Management of intracranial invasive olfactory neuroblastoma:

Esthesioneuroblastoma with distant metastases: Systematic review & meta-analysis

BACKGROUND

The purpose of this study was to determine the clinical outcomes and review the management strategies for metastatic esthesioneuroblastoma.

METHODS

We conducted a systematic review and meta-analysis.

RESULTS

Forty-eight studies totaling 118 patients met inclusion criteria. Chemotherapy in combination with surgery and/or radiation exhibited the best overall survival when compared to monotherapy and no treatment (P < .001). However, most patients (66%) received either monotherapy or no therapy. The number and location of metastases among the 3 treatment groups did not significantly differ (P = .85). Treatment modality remained significantly associated with overall survival on multivariable analysis (P < .001). Platinum-based chemotherapy was most commonly utilized but did not provide a survival benefit when compared with all other regimens (P = .88).

CONCLUSION

Distant metastases with esthesioneuroblastoma portend a poor prognosis. Chemotherapy in combination with surgery and/or radiation was associated with improved overall survival. Further research into the optimal systemic therapeutic regimen for patients with distant metastases is critical.

Esthesioneuroblastoma located in the thoracic extradural space: Case report

Objective

Esthesioneuroblastoma accounted for only 6% of the malignant nasal cavity neoplasms (ENB) is a rare tumor which originates from the olfactory epithelium. ENB’s are locally agresive and can metastasize by lymphatic and hematogenous routes. A patient with the mass on the nasal dorsum was reported in this article.

Case history

A 52–year-old-man admitted to the hospital with a 3 months history of progressive nasal obstruction, epistaxis and mass on the nasal dorsum. On rhinoscopy, a polypoid mass was seen in the both nasal cavity and intranasal biopsy with local anesthesia was performed. Histopathologic diagnosis of the tumor was Kadish stage B esthesioneuroblastoma. Tumor was excised by using bilateral endoscopic endonasal resection and lateral rhinotomy approach and paranasal radiotherapy performed postoperatively. Ten months after surgery, neck metastasis was occured and patient was underwent neck dissection. Twenteeth months after initial treatment, distant metastasis was identified on the T 10 vertebra and following the cranial and spinal radiotherapy to the neck he was free of local recurrence at follow up 13 months after surgery.

Conclusion

It has been known that the metastasis of the ENB to the spinal cord is an uncommon event, and it occurs often years after initial diagnosis. MRI scan is helpful for making the diagnosis, and surgery is the treatment of choice for obtaining diagnostic tissue and debulking the tumor. Radiotherapy is also a mainstay of postoperative treatment.

Esthesioneuroblastoma: one of the causes of proptosis

Esthesioneuroblatoma (Olfactory neuroblastoma) is a rare malignant neoplasm arising from the olfactory epithelium with bimodal age distribution between with first peak in second decades and second peak in sixth decade. Proptosis due to esthesioneuroblastoma is one of the rare causes. They have a long natural history characterized by frequent local or regional recurrence. Computed tomography and magnetic resonance imaging are the imaging modalities for diagnosing these tumors. A multidisciplinary approach with surgery and radiation therapy is an excellent treatment options for these tumors with chemotherapy being used to treat advanced or recurrent disease.

Vertebral column metastases from an esthesioneuroblastoma: chemotherapy, radiation, and resection for recurrence with 15-year followup

Esthesioneuroblastoma (ENB) is an uncommon aggressive malignant intranasal neoplasm that originates from neural crest cells of the olfactory epithelium. Although local invasion to the sinuses is common, spinal metastasis of ENB is rare with only 28 documented cases involving the spine spinal cord, or leptomeninges. We report a case of ENB with multiple drop metastases to the cervical and thoracic spine, and review the patient's disease, medical history, and multiple interventions during a span of 15 years following the initial cranial resection. Despite aggressive multiple surgical resections, radiation, and chemotherapy, the tumor had significant progression and recurrence. The literature is reviewed, followed by a discussion of the natural progression of the disease and various reported interventions. Although a combination of surgery with chemotherapy and radiation therapy has been recommended, no definitive management has been established for ENB. Further research is needed to determine decisive treatment for metastatic ENB to the spine.

Bortezomib sensitizes primary human esthesioneuroblastoma cells to TRAIL-induced apoptosis

TNF-related apoptosis-inducing ligand (TRAIL), a promising novel anti-cancer cytokine of the TNF superfamily, and Bortezomib, the first-in-class clinically used proteasome inhibitor, alone or in combination have been shown to efficiently kill numerous tumor cell lines. However, data concerning primary human tumor cells are very rare. Using primary esthesioneuroblastoma cells we analyzed the anti-tumor potential and the mechanism employed by Bortezomib in combination with TRAIL for the treatment of this rare but aggressive tumor. Expression of components of the TRAIL pathway was analyzed in tumor specimens and isolated primary tumor cells at the protein level. Cells were treated with TRAIL, Bortezomib, and a combination thereof, and apoptosis induction was quantified. Clonogenicity assays were performed to elucidate the long-term effect of this treatment. Despite expressing all components of the TRAIL pathway, freshly isolated primary esthesioneuroblastoma cells were completely resistant to TRAIL-induced apoptosis. They could, however, be very efficiently sensitized by subtoxic doses of Bortezomib. The influence of Bortezomib on the TRAIL pathway was analyzed and showed upregulation of TRAIL death receptor expression, enhancement of the TRAIL death-inducing signaling complex (DISC), and downregulation of anti-apoptotic proteins of the TRAIL pathway. Of clinical relevance, TRAIL-resistant primary tumor cells could be repeatedly sensitized by Bortezomib, providing the basis for repeated clinical application schedules. This is the first report on the highly synergistic induction of apoptosis in primary esthesioneuroblastoma cells by Bortezomib and TRAIL. This combination, therefore, represents a promising novel therapeutic option for esthesioneuroblastoma.

Treatment of esthesioneuroblastoma: a 16-year meta-analysis of 361 patients

OBJECTIVES/HYPOTHESIS

This study reviews the published outcomes related to surgical (open, endoscopic, and endoscopic-assisted) and nonsurgical treatment for esthesioneuroblastoma.

STUDY DESIGN

Literature meta-analysis.

METHODS

A meta-analysis of individual patient data for esthesioneuroblastoma publications between 1992 (the earliest identified description of endoscopic resection) and 2008 was conducted. A total of 49 journal articles, comprising 1,170 cases of esthesioneuroblastoma, were included in the study. Criteria for meta-analysis inclusion were five or more patients in a study with sufficient patient data resolution for analysis. Twenty-three studies comprising 361 patients met all inclusion criteria. The overall treatment and outcome at final follow-up of each patient was recorded. Patients were pooled according to treatment techniques and compared to one another using a Kaplan-Meier survival curve and the Mann-Whitney U test to examine differences in follow-up times and publication years.

RESULTS

Log-rank tests showed a greater published survival rate for endoscopic surgery compared to open surgery (P = .0019), even when stratifying for publication year (P = .0018). There was no significant difference in follow-up time. Review of Kadish tumor staging for each modality showed larger tumors were more often treated with an open approach, but open and endoscopic survival measures were comparable.

CONCLUSIONS

These results suggest that endoscopic surgery is a valid treatment method with comparable survival to open surgery. Further prospective analysis will be beneficial.

Esthesioneuroblastoma metastatic to the thoracic intradural and extradural space

BACKGROUND CONTEXT

Ethesioneuroblastoma (ENB) is a rare tumor of the olfactory epithelium that has been shown to metastasize mostly to the cervical lymphatics, with only infrequent spread to other locations. We report a rare case of ENB characterized by recurrence and distant metastasis to the T7-T8 intradural and extradural space.

PURPOSE

To report a rare case of recurrent ENB metastatic to the thoracic intradural and extradural space.

STUDY DESIGN/SETTING

Case report with a review of the literature.

METHODS

A 64-year-old man with recurrent ENB presented with chronic pain in the neck, shoulder, and back. His neurologic exam was normal. Computed tomography of the chest showed no pulmonary metastasis and a high-attenuation spinal canal mass at T8 was noted on magnetic resonance imaging. A laminectomy at T7-T8 was performed for resection of a large epidural mass. A tumor was seen penetrating through the dura, and a midline durotomy was performed for resection of a large intradural mass. Frozen section and permanent stains were consistent with metastatic ENB.

RESULTS

The postoperative period was uneventful, and included pain management and physical therapy, followed by chemotherapy and radiation. The patient remains free of spinal recurrence 2 years after surgery.

CONCLUSIONS

Metastasis of ENB to the spinal column is rare, and of those instances, 80% are localized to the cauda equina. Recurrent ENB metastatic to the thoracic intradural and extradural space is extremely rare, and was successfully treated with surgical resection.