuracy of the initial assessment and the treatment outcomes.
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Affiliation(s)
- Liuba Soldatova
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Raewyn G. Campbell
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Ricardo L. Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Daniel M. Prevedello
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Paul Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Bradley A. Otto
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Leo F. Ditzel Filho
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
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17
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van der Laan TP, Iepsma R, Witjes MJH, van der Laan BFAM, Plaat BEC, Halmos GB. Meta-analysis of 701 published cases of sinonasal neuroendocrine carcinoma: The importance of differentiation grade in determining treatment strategy. Oral Oncol 2016; 63:1-9. [PMID: 27938993 DOI: 10.1016/j.oraloncology.2016.10.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 09/19/2016] [Accepted: 10/02/2016] [Indexed: 12/27/2022]
Abstract
The aim of this meta-analysis was to provide treatment guidelines for sinonasal neuroendocrine carcinoma (SNC) by combining all available data in the literature. A literature search for all studies concerning SNC was performed against the MEDLINE and EMBASE databases. Available clinical data was normalized, pooled, and statistically analyzed. A total of 701 cases of SNC were available for analysis, comprising 127 well or moderately differentiated sinonasal neuroendocrine carcinomas (SNEC), 459 sinonasal undifferentiated carcinoma (SNUC) and 115 sinonasal small cell carcinoma (SmCC). Tumor type was the most important predictor of survival, with a 5-year disease-specific survival (DSS) of 70.2% for SNEC, 35.9% for SNUC and 46.1% for SmCC. Tumor stage on presentation was of limited value in predicting survival or response to treatment. Overall, the application of surgery yielded significantly better results (5-year DSS 52.2% versus 30.1%, p<0.001). In SNUC, radiotherapy was a beneficial supplement to surgery (5-year DSS 54.7% versus 15.7%, p=0.027), while radiotherapy as monotherapy performed poorly (5-year DSS 17.9%). Chemotherapy did not appear to contribute to survival. Based on these findings, we can conclude that the most important predictors of survival in SNC are differentiation grade and the associated choice of treatment modality. In contrast to other head and neck cancers, tumor staging appears of limited value in predicting survival or deciding on a treatment strategy. Surgery should be the cornerstone of treatment, supplemented by radiotherapy in poorly differentiated subtypes (SNUC, SmCC). Chemotherapy does not appear to contribute to survival.
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Affiliation(s)
- Tom P van der Laan
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology/Head and Neck Surgery, The Netherlands; University of Groningen, Graduate School of Medical Sciences (Damage and Repair in Cancer Development and Cancer Treatment), The Netherlands
| | - René Iepsma
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology/Head and Neck Surgery, The Netherlands
| | - Max J H Witjes
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, The Netherlands
| | - Bernard F A M van der Laan
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology/Head and Neck Surgery, The Netherlands; University of Groningen, Graduate School of Medical Sciences (Damage and Repair in Cancer Development and Cancer Treatment), The Netherlands
| | - Boudewijn E C Plaat
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology/Head and Neck Surgery, The Netherlands
| | - Gyorgy B Halmos
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology/Head and Neck Surgery, The Netherlands.
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Elkhatib AH, Soldatova L, Carrau RL, Hachem RA, Ditzel L, Campbell R, Prevedello DM, Prevedello L, Filho LFSD, Campbell RG. Role of 18 F-FDG PET/CT differentiating olfactory neuroblastoma from sinonasal undifferentiated carcinoma. Laryngoscope 2016; 127:321-324. [PMID: 27481043 DOI: 10.1002/lary.26194] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/10/2016] [Accepted: 06/22/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The purpose of this study is to demonstrate the potential contribution of positron emission tomography (PET)/computed tomography (CT) to help differentiate olfactory neuroblastoma (ONB) from sinonasal undifferentiated carcinoma (SNUC). METHODS Following approval by the institutional review board at the Wexner Medical Center at the Ohio State University, Columbus, Ohio, a pilot study with retrospective review of patients with biopsy-proven diagnosis of ONB s and SNUC s was conducted. Staging PET/CT scans were reviewed to document the maximum standardized uptake value (SUVmax). A statistical comparison of SUVmax was performed. RESULTS We identified 13 patients (7 with ONBs and 6 with SNUCs) with mean age 60.2 years who had undergone staging F-18 fluorodeoxyglucose (18 F-FDG) PET/CT of the primary tumor at the time of their diagnosis. Mean SUVmax was found to be five-fold higher in SNUC patients (35.63, range 10.8-77.9) than in ONB patients (7.24, range 4.6-10.7) (P ≤ 0.00169). CONCLUSION Maximum standardized uptake value of 18 F-FDG PET/CT can be used to initially discriminate between ONB and SNUC. This finding may prove helpful to guide diagnostic and treatment planning when the histopathologic diagnosis is inconclusive. LEVEL OF EVIDENCE 4. Laryngoscope, 2016 127:321-324, 2017.
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Affiliation(s)
- Ahmad H Elkhatib
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Ohio, U.S.A
| | - Liuba Soldatova
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Ohio, U.S.A.,Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Ohio, U.S.A
| | - Ralph Abi Hachem
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Ohio, U.S.A
| | - Leo Ditzel
- Department of Neurosurgery, Hospital Santa Cruz, Curitiba, Brazil
| | - Raewyn Campbell
- Department of Otolaryngology-Head & Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Daniel M Prevedello
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Ohio, U.S.A.,Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Ohio, U.S.A
| | - Luciano Prevedello
- Department of Radiology, The Ohio State University Wexner Medical Center, Ohio, U.S.A
| | | | - Raewyn G Campbell
- Department of Otolaryngology-Head & Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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An Eustachian Tube Neuroendocrine Carcinoma: A Previously Undescribed Entity and Review of the Literature. Case Rep Surg 2016; 2016:4643615. [PMID: 27429827 PMCID: PMC4939327 DOI: 10.1155/2016/4643615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 05/20/2016] [Accepted: 06/05/2016] [Indexed: 11/17/2022] Open
Abstract
Primary sinonasal and middle ear neuroendocrine carcinomas are rare malignancies of the head and neck. Owing to the rarity of these tumors, the clinical behavior and optimal management of these tumors are not well defined. We present a case of an incidentally discovered sinonasal neuroendocrine carcinoma that was found to originate from the Eustachian tube, which has not previously been described in the literature. This patient was treated with primary surgical resection using a combination of transnasal and transaural approaches and achieved an incomplete resection. Follow-up imaging demonstrated continued tumor growth in the Eustachian tube as well as a new growth in the ipsilateral cerebellopontine angle and findings suspicious of perineural invasion. However, the tumor exhibited a benign growth pattern and despite continued growth the patient did not receive additional treatment and he remains asymptomatic 35 months following his original surgery.
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RISSON-PINO G, TUR-GONZÁLEZ R, SANTOS-GORJÓN P, SÁNCHEZ-TERRADILLOS E, MINGO-SÁNCHEZ E. Tumor carcinoide atípico nasal. Descripción de un caso. REVISTA ORL 2016. [DOI: 10.14201/orl201672.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Takahashi Y, Lee J, Pickering C, Bell D, Jiffar TW, Myers JN, Hanna EY, Kupferman ME. Human epidermal growth factor receptor 2/neu as a novel therapeutic target in sinonasal undifferentiated carcinoma. Head Neck 2016; 38 Suppl 1:E1926-34. [PMID: 26752332 DOI: 10.1002/hed.24350] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/27/2015] [Accepted: 10/17/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sinonasal undifferentiated carcinoma (SNUC) is a rare and aggressive cancer. Despite multimodal therapy, the prognosis in SNUC remains poor, and new therapies are needed. Thus, the purpose of this study was to explore potential therapeutic targets in SNUC. METHODS Using the human-derived SNUC MDA8788-6 cell line, we performed whole genome single nucleotide polymorphism (SNP) analysis to identify copy number changes in this line. Protein expression levels were evaluated by Western blotting. Cell growth inhibition was assessed by methylthiazol tetrazolium (MTT) and clonogenic assays. The mouse flank model was used to examine the effect of growth inhibition in vivo. RESULTS The ERBB2 gene was highly amplified and cell extracts showed human epidermal growth factor receptor 2 (HER2) was overexpressed and phosphorylated in MDA8788-6. Lapatinib effectively inhibited the HER2 signaling pathway in our SNUC cell line. HER2 inhibition successfully suppressed the cell growth of MDA8788-6 cells both in vitro and in vivo. CONCLUSION Targeting HER2 may be a promising avenue for the development of novel therapies for SNUC. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1926-E1934, 2016.
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Affiliation(s)
- Yoko Takahashi
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Junegoo Lee
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Curtis Pickering
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diana Bell
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tilahun W Jiffar
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Patel TD, Vazquez A, Dubal PM, Baredes S, Liu JK, Eloy JA. Sinonasal neuroendocrine carcinoma: a population-based analysis of incidence and survival. Int Forum Allergy Rhinol 2015; 5:448-53. [DOI: 10.1002/alr.21497] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/05/2014] [Accepted: 12/30/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Tapan D. Patel
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Alejandro Vazquez
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Pariket M. Dubal
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey; Rutgers New Jersey Medical School; Newark NJ
| | - James K. Liu
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey; Rutgers New Jersey Medical School; Newark NJ
- Department of Neurological Surgery; Rutgers New Jersey Medical School; Newark NJ
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark NJ
- Center for Skull Base and Pituitary Surgery; Neurological Institute of New Jersey; Rutgers New Jersey Medical School; Newark NJ
- Department of Neurological Surgery; Rutgers New Jersey Medical School; Newark NJ
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Chambers KJ, Lehmann AE, Remenschneider A, Dedmon M, Meier J, Gray ST, Lin DT. Incidence and survival patterns of sinonasal undifferentiated carcinoma in the United States. J Neurol Surg B Skull Base 2014; 76:94-100. [PMID: 25844294 DOI: 10.1055/s-0034-1390016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/14/2014] [Indexed: 10/24/2022] Open
Abstract
Objective To determine trends in sinonasal undifferentiated carcinoma (SNUC) survival patterns in the United States. Design Retrospective review of national database. Participants All cases of SNUC in the National Cancer Institute's Surveillance Epidemiology and End Results program from 1973 to 2010 were examined. Main Outcome Measures Age-adjusted incidence and survival rates were calculated and stratified by demographic information and treatment modality. Cohort analysis was performed to analyze survival patterns over time. Results A total of 318 SNUC cases were identified. Age-adjusted incidence rate (IR) was 0.02 per 100,000. Incidence was greater in males (IR: 0.03) than females (IR: 0.01; p = 0.03). Overall 5- and 10-year relative survival rate was 34.9% and 31.3%, respectively. Overall median survival was 22.1 months. Median survival following surgery combined with radiation was 41.9 months. Five-year relative survival rate following surgery, radiation, or surgery combined with radiation was 38.7%, 36.0%, and 39.1%, respectively. Median survival from 1973-1986 and 1987-2010 was 14.5 and 23.5 months, respectively. Conclusions This study provides new data regarding survival patterns of SNUC in the United States, confirming survival benefit with surgery and radiation as well as identifying a trend toward improved survival in recent decades.
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Affiliation(s)
- Kyle J Chambers
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Ashton E Lehmann
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Aaron Remenschneider
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Matthew Dedmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Josh Meier
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Massachusetts, United States ; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
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Gray ST, Herr MW, Sethi RKV, Diercks G, Lee L, Curry W, Chan A, Clark J, Holbrook EH, Rocco J, Sadow PM, Lin DT. Treatment outcomes and prognostic factors, including human papillomavirus, for sinonasal undifferentiated carcinoma: a retrospective review. Head Neck 2014; 37:366-74. [PMID: 24421248 DOI: 10.1002/hed.23606] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 10/16/2013] [Accepted: 01/08/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sinonasal undifferentiated carcinoma (SNUC) is a high-grade, aggressive neoplasm. Low incidence and poor outcomes make identification of prognostic factors and treatment standardization difficult. Similarly, little is known regarding the association of human papillomavirus (HPV) with SNUC. METHODS A retrospective review was conducted. Extracted information included treatment received, tumor recurrence, patient survival, p16 expression, and HPV status. The Kaplan-Meier method was used to estimate overall survival (OS) and disease-free survival (DFS). Survival trends were compared using the log-rank test. RESULTS Nineteen patients received multimodality treatment for SNUC. Five-year OS and DFS rates were 45.2% and 50.7%, respectively, with no significant difference between treatment types. Tumors from 11 patients were p16-positive and 9 of these were also HPV-positive. Kaplan-Meier analysis demonstrated improved survival. CONCLUSION Our series demonstrates a higher prevalence of HPV in SNUC than previously reported. HPV-positive SNUCs may benefit from improved survival and should be investigated further in future studies.
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Affiliation(s)
- Stacey T Gray
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts
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Yoshida E, Aouad R, Fragoso R, Farwell DG, Gandour-Edwards R, Donald PJ, Chen AM. Improved clinical outcomes with multi-modality therapy for sinonasal undifferentiated carcinoma of the head and neck. Am J Otolaryngol 2013; 34:658-63. [PMID: 23993024 DOI: 10.1016/j.amjoto.2013.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/18/2013] [Accepted: 06/21/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To examine outcomes among patients treated for sinonasal undifferentiated carcinoma (SNUC) of the head and neck. STUDY DESIGN Retrospective review. METHODS The records of 16 consecutive patients with newly diagnosed, non-metastatic SNUC were analyzed. Initial treatment consisted of: surgery alone (6 patients), surgery with post-operative chemoradiotherapy (4 patients), and primary radiation therapy with concurrent chemotherapy (6 patients). RESULTS The median survival for patients treated by surgery followed by postoperative chemoradiotherapy was 30 months compared to 7 months and 9 months for patients treated by surgery alone and upfront chemoradiotherapy, respectively (p=0.20). The 2-year locoregional control was 18% for patients treated with upfront chemoradiotherapy, 37% for patients treated with surgery alone, and 78% for patients treated with surgery plus chemoradiotherapy (p=0.49). CONCLUSION While the potential role of selection bias must be considered, multi-modality therapy using surgery and post-operative chemoradiotherapy yielded the most favorable outcomes for SNUC and should be recommended whenever feasible.
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Subedi N, Prestwich R, Chowdhury F, Patel C, Scarsbrook A. Neuroendocrine tumours of the head and neck: anatomical, functional and molecular imaging and contemporary management. Cancer Imaging 2013; 13:407-22. [PMID: 24240099 PMCID: PMC3830426 DOI: 10.1102/1470-7330.2013.0034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Neuroendocrine tumours (NETs) of the head and neck are rare neoplasms and can be of epithelial or non-epithelial differentiation. Although the natural history of NETs is variable, it is crucial to establish an early diagnosis of these tumours as they can be potentially curable. Conventional anatomical imaging and functional imaging using radionuclide scintigraphy and positron emission tomography/computed tomography can be complementary for the diagnosis, staging and monitoring of treatment response. This article describes and illustrates the imaging features of head and neck NETs, discusses the potential future role of novel positron-emitting tracers that are emerging into clinical practice and reviews contemporary management of these tumours. Familiarity with the choice of imaging techniques and the variety of imaging patterns and treatment options should help guide radiologists in the management of this rare but important subgroup of head and neck neoplasms.
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Affiliation(s)
- Navaraj Subedi
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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van der Laan TP, Bij HP, van Hemel BM, Plaat BEC, Wedman J, van der Laan BFAM, Halmos GB. The importance of multimodality therapy in the treatment of sinonasal neuroendocrine carcinoma. Eur Arch Otorhinolaryngol 2013; 270:2565-8. [DOI: 10.1007/s00405-013-2554-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 05/03/2013] [Indexed: 11/25/2022]
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La Rosa S, Furlan D, Franzi F, Battaglia P, Frattini M, Zanellato E, Marando A, Sahnane N, Turri-Zanoni M, Castelnuovo P, Capella C. Mixed exocrine-neuroendocrine carcinoma of the nasal cavity: clinico-pathologic and molecular study of a case and review of the literature. Head Neck Pathol 2013; 7:76-84. [PMID: 22740238 PMCID: PMC3597157 DOI: 10.1007/s12105-012-0379-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/12/2012] [Indexed: 01/05/2023]
Abstract
Sinonasal intestinal-type adenocarcinomas (ITACs) are rare neoplasms histologically resembling intestinal adenocarcinomas. Although a neuroendocrine differentiation in ITACs has been described, true mixed exocrine-neuroendocrine carcinomas, neoplasms in which each component represents at least 30 % of the lesion, are extremely rare and their molecular alterations are largely unknown. We describe herein the clinico-pathologic features, the methylation profile, chromosomal gains and losses, and mutation analysis of KRAS, BRAF and p53 in a nasal mixed exocrine-neuroendocrine carcinoma resected in a 79-year-old man. The tumor was composed of an ITAC and a poorly differentiated neuroendocrine carcinoma. Both exocrine and neuroendocrine components were CK8, CK20, CDX2 and p53 positive, and CK7 and TTF1 negative. The neuroendocrine component also showed immunoreactivity for chromogranin A, synaptophysin, serotonin and glicentin. Gains and losses were found at following chromosome regions: 17p13 (TP53), 14q24 (MLH3), 19q13 (KLK3), 5q21 (APC), 7q21 (CDK6), 9q34 (DAPK1), 12p13 (TNFRSF 1A, CDKN1B), 13q12 (BRCA2), 17p13.3 (HIC1), 18q21 (BCL2), and 22q12 (TIMP3). Aberrant methylation was detected only in the neuroendocrine component and involved APC and DAPK1 genes. No mutation of KRAS (exons 2-4), BRAF (exon 15), and p53 (exons 4-10) was found in both components. The results suggest a monoclonal origin of the tumor from a pluripotent cell undergoing a biphenotypic differentiation and that the neuroendocrine differentiation may be from an exocrine to an endocrine pathway. We have also reviewed the literature on sinonasal mixed exocrine-neuroendocrine carcinomas to give to the reader a comprehensive overview of these very rare tumor types.
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Affiliation(s)
- Stefano La Rosa
- Department of Pathology, Ospedale di Circolo, viale Borri 57, 21100 Varese, Italy.
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Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses: a rare case. The Journal of Laryngology & Otology 2012; 126:1284-6. [DOI: 10.1017/s0022215112002435] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We report a rare case of small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses with intracranial extension, and discuss the management of this rare tumour.Results:Small cell neuroendocrine carcinoma involving the nasal cavity and paranasal sinuses with intracranial extension may be treated successfully with surgery alone, without development of local recurrence.Conclusion:Small cell neuroendocrine carcinoma is a locally aggressive tumour with a high rate of recurrence. Early and aggressive surgical excision with or without radiotherapy or chemotherapy can improve a patient's outcome and prognosis. Regular follow up is needed to detect any local or distant recurrence.
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Takahashi Y, Kupferman ME, Bell D, Jiffar T, Lee JG, Xie TX, Li NW, Zhao M, Frederick MJ, Gelbard A, Myers JN, Hanna EY. Establishment and characterization of novel cell lines from sinonasal undifferentiated carcinoma. Clin Cancer Res 2012; 18:6178-87. [PMID: 23032744 DOI: 10.1158/1078-0432.ccr-12-1876] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Sinonasal undifferentiated carcinoma (SNUC) is a rare and aggressive cancer. Despite the use of multimodality treatment, the overall prognosis remains poor. To better understand the biologic features of SNUC and help develop new therapies for the disease, we established SNUC cell lines and characterized their biologic behaviors. EXPERIMENTAL DESIGN Cell lines were established from a patient with a T4N0M0 SNUC of the right maxillary sinus who was treated with surgical resection at our center. Tumor colonies were harvested and were sequentially replated onto larger plates. Two populations were developed and labeled MDA8788-6 and MDA8788-7. These cell lines were characterized with molecular, biomarker, functional, and histologic analyses. RESULTS Short tandem repeat genotyping revealed that the cell line is isogenic to the parental tumor, and cytogenetic analysis identified 12 chromosomal translocations. The SNUC cell lines do not form colonies in soft agar but are tumorigenic and nonmetastatic in an orthotopic mouse model of sinonasal cancer. Western blot analysis revealed that both MDA8788 cell lines express epithelial markers but do not express mesenchymal markers or the endocrine marker synaptophysin. CONCLUSIONS This is the first report of the establishment of stable human-derived SNUC cell lines. The lines were highly tumorigenic and maintain the histologic and molecular features of the original tumor. These cell lines should serve as useful tools for the future study of SNUC biology and the development and testing of novel therapies for this deadly disease.
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Affiliation(s)
- Yoko Takahashi
- Department of Head and Neck Surgery and Pathology, The University of Texas MD Anderson Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA
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Mitchell EH, Diaz A, Yilmaz T, Roberts D, Levine N, DeMonte F, Hanna EY, Kupferman ME. Multimodality treatment for sinonasal neuroendocrine carcinoma. Head Neck 2012; 34:1372-6. [PMID: 22052583 DOI: 10.1002/hed.21940] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Neuroendocrine carcinoma (NEC) of the paranasal sinuses is rare, accounting for 5% of sinonasal malignancies. The purpose of this study was to assess prognostic factors and survival rates for sinonasal NEC. METHODS A retrospective review of patients with NEC treated from 1990 to 2004 was performed. Patient demographics, TNM classification, treatment modality, recurrences, and survival were evaluated. RESULTS NEC was identified in 28 patients; the most common primary site was the ethmoid sinuses. Most patients presented with advanced tumors; few had regional or distant metastasis. Local recurrence rate was 21%. Five-year overall survival (OS) and disease-specific survival (DSS) rates were 65% and 78%, respectively. Response to chemotherapy predicted for improved survival, although no differences in outcomes were noted between definitive management strategies. CONCLUSION NEC of the paranasal sinuses is an exceedingly rare malignancy of the paranasal sinuses. Our data suggests definitive management with surgery or radiotherapy offers durable control. The response to chemotherapy may predict for overall outcomes.
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Affiliation(s)
- Elisabeth H Mitchell
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed Army Medical Center, Washington, District of Columbia, USA
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Abstract
Sinonasal carcinomas are uncommon neoplasms accounting for approximately 3% to 5% of all upper respiratory tract malignancies. Sinonasal malignancies in most cases do not cause early symptoms and present in an advanced stage of disease. Exact staging necessitates a clinical and endoscopic examination with biopsy and imaging. Tumor resection using an open or endoscopic approach is usually considered the first treatment option. In general, sinonasal carcinomas are radiosensitive, so adjuvant or neoadjuvant radiation treatment may be indicated in advanced disease. Multidisciplinary surgical and medical oncologic approaches, including ablation and reconstruction, have enhanced the survival outcome over the past few decades.
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Abstract
More than 70 benign and malignant sinonasal tumours and tumour-like conditions have been described. However, sinonasal tumours are rare, and sinonasal cancers comprise only 3% of all head and neck cancers and 1% of all malignancies, with a peak incidence in the 5th to 7th decades and with a male preponderance. The early symptoms and imaging findings of sinonasal tumours are similar to rhinosinusitis with runny and stuffy nose, lacrimation and epistaxis and therefore neglected both by the patients and doctors. When late symptoms such as anosmia, visual disturbances, cranial neuropathy (Cn II, IV, V, VI) or facial swelling appear, the patient is referred to sinonasal endoscopy or imaging. At the time of correct diagnosis more than half of the tumours have reached an advanced stage with a poor prognostic outcome. Even if imaging is performed in the early stages, a radiologist inexperienced with sinonasal anatomy and tumour features may easily interpret early signs of a malignant tumour as rhinosinusitis or a lesion that does not require follow-up. This article presents the imaging findings in some of the most common benign and malignant sinonasal tumours, and the TNM classification and staging of sinonasal carcinomas.
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Reiersen DA, Pahilan ME, Devaiah AK. Meta-analysis of treatment outcomes for sinonasal undifferentiated carcinoma. Otolaryngol Head Neck Surg 2012; 147:7-14. [PMID: 22460731 DOI: 10.1177/0194599812440932] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study reviews the published outcomes regarding sinonasal undifferentiated carcinoma (SNUC) since the initial description in 1986. This article attempts to (1) understand and better describe the benefit and survival advantages associated with using radiation, chemotherapy, and surgical treatment and (2) support the recommendations of a treatment regimen with current available data in the literature. DATA SOURCES Published English-language literature. REVIEW METHODS A PubMed search for articles related to SNUC, along with the bibliographies of those articles to avoid missing articles. All articles were examined for an independent patient data meta-analysis. Thirty studies with 167 cases from 1986 to October 2009 were identified. Demographics, disease extent, treatment, follow-up, and survival were analyzed. Patient cohorts mirroring Kadish staging were created. Kaplan-Meier curves were constructed. RESULTS Follow-up range was 1 to 195 months (mean 23.4 months, median 15 months). At last follow-up, 26.3% of patients were alive with no evidence of disease, 21.0% were alive with disease, and 52.7% were dead of disease. The use of surgery was found to be the best single modality, but chemotherapy and radiation were important as adjuncts in extensive and aggressive disease. The presence of neck metastases was a poor prognostic sign. CONCLUSION This study, containing the largest pool of SNUC patients, confirms a poor overall prognosis. The data suggest that the optimal treatment should include surgery, with radiation and/or chemotherapy as adjunct treatments. Neck disease in advanced local disease is a poor prognostic sign and merits aggressive treatment with multimodality therapy.
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Affiliation(s)
- David A Reiersen
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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Kusunoki T, Ikeda K. Neuroendocrine Carcinoma Arising in a Wound of the Postoperative Maxillary Sinus. Clin Pract 2012; 2:e16. [PMID: 24765415 PMCID: PMC3981353 DOI: 10.4081/cp.2012.e16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 11/02/2011] [Accepted: 01/12/2012] [Indexed: 11/23/2022] Open
Abstract
We report a case of a neuroendocrine carcinoma arising in a wound of the postoperative maxillary sinus that was difficult to distinguish from a postoperative maxillary cyst. The patient was a 65-year-old Japanese woman who complained of left exophthalmos with cheek swelling and eye movement disorders. In past history, she had, 40 years previously undergone operation on the bilateral maxillary sinus by Caldwell-Luc's method. In a preoperative computed tomography, a mass occupied the left maxillary sinus showing irregular densities with destruction of the posterior bone walls and invasion into the left orbital. Both TI and T2 weighted magnetic resonance imaging showed low intensities and unevenness in the mass. We performed a biopsy of the maxillary tumor according to Caldwell-Luc's method. Histological examination diagnosed neuroendocrine carcinoma. Radiation therapy (total 66Gy) resulted in partial response for this tumor. However, sinonasal neuroendocrine carcinoma has been identified as highly aggressive, with a high probability of recurrence and metastasis.
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Abstract
The sinonasal tract (SNT) includes the nasal cavity and paranasal sinuses (maxillary, ethmoid, frontal, and sphenoid) and may give rise to a variety of nonneoplastic and neoplastic proliferations, including benign and malignant neoplasms. The benign neoplasms of the SNT include epithelial neoplasms of surface epithelial origin, minor salivary gland origin, and mesenchymal origin. The spectrum of malignant neoplasms of the SNT includes epithelial malignancies, sinonasal undifferentiated carcinoma, malignant salivary gland neoplasms, neuroectodermal neoplasms, neuroendocrine neoplasms, melanocytic neoplasm, and sarcomas. This article concentrates on some of the more common types of benign and malignant neoplasms.
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Affiliation(s)
- Joaquín J García
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Bruce M Wenig
- Department of Diagnostic Pathology and Laboratory Medicine, Beth Israel Medical Center, St. Luke's-Roosevelt Hospitals, Room 34, Silver Building 11th Floor, First Avenue at 16th Street, New York, NY 10003, USA
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Wadsworth B, Bumpous JM, Martin AW, Nowacki MR, Jenson AB, Farghaly H. Expression of p16 in sinonasal undifferentiated carcinoma (SNUC) without associated human papillomavirus (HPV). Head Neck Pathol 2011; 5:349-54. [PMID: 21805120 PMCID: PMC3210220 DOI: 10.1007/s12105-011-0285-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 07/20/2011] [Indexed: 11/28/2022]
Abstract
Sinonasal undifferentiated carcinoma (SNUC) is an uncommon and highly aggressive neoplasm of the paranasal sinuses and nasal cavity. Its undifferentiated histologic appearance often requires immunohistochemical studies to distinguish it from other high-grade neoplasms. Due to the rarity of SNUC, its immunohistochemical staining profile has been incompletely characterized, and little work has been done on its expression of the markers for human papillomavirus (HPV). Our objective is to expand our knowledge of its immunophenotype and its association with HPV in order to define markers with mechanistic potential in the disease process, or of possible therapeutic importance. A total of five patients (one woman and four men) with SNUC, ranging in age from 26 to 75 years (mean 56.8 years) were compared to five patients (five men) with poorly differentiated squamous cell carcinoma (PDSCC), ranging in age from 53 to 75 years (mean 62.2 years). PDSCC was chosen as a control, given its well-reported immunohistochemical profile and negativity for HPV markers. The immunohistochemical panel included: CK7, CK19, EMA, NSE, chromogranin, p53, CK5/6, p63, CK14, S100, HMB-45, desmin, muscle specific actin, and CD45. Additionally, tests for p16, EBV, and HPV (subtypes 6, 11 16, 18) were performed. The diagnosis of SNUC was confirmed in all cases by histology and immunohistochemical stains. An interesting finding of strong diffuse positivity for p16 was noted in all SNUC cases, compared to only two of five PDSCC that were positive for p16. HPV DNA was not detected in any SNUC cases or any cases of PDSCC. All SNUC cases demonstrated over expression of p16 in the absence of HPV DNA expression. This may represent residual epithelial p16 staining, which is normally present in the sinonasal tract. Due to the rarity of SNUC, more cases will need to be evaluated to confirm the absence of HPV DNA.
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Affiliation(s)
- Beth Wadsworth
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY USA
| | - Jeffery M. Bumpous
- Department of Otolaryngology, University of Louisville, Louisville, KY USA
| | - Alvin W. Martin
- Department of Pathology at Norton Hospital, Louisville, KY USA
| | | | - Alfred B. Jenson
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY USA
| | - Hanan Farghaly
- Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY USA
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Villano JL, Bressler L, Propp JM, Valyi-Nagy T, Martin IK, Dolecek TA, McCarthy BJ. Descriptive epidemiology of selected olfactory tumors. J Neurooncol 2010; 100:73-80. [PMID: 20151173 DOI: 10.1007/s11060-010-0140-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 01/31/2010] [Indexed: 10/19/2022]
Abstract
Olfactory tumors, especially olfactory neuroblastomas (ON) and carcinomas with neuroendocrine differentiation (CND), are extremely rare, and little descriptive epidemiologic information is available. The objective of this study was to more fully describe selected olfactory tumors using a large population-based cancer incidence database. The Surveillance, Epidemiology and End Results (SEER) 9 registries limited-use data were reviewed from 1973 to 2006 for selected nasal cavity (C30.0) and accessory sinus (C31.0-31.9) tumors. Frequencies, incidence rates, and relative survival rates were estimated using SEER*Stat, v6.5.2. The majority of cases were squamous cell carcinoma (SCC), while the incidence of ON was greater than CND. For ON, the incidence was highest in the 60-79 year age group, while for SCC, the incidence was highest in the 80+ year age group. For CND, the incidence leveled off in the oldest age groups. Survival rates were highest for ON (>70% alive at 5 years after diagnosis) and poorest for CND (44% alive at 5 years). Adjuvant radiation therapy did not improve survival over surgery alone in ON. In SCC, survival was worse in patients who received adjuvant radiation compared to patients who had surgery alone. Our analysis confirms some previously published information, and adds new information about the incidence and demographics of ON and CND. In addition, our analysis documents the lack of benefit of adjuvant radiation in ON. It is not feasible to conduct prospective trials in patients with these rare diseases, and the importance of registry data in learning about olfactory tumors is emphasized.
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Affiliation(s)
- J Lee Villano
- Department of Medicine, The University of Illinois at Chicago, Chicago, IL, USA
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Casiraghi O, Lefèvre M. [Undifferentiated malignant round cell tumors of the sinonasal tract and nasopharynx]. Ann Pathol 2009; 29:296-312. [PMID: 19900635 DOI: 10.1016/j.annpat.2009.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 09/24/2009] [Indexed: 10/20/2022]
Abstract
Undifferentiated malignant round cell tumors of the sinonasal tract and nasopharynx comprise of aggressive malignant neoplasms with overlapping morphologic features, which yet are very different and can be identified as carcinoma, lymphoma, sarcoma, melanoma or olfactory neuroblastoma. Differentiating these tumors is important because their treatment and prognosis are quite different. Because of the limited initial biopsy tissue materials, major differential diagnostic difficulties may arise. The use of a panel of immunohistochemical markers and the identification, in some cases, of specific chromosomal translocations are most often required. We describe clinical, morphological, immunohistochemical and molecular features as well as therapeutic management and prognosis of rhabdomyosarcoma (RMS), Ewing sarcoma/primitive neuroectodermic tumor (EWS/PNET), nonkeratinizing nasopharyngeal carcinoma, undifferentiated subtype (UCNT), olfactory neuroblastoma (ONB), small cell carcinoma, neuroendocrine type (SCCNET), sinonasal undifferentiated carcinoma (SNUC) and mucosal melanoma. Mesenchymal chondrosarcoma, small round cell synovialosarcoma, lymphomas and plasmocytoma are not introduced. The most important features of diagnosis will be summarized in two tables.
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Affiliation(s)
- Odile Casiraghi
- Département de pathologie, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif, France.
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Abstract
Olfactory neuroblastoma (ONB) is a malignant neuroectodermal tumor that typically occurs in the superior nasal cavity. It is a distinct entity with features that include nesting, low-grade stippled nuclei, and neurofibrillary stroma with formation of pseudorosettes. It has a distinctive immunoprofile that includes keratin negativity, neuroendocrine marker positivity, and S100 positive sustentacular cells, which surround the nests of tumor in a supportive manner. Although the typical clinicopathologic features leave little room for misinterpretation, the wide variability in this tumor may cause diagnostic difficulty. This includes immunophenotypic diversity or patchy staining with immunomarkers, wide spectrum of grade and histology, posttreatment changes, and occasional divergent differentiation. In addition, problems in sampling, preservation, and clinical localization may make the diagnosis more challenging. A large group of tumors may show morphologic overlap with ONB, with some mimicking low-grade tumors, whereas others mimic high-grade tumors. This differential diagnosis has important treatment and prognostic implications. Further complicating the issue is that many of the mimics themselves may show great morphologic and immunophenotypic variability. This manuscript will review the typical clinical and pathologic features of ONB, address the great variability of ONB in our experience, will focus on the differential diagnosis and report on recent findings in these tumors including molecular genetics where applicable.
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A limited immunohistochemical panel helps differentiate small cell epithelial malignancies of the sinonasal cavity and nasopharynx. Appl Immunohistochem Mol Morphol 2009; 17:207-10. [PMID: 19077909 DOI: 10.1097/pai.0b013e31818fc85c] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Distinguishing small cell epithelial malignancies of the sinonasal cavity and nasopharynx is difficult due to overlapping morphologic characteristics, particularly in small biopsies. This distinction is important, however, because of the inherent differences in biology, natural history, prognosis, and treatment among these neoplasms. The aim of this study is to identify a limited immunohistochemical panel that may help to differentiate these morphologically similar small cell epithelial malignancies. DESIGN We reviewed 37 cases of histologically similar small cell epithelial malignancies of the sinonasal cavity and nasopharynx: nasopharyngeal carcinoma (NPC) (16), basaloid squamous cell carcinoma (BSCC) (15), and high-grade neuroendocrine carcinoma (HGNEC) (6) obtained at Jackson Memorial Hospital/UM Sylvester Comprehensive Cancer Center between 2003 and 2007. Immunohistochemistry for pancytokeratin (CK), CK5/6, p63, and HLA-DR was performed using the labeled streptavidin-biotin method. RESULTS All cases in this study were positive for CK and p63. The CK staining pattern of HGNEC was characteristically dot-like whereas the remaining tumors stained with strong and diffuse cytoplasmic membrane positivity. Likewise, the p63 staining pattern of HGNEC was focal and weak whereas the remaining tumors stained with diffuse and strong nuclear positivity. Immunohistochemistry for HLA-DR was positive in all cases of NPC, whereas BSCC and HGNEC were uniformly negative. Cases of NPC and BSCC were positive for CK5/6 whereas cases of HGNEC were negative. CONCLUSIONS A limited immunohistochemical panel of CK, CK5/6, p63, and HLA-DR is useful in discriminating nasopharyngeal, basaloid squamous cell, and high-grade neuroendocrine carcinomas of the sinonasal cavity and nasopharynx.
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Chatterjee DN, Mondal A. Small cell neuroendocrine carcinoma of nose and paranasal sinuses: a study of three cases with short review of the literature. Indian J Otolaryngol Head Neck Surg 2009; 61:43-6. [PMID: 23120603 DOI: 10.1007/s12070-009-0033-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Primary small cell neuroendocrine carcinoma (SNEC) of nose and paranasal sinuses is an extremely rare malignant tumour known for its aggressive clinical course, high rate of recurrence and poor prognosis. Only 69 cases have been reported in world literature till March, 2006. This tumour usually occurs in elderly persons with main complaints being nasal obstruction, epistaxis, loss of visual acuity, exophthalmos, local pain and rarely tender swelling over the sinuses. Computerized tomography scan (CT) is essential to assess the size, extent of the tumour, evidence of bone destruction and infiltration to orbit and brain. Due to its rarity, the understanding of pathogenesis of the disease, diagnosis and ideal treatment have been difficult. The origin of the tumour is believed from basal cells of the olfactory mucosa. The present study deals with three cases of SNECs of nose and paranasal sinuses in elderly males, their clinical presentations, CT scan findings, histopathological diagnosis with short review of literature.
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Affiliation(s)
- D N Chatterjee
- Department of ENT, Ankur Bhadreswar Hospital, Hooghly, West Bengal India
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Molecular and phenotypic analysis of poorly differentiated sinonasal neoplasms: an integrated approach for early diagnosis and classification. Hum Pathol 2009; 40:283-92. [PMID: 19150107 PMCID: PMC4573623 DOI: 10.1016/j.humpath.2008.07.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 07/21/2008] [Accepted: 07/21/2008] [Indexed: 02/03/2023]
Abstract
Primary poorly differentiated (small round and non-small) sinonasal neoplasms comprise histogenetically and biologically diverse entities with overlapping morphologic features. Because of the limited initial biopsy tissue materials, differential diagnostic difficulties may arise and complicate timely management of some cases. We used immunohistochemical and molecular marker analyses in a large cohort of these tumors to optimize their early diagnosis and classification. Fifty-two tumors of the skull base and sinonasal regions and, for comparison, 19 poorly differentiated neoplasms of other head and neck sites were analyzed by a panel of immunohistochemical markers including those of epithelial, mesenchymal, melanocytic, and neuroectodermal origin using tissue microarray. Reverse transcriptase-polymerase chain reaction analysis of messenger RNA for EWS-FLI1 and PAX-FKHR fusion transcripts and the human achaete-scute homolog-1 gene was performed on 24 of the 52 sinonasal tumors and the 19 tumors of other sites for comparison. The immunohistochemical results substantiated the phenotypic assessment and the initial diagnosis in 49 of the 52 tumors. In 4 instances the integrated markers and phenotypic analyses led to reclassification of 3 tumors and confirmed the histogenesis of a mesenchymal tumor with aberrant cytokeratin expression. Molecular analysis of the EWS-FLI1 fusion gene transcript revealed 4 (9.3%) of the 43 tumors to be positive; all were Ewing sarcomas. The human achaete-scute homolog-1 gene transcript was identified in 10 (23.8%) of 42 tumors: 3 of 6 neuroblastomas, all 4 neuroendocrine carcinomas, and 1 each in sinonasal undifferentiated carcinoma, rhabdomyosarcoma, and melanoma. The PAX-FKHR fusion transcript was not detected in any tumors. We conclude that (1) an integrated morphologic and biomarker algorithm may better optimize the early diagnosis of poorly differentiated sinonasal and skull-base tumors; (2) molecular analysis may assist in future biological stratification of certain classes of these tumors; and (3) the human achaete-scute homolog-1 gene transcript is a nonspecific marker for the diagnosis of neuroblastoma.
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Abstract
The sinonasal malignancies of putative neuroendocrine origin-esthesioneuroblastoma, sinonasal neuroendocrine carcinoma, sinonasal undifferentiated carcinoma, and sinonasal small cell carcinoma-are uncommon malignancies that frequently present with locally advanced disease. Pathologic distinction between these entities can be difficult, but is important to guide management. These malignancies require complex multimodality treatment and are best managed by multidisciplinary teams in major centers that have expertise in sinonasal malignancies.
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Affiliation(s)
- Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag No 1, A'Beckett Street, Melbourne 8006, Australia.
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45
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Ma ATW, Lei KIK. Small cell neuroendocrine carcinoma of the ethmoid sinuses presenting with generalized seizure and syndrome of inappropriate antidiuretic hormone secretion: a case report and review of literature. Am J Otolaryngol 2009; 30:54-7. [PMID: 19027514 DOI: 10.1016/j.amjoto.2007.12.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Accepted: 12/29/2007] [Indexed: 01/07/2023]
Abstract
Small cell neuroendocrine carcinoma of the paranasal sinuses is extremely rare. We present a case of small cell neuroendocrine carcinoma of the ethmoid sinuses associated with syndrome of inappropriate antidiuretic hormone secretion that resolved after chemotherapy, followed by a review of the literature.
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Affiliation(s)
- Ada T W Ma
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong.
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46
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Schmidt ER, Berry RL. Diagnosis and treatment of sinonasal undifferentiated carcinoma: report of a case and review of the literature. J Oral Maxillofac Surg 2008; 66:1505-10. [PMID: 18571040 DOI: 10.1016/j.joms.2007.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 10/11/2007] [Accepted: 12/10/2007] [Indexed: 11/19/2022]
Affiliation(s)
- Eric R Schmidt
- Department of Oral and Maxillofacial Surgery, David Grant Medical Center, Travis Air Force Base, CA, USA.
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Tetzlaff MT, Liu P, O'Malley BW, LiVolsi VA, Elder D. Report of a case of sinonasal undifferentiated carcinoma arising in a background of extensive nasal gliomatosis. Head Neck 2008; 30:549-55. [PMID: 17972313 DOI: 10.1002/hed.20707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Sinonasal undifferentiated carcinoma (SNUC) is a relatively rare, aggressive malignancy of adulthood. Nasal glial heterotopia is a benign congenital condition in which mature benign brain tissue develops outside the central nervous system. METHODS A 37-year-old man was seen with right nasal obstruction, epistaxis, and headache. Imaging showed a radiologically malignant mass lesion. Biopsy and subsequent resection were performed in the evaluation and treatment of this lesion. Histologic and immunohistochemical assessments of the biopsy and resection specimens on the pathology material classified the lesional tissue. RESULTS Histology and immunohistochemistry of the biopsy specimen demonstrated an SNUC that was subsequently resected following chemotherapy. In addition to SNUC, the resection specimen revealed extensive, multifocal nasal glial heterotopia (so called "nasal glioma"). CONCLUSIONS This is the first known case in the literature in which these 2 relatively rare entities coincide.
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Affiliation(s)
- Michael T Tetzlaff
- Department of Pathology and Laboratory Medicine, Hospital for the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania, USA.
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Abstract
Neuroendocrine carcinoma (NEC) is rare. We report a case of probable sinonasal NEC in a 73-year-old man who had presented with a history of right nasal obstruction, nasal discharge, and recurrent epistaxis. On examination, a red, friable, gelatinous, polypoid mass with a tendency to bleed was seen in the right nasal cavity. Computed tomography revealed that the lesion was confined to the right nasal cavity; coincidental or reactive opacification was seen in the adjacent sinuses. The final histologic evaluation of the excised biopsy specimens yielded a diagnosis of an invasive, poorly differentiated NEC, probably a large-cell variant, with the differential diagnosis lying at a point somewhere between poorly differentiated large-cell NEC and high-grade olfactory neuroblastoma. The patient underwent a right lateral rhinotomy and medial maxillectomy followed by adjuvant radiotherapy. At 20 months of follow-up, he exhibited no sign of recurrence.
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Affiliation(s)
- Dulani Mendis
- From the Department of ENT Surgery, Queen's Hospital, Burton-upon-Trent, U.K
| | - Nasser Malik
- Department of ENT Surgery, Royal Wolverhampton Hospitals, U.K
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50
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Chen YJ, Chen JT, Chen PL. An Unusual Optic Neuropathy Case Caused by Sinonasal Undifferentiated Carcinoma. Neuroophthalmology 2008. [DOI: 10.1080/01658100802504242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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