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Kuan EC, Wang EW, Adappa ND, Beswick DM, London NR, Su SY, Wang MB, Abuzeid WM, Alexiev B, Alt JA, Antognoni P, Alonso-Basanta M, Batra PS, Bhayani M, Bell D, Bernal-Sprekelsen M, Betz CS, Blay JY, Bleier BS, Bonilla-Velez J, Callejas C, Carrau RL, Casiano RR, Castelnuovo P, Chandra RK, Chatzinakis V, Chen SB, Chiu AG, Choby G, Chowdhury NI, Citardi MJ, Cohen MA, Dagan R, Dalfino G, Dallan I, Dassi CS, de Almeida J, Dei Tos AP, DelGaudio JM, Ebert CS, El-Sayed IH, Eloy JA, Evans JJ, Fang CH, Farrell NF, Ferrari M, Fischbein N, Folbe A, Fokkens WJ, Fox MG, Lund VJ, Gallia GL, Gardner PA, Geltzeiler M, Georgalas C, Getz AE, Govindaraj S, Gray ST, Grayson JW, Gross BA, Grube JG, Guo R, Ha PK, Halderman AA, Hanna EY, Harvey RJ, Hernandez SC, Holtzman AL, Hopkins C, Huang Z, Huang Z, Humphreys IM, Hwang PH, Iloreta AM, Ishii M, Ivan ME, Jafari A, Kennedy DW, Khan M, Kimple AJ, Kingdom TT, Knisely A, Kuo YJ, Lal D, Lamarre ED, Lan MY, Le H, Lechner M, Lee NY, Lee JK, Lee VH, Levine CG, Lin JC, Lin DT, Lobo BC, Locke T, Luong AU, Magliocca KR, Markovic SN, Matnjani G, McKean EL, Meço C, Mendenhall WM, Michel L, Na'ara S, Nicolai P, Nuss DW, Nyquist GG, Oakley GM, Omura K, Orlandi RR, Otori N, Papagiannopoulos P, Patel ZM, Pfister DG, Phan J, Psaltis AJ, Rabinowitz MR, Ramanathan M, Rimmer R, Rosen MR, Sanusi O, Sargi ZB, Schafhausen P, Schlosser RJ, Sedaghat AR, Senior BA, Shrivastava R, Sindwani R, Smith TL, Smith KA, Snyderman CH, Solares CA, Sreenath SB, Stamm A, Stölzel K, Sumer B, Surda P, Tajudeen BA, Thompson LDR, Thorp BD, Tong CCL, Tsang RK, Turner JH, Turri-Zanoni M, Udager AM, van Zele T, VanKoevering K, Welch KC, Wise SK, Witterick IJ, Won TB, Wong SN, Woodworth BA, Wormald PJ, Yao WC, Yeh CF, Zhou B, Palmer JN. International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors. Int Forum Allergy Rhinol 2024; 14:149-608. [PMID: 37658764 DOI: 10.1002/alr.23262] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field. METHODS In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format, and completed sections underwent a thorough and iterative consensus-building process. The final document underwent rigorous synthesis and review prior to publication. RESULTS The ICSNT document consists of four major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention. CONCLUSION As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.
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Affiliation(s)
- Edward C Kuan
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Sinonasal and Skull Base Tumor Program, Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Borislav Alexiev
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Paolo Antognoni
- Division of Radiation Oncology, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Mihir Bhayani
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Diana Bell
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Manuel Bernal-Sprekelsen
- Otorhinolaryngology Department, Surgery and Medical-Surgical Specialties Department, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Christian S Betz
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, UNICANCER, Université Claude Bernard Lyon I, Lyon, France
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Claudio Callejas
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Roy R Casiano
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Simon B Chen
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Marc A Cohen
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gianluca Dalfino
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Iacopo Dallan
- Department of Otolaryngology-Head and Neck Surgery, Pisa University Hospital, Pisa, Italy
| | | | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Angelo P Dei Tos
- Section of Pathology, Department of Medicine, University of Padua, Padua, Italy
| | - John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - James J Evans
- Department of Neurological Surgery and Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nyssa F Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Nancy Fischbein
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Adam Folbe
- Department of Otolaryngology-Head and Neck Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Meha G Fox
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Christos Georgalas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Nicosia Medical School, Nicosia, Cyprus
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Jessica W Grayson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jordon G Grube
- Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Ashleigh A Halderman
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of South Wales, Sydney, New South Wales, Australia
| | - Stephen C Hernandez
- Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Adam L Holtzman
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Claire Hopkins
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Zhigang Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Zhenxiao Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Alfred M Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - David W Kennedy
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohemmed Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Anna Knisely
- Department of Otolaryngology, Head and Neck Surgery, Swedish Medical Center, Seattle, Washington, USA
| | - Ying-Ju Kuo
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Devyani Lal
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ming-Ying Lan
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matt Lechner
- UCL Division of Surgery and Interventional Science and UCL Cancer Institute, University College London, London, UK
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jivianne K Lee
- Department of Head and Neck Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Victor H Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Corinna G Levine
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jin-Ching Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Brian C Lobo
- Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Tran Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Svetomir N Markovic
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gesa Matnjani
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Erin L McKean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Cem Meço
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University Medical School, Ankara, Turkey
- Department of Otorhinolaryngology Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Loren Michel
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shorook Na'ara
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Daniel W Nuss
- Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Gurston G Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gretchen M Oakley
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kazuhiro Omura
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Richard R Orlandi
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - David G Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alkis J Psaltis
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Mindy R Rabinowitz
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ryan Rimmer
- Department of Otolaryngology-Head and Neck Surgery, Yale University, New Haven, Connecticut, USA
| | - Marc R Rosen
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Olabisi Sanusi
- Department of Neurosurgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Zoukaa B Sargi
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philippe Schafhausen
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Raj Shrivastava
- Department of Neurosurgery and Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carl H Snyderman
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Aldo Stamm
- São Paulo ENT Center (COF), Edmundo Vasconcelos Complex, São Paulo, Brazil
| | - Katharina Stölzel
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Baran Sumer
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pavol Surda
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charles C L Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raymond K Tsang
- Department of Otolaryngology-Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Aaron M Udager
- Department of Pathology, Michigan Center for Translational Pathology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Thibaut van Zele
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Kyle VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Stephanie N Wong
- Division of Otorhinolaryngology, Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter-John Wormald
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Chien-Fu Yeh
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bing Zhou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Shen Z, Chen X, Sun C, Lu T, Shi Y, Zhang H, Ye J, Wang L, Zhu T, Miao Y, Zhang X, Wang L, Cai G, Sang W. Comparative analysis of clinicopathologic characteristics and prognosis between nasal and nonnasal extranodal NK/T-cell lymphoma. Cancer Med 2023; 12:21138-21147. [PMID: 37902266 PMCID: PMC10726883 DOI: 10.1002/cam4.6674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/04/2023] [Accepted: 10/04/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND The clinicopathologic characteristics and prognosis of nasal and nonnasal extranodal natural killer T-cell lymphoma (ENKTL) are considered to be different. However, the underlying features responsible for these differences are not well clarified especially in the era of asparaginase therapy. METHODS In total, 1007 newly diagnosed ENKTL patients from 11 medical centers were included in this study. Clinicopathologic characteristics and survival data were collected. The chi-squared test and Kruskal-Wallis test were utilized for the comparison of different groups. Univariable and multivariable Cox proportional hazards models were used to screen prognostic factors. RESULTS Overall, 869 (86.3%) patients were nasal forms. Compared to patients with nasal ENKTL, nonnasal patients were at more advanced stages and had poor performance status, bone marrow involvement, elevated serum lactate dehydrogenase (LDH), and CD56-negative status (p < 0.05). The 5-year overall survival (OS) for nasal and nonnasal patients were 65.6% and 45.0%, respectively. The OS of nasal forms patients were superior to nonnasal patients, especially in Eastern Cooperative Oncology Group performance status (ECOG PS) (≥2), advanced stage, KPI (HIR/HR), IPI (HIR/HR), PINK (HR), and high EBV DNA load groups. In patients treated with pegaspargase/L-asparaginase-based regimens, the OS of nasal patients was better than that of nonnasal patients. After adjusting the covariates of age, stage, ECOG PS score, LDH, B symptoms, and BM involvement, results showed that the nonnasal site was associated with poor survival of ENKTL. CONCLUSIONS The clinicopathologic characteristics and prognosis of nasal and nonnasal ENKTL patients are different. Nasal forms patients had superior OS than nonnasal patients, especially in the era of asparaginase.
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Affiliation(s)
- Ziyuan Shen
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Xicheng Chen
- Department of HematologyAffiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
| | - Cai Sun
- Department of HematologyAffiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
| | - Tianyi Lu
- Department of HematologyAffiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
| | - Yuye Shi
- Department of HematologyThe First People's Hospital of Huai'anHuai'anJiangsuChina
| | - Hao Zhang
- Department of HematologyThe Affiliated Hospital of Jining Medical UniversityJiningShandongChina
| | - Jingjing Ye
- Department of HematologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Ling Wang
- Department of HematologyTai'an Central HospitalTai'anShandongChina
| | - Taigang Zhu
- Department of HematologyThe General Hospital of Wanbei Coal‐Electric GroupSuzhouAnhuiChina
| | - Yuqing Miao
- Department of HematologyYancheng First People's HospitalYanchengJiangsuChina
| | - Xudong Zhang
- Department of HematologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Liang Wang
- Department of Hematology, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Wei Sang
- Department of HematologyAffiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
- Blood Diseases Institute, Xuzhou Medical UniversityXuzhouJiangsuChina
- Key Laboratory of Bone Marrow Stem CellXuzhouJiangsuChina
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3
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Kandel D, Dhakal S, Thapa S, Dhakal P, Rayamajhi S, Baniya J. Natural killer cell T-cell lymphoma (nasal type), a rare and aggressive type of non-Hodgkin's lymphoma: Case report. Radiol Case Rep 2023; 18:4052-4056. [PMID: 37701358 PMCID: PMC10493876 DOI: 10.1016/j.radcr.2023.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/14/2023] Open
Abstract
In the sinonasal tract, diffuse large B-cell lymphomas are the predominant type non-Hodgkin's lymphoma while natural killer (NK) cell T-cell lymphoma, the nasal type, constitute only 3%-12% of NHLs in this region and is the more aggressive subtype. NK cell T-cell lymphoma mostly occurs in male at the median age of 50 years and has got a poor prognosis with a 3-years overall survival (OS) of 46.3% and a 5-years OS of 42%. We present a case of a 37 year old lady with a mass in nasal cavity extending to the nasopharynx and upper cervical lymphadenopathy. Biopsy from the nasal mass showed features of NHL, NK cell T-cell type although immunohistochemistry was not available for the definite diagnosis. For localized diseases, chemo-radiotherapy forms the mainstay of treatment with complete remission in up to 50% of cases while chemotherapy alone is given to patients with disseminated disease with a very poor outcome (5-year survival of 10%-45% only). In our case, the patient received first dose of chemotherapy and then died at home before receiving the second dose showing the aggressive nature of the disease. Timely diagnosis with typical imaging features and histological diagnosis can improve the outcome with complete cure in almost half of the cases with localized disease.
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Affiliation(s)
- Devraj Kandel
- Department of Radiodiagnosis and Imaging, National Academy of Medical Sciences, Mahabouddha, Kathmandu, Nepal
| | - Shishan Dhakal
- Department of Dermatology and Venerology, National Academy of Medical Sciences, Mahabouddha, Kathmandu, Nepal
| | - Sushila Thapa
- Department of Pathology, National Academy of Medical Sciences, Mahabouddha, Kathmandu, Nepal
| | - Prakash Dhakal
- Department of Radiodiagnosis and Imaging, National Academy of Medical Sciences, Mahabouddha, Kathmandu, Nepal
| | | | - Jagat Baniya
- Department of Radiodiagnosis and Imaging, Lumbini Provincial Hospital, Butwal, Rupandehi, Nepal
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4
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Akay S, Pollard JH, Saad Eddin A, Alatoum A, Kandemirli S, Gholamrezanezhad A, Menda Y, Graham MM, Shariftabrizi A. PET/CT Imaging in Treatment Planning and Surveillance of Sinonasal Neoplasms. Cancers (Basel) 2023; 15:3759. [PMID: 37568575 PMCID: PMC10417627 DOI: 10.3390/cancers15153759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Sinonasal cancers are uncommon malignancies with a generally unfavorable prognosis, often presenting at an advanced stage. Their high rate of recurrence supports close imaging surveillance and the utilization of functional imaging techniques. Whole-body 18F-FDG PET/CT has very high sensitivity for the diagnosis of sinonasal malignancies and can also be used as a "metabolic biopsy" in the characterization of some of the more common subgroups of these tumors, though due to overlap in uptake, histological confirmation is still needed. For certain tumor types, radiotracers, such as 11C-choline, and radiolabeled somatostatin analogs, including 68Ga-DOTATATE/DOTATOC, have proven useful in treatment planning and surveillance. Although serial scans for posttreatment surveillance allow the detection of subclinical lesions, the optimal schedule and efficacy in terms of survival are yet to be determined. Pitfalls of 18F-FDG, such as post-surgical and post-radiotherapy crusting and inflammation, may cause false-positive hypermetabolism in the absence of relapse.
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Affiliation(s)
- Sinan Akay
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Janet H. Pollard
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Assim Saad Eddin
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Aiah Alatoum
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Sedat Kandemirli
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90030, USA
| | - Yusuf Menda
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Michael M. Graham
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Ahmad Shariftabrizi
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
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Nagornaya N, Saigal G, Bhatia R. Malignant and Nonmalignant Sinonasal Tumors. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00026-2. [PMID: 37149426 DOI: 10.1016/j.coms.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Sinonasal tumors are rare, diverse, complex lesions with overlapping demographic and clinical features. Malignant tumors are more common, with a grave prognosis, and require biopsy for accurate diagnosis. This article briefly reviews the classification of sinonasal tumors and provides imaging examples and imaging characteristics of each clinically important nasal and paranasal mass lesions. Although there are no true pathognomonic imaging features, it is important for the radiologist to have a broad knowledge of the various CT and MR imaging findings that can help narrow the differential diagnosis and aid in early diagnosis and mapping of tumor for treatment planning.
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Affiliation(s)
- Natalya Nagornaya
- Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1611 NW12th Avenue, WW- 279, Miami, FL 33136, USA.
| | - Gaurav Saigal
- Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1611 NW12th Avenue, WW- 279, Miami, FL 33136, USA
| | - Rita Bhatia
- Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1611 NW12th Avenue, WW- 279, Miami, FL 33136, USA
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6
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Manta AI, Wilson-Pogmore AA, Sullivan TJ. Thirty Years of Experience With Ocular Adnexal T-Cell Lymphoma. Ophthalmic Plast Reconstr Surg 2023; 39:266-274. [PMID: 36727764 DOI: 10.1097/iop.0000000000002309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the disease characteristics and survival of patients with ocular adnexal T-cell lymphoma. METHODS A retrospective, observational study of patients with a histopathological diagnosis of T-cell lymphoma of the ocular adnexa seen between 1992 and 2022. Demographic data, clinical presentation, imaging, histology, immunohistochemistry, treatment, and outcomes were reviewed. RESULTS Fifteen patients were included in the study with the mean age at diagnosis of 50 years old (range 7-85). The most common presenting symptoms were ulcerated eyelid skin lesions (40%) followed by eyelid swelling (13.3%), and lacrimal passageways obstruction (13.3%). The anaplastic large cell lymphoma (33%) and primary cutaneous T-cell lymphoma (33%) were the most diagnosed peripheral T-cell lymphoma subtypes, followed by the nasal type natural killer/T-cell lymphoma (27%) and peripheral T-cell lymphoma not otherwise specified (7%). The most prevalent stage of disease progression was stage I and stage IV (Ann Arbor classification) with seven (47%) patients each. Eight (53%) patients succumbed to the disease process of which three (37.5%) deceased in the first six months and six (75%) within the first year of diagnosis. We identified a strong statistical association between stage and disease-related death ( p = 0.003). CONCLUSIONS Peripheral T-cell lymphoma occurring in the orbit and ocular adnexa is extremely rare. Advanced stage at diagnosis leads to almost certain death from the disease despite aggressive local and systemic treatment. Early diagnosis improves the chances of survival but can be hindered by this condition's ability to simulate benign inflammatory conditions both clinically and histologically.
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Affiliation(s)
- Alexandra I Manta
- Department of Ophthalmology, Division of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Ario A Wilson-Pogmore
- Department of Ophthalmology, Division of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Australia
- Faculty of Medicine, Griffith University, Australia
| | - Timothy J Sullivan
- Department of Ophthalmology, Division of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Australia
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7
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Shao HF, Yang QL, Qu YH, Chi XX, Mao N, Zhang T, Sui XL, Wei HL. Differentiation between atypical sinonasal non-Hodgkin's lymphoma and inverted papilloma. Clin Radiol 2023; 78:e22-e27. [PMID: 36182333 DOI: 10.1016/j.crad.2022.08.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 01/07/2023]
Abstract
AIM To seek additional magnetic resonance imaging (MRI) features to improve the accuracy of differentiation between atypical sinonasal non-Hodgkin's lymphoma (NHL) and inverted papilloma (IP) using conventional MRI and apparent diffusion coefficient (ADC) maps. MATERIALS AND METHODS MRI examinations from 44 atypical cases (21 NHLs and 23 IPs) in sinonasal regions were reviewed retrospectively. Imaging features included tumour laterality, extension, T1-weighted imaging (WI)/T2WI signal intensity homogeneity and ratios, enhancement homogeneity and ratios, and ADCmean. RESULTS In cases of NHL, homogeneous signal intensity was often observed on T2WI, which was homogeneous and significantly less enhanced than the turbinate, with lower ADCmean. Whereas in IPs, heterogeneous signal intensity was seen on T2WI, which was heterogeneous and of comparable enhancement to the turbinate, and higher ADCmean values were commonly seen. An ADCmean cut-off point of 1.10 × 10-3 mm2/s achieved 100% sensitivity, 90% specificity, and 90% accuracy. In addition, special features were observed that support the distinction between the two tumours, including intestinal pattern enhancement in NHL and spot-like appearance on T2WI and enhancement in IP. CONCLUSIONS ADCmean was the most valuable metric for differentiating between the atypical sinonasal NHLs and IPs.
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Affiliation(s)
- H F Shao
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Street, Yantai 264000, Shandong, PR China
| | - Q L Yang
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Street, Yantai 264000, Shandong, PR China
| | - Y H Qu
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Street, Yantai 264000, Shandong, PR China
| | - X X Chi
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Street, Yantai 264000, Shandong, PR China
| | - N Mao
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Street, Yantai 264000, Shandong, PR China
| | - T Zhang
- Department of Otolaryngology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Street, Yantai 264000, Shandong, PR China
| | - X L Sui
- Department of Pathology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Street, Yantai 264000, Shandong, PR China
| | - H L Wei
- Department of Radiology, Yantai Yuhuangding Hospital, The Affiliated Hospital of Qingdao University, No. 20 Yuhuangding East Street, Yantai 264000, Shandong, PR China.
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8
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Jing D, You D, Liu Z, Wang W. Primary Orbital Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type, without Nasal Involvement. J Clin Med 2022; 11:jcm11237010. [PMID: 36498585 PMCID: PMC9737387 DOI: 10.3390/jcm11237010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Extranodal natural killer/T-cell lymphoma (ENKL) usually occurs in the nose or the nasopharynx, but extranasal and disseminated disease can occur. In this disease, orbital involvement is more commonly seen, but without nasal involvement is rare. A 61-year-old woman was referred with a one-month history of a remarkably enlarging salmon-colored mass arising in the right inner canthus, with redness and painlessness. The motility of the right eye was limited in the medial direction, with external deviation of the eyeball. A magnetic resonance imaging (MRI) scan of the orbits showed a mass of irregular shape located in the right inner canthus, without any sinus involvement. A histopathological examination concluded a diagnosis of primary orbital extranodal natural killer/T-cell lymphoma, nasal type. Her orbital mass significantly reduced to near disappeared after chemotherapy. From the first visit to the present, the survival duration of this patient was more than 1 year. This patient was still alive with a high quality of life and with no systemic metastasis. Extranodal natural killer/T-cell lymphoma, nasal type may primarily arise in the orbit without nasal involvement. Early discovery, early biopsy and diagnosis and early appropriate treatment can successfully control tumors and improve prognosis.
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Affiliation(s)
- Dalan Jing
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Debo You
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Ziyuan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
- Correspondence: (Z.L.); (W.W.); Tel.: +86-13581780059 (Z.L.); +86-13901193152 (W.W.)
| | - Wei Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
- Correspondence: (Z.L.); (W.W.); Tel.: +86-13581780059 (Z.L.); +86-13901193152 (W.W.)
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9
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Bhari A, Agrawal S, Pushker N, Das P. Nasal natural killer/T-cell lymphoma mimicking orbital cellulitis: A diagnostic dilemma. Med J Armed Forces India 2022. [DOI: 10.1016/j.mjafi.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Bitner BF, Htun NN, Wang BY, Brem EA, Kuan EC. Sinonasal lymphoma: A primer for otolaryngologists. Laryngoscope Investig Otolaryngol 2022; 7:1712-1724. [PMID: 36544932 PMCID: PMC9764779 DOI: 10.1002/lio2.941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/28/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Sinonasal lymphomas are a rare entity that commonly present with nonspecific sinonasal symptoms and are often recognized immediately. Through this review, we aim to summarize important principles in diagnosis and treatment of sinonasal lymphomas, with the goal of disseminating the current knowledge of this under-recognized malignancy to otolaryngologists. Methods Systemic review using PRISMA guidelines of foundational scholarly articles, guidelines, and trials were reviewed focusing on clinical characteristics of key sinonasal lymphoma subtypes, along with available treatments in the otolaryngology, medical oncology, and radiation oncology literature. Results Sinonasal lymphoma are derived from clonal proliferation of lymphocytes at various stages of differentiation, of which diffuse large B-cell lymphoma (DLBCL) and extranodal natural killer/T-cell lymphoma (ENKTL) are the most common. Diagnosis and staging require biopsy with immunohistochemistry in conjunction with imaging and laboratory studies. Treatment is ever evolving and currently includes multi-agent chemotherapy and/or radiation therapy. Conclusion Otolaryngologists may be the first to recognize sinonasal lymphoma, which requires a comprehensive workup and a multidisciplinary team for treatment. Symptoms are nonspecific and similar to many sinonasal pathologies, and it is crucial for otolaryngologists to keep a broad differential. Level of Evidence 5.
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Affiliation(s)
- Benjamin F. Bitner
- Department of Otolaryngology – Head and Neck SurgeryUniversity of California Irvine Medical CenterOrangeCaliforniaUSA
| | - Nyein Nyein Htun
- Department of Pathology and Laboratory MedicineUniversity of California Irvine Medical CenterOrangeCaliforniaUSA
| | - Beverly Y. Wang
- Department of Pathology and Laboratory MedicineUniversity of California Irvine Medical CenterOrangeCaliforniaUSA
| | - Elizabeth A. Brem
- Department of Medicine, Division of Hematology and OncologyUniversity of California Irvine Medical CenterOrangeCaliforniaUSA
| | - Edward C. Kuan
- Department of Otolaryngology – Head and Neck SurgeryUniversity of California Irvine Medical CenterOrangeCaliforniaUSA,Department of Neurological SurgeryUniversity of California Irvine Medical CenterOrangeCaliforniaUSA
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11
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Kawaura R, Ohnishi M, Hori T. Recurrence 14 Years After Initial Treatment of Extranodal NK/T Cell Lymphoma, Nasal Type. Cureus 2022; 14:e24177. [PMID: 35602784 PMCID: PMC9116688 DOI: 10.7759/cureus.24177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 11/26/2022] Open
Abstract
Extranodal NK/T cell lymphoma, nasal type (ENKL) primarily involves the nasal cavity. Although patients might visit an otorhinolaryngologist with nasal symptoms, such as nasal obstruction and epistaxis, it would be difficult to make a diagnosis correctly. We present a case of ENKL in which the patient had been in remission after initial treatment and relapsed 14 years after treatment. The patient had a worsening of nasal symptoms before the recurrence, but on this occasion, treatment such as sinusitis was successful in alleviating the symptoms. Although recurrence of lymphoma 10 years after treatment is rare, the possibility of recurrence should always be considered in post-malignant lymphoma cases as with any malignant tumor.
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Affiliation(s)
- Ryo Kawaura
- Department of Head and Neck Surgery-Otolaryngology, Ogaki Municipal Hospital, Ogaki, JPN
| | - Masami Ohnishi
- Department of Head and Neck Surgery-Otolaryngology, Ogaki Municipal Hospital, Ogaki, JPN
| | - Tomoya Hori
- Department of Head and Neck Surgery-Otolaryngology, Ogaki Municipal Hospital, Ogaki, JPN
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12
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Abstract
ABSTRACT Sinonasal cavity is an important subsite in head and neck tumors. There are a myriad of malignancies that present within this area. Adequate staging for treatment planning requires multimodality evaluation. Magnetic resonance imaging (MRI) forms an important component in the evaluation of sinonasal tumors. We sought to review the most common sinonasal tumors, including sinonasal anatomy, clinical features, and common imaging features. A literature review was performed to evaluate common sinonasal tumors. Owing to the different tissue types within the sinonasal cavity, there are multiple different tumor pathologies within the sinonasal compartment. Most present in adults although some present in the young. Many of these tumor types have imaging overlaps, although some have a characteristic appearance. MRI can aid in soft tissue delineation, evaluation of multicompartmental extension, intracranial spread, and perineural spread. Sinonasal tumors are a heterogeneous group for which soft tissue delineation via MRI forms an important role in ensuring adequate treatment planning to improve outcomes, decreasing morbidity, and improve functional outcomes.
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Affiliation(s)
- Akinrinola Famuyide
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | - Amy Juliano
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Gul Moonis
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
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13
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Zeng J, Liu L, Li J, Huang Q, Pi L, Jin K. MRI features of different types of sinonasan rhabdomyosarcomas: a series of eleven cases. Dentomaxillofac Radiol 2021; 50:20210030. [PMID: 33835837 DOI: 10.1259/dmfr.20210030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To retrospectively analyze magnetic resonance imaging (MRI) features of various pathological subtypes of sinonasal rhabdomyosarcoma (RMS) and explore correlations between imaging features and pathological subtypes. METHODS In total, 11 cases with embryonal, alveolar or pleomorphic sinonasal RMSs, confirmed by surgical pathology, were selected. Their characteristics and distinctive imaging features were analysed, and the correlation between pathology and imaging features was explored. RESULTS Bone destruction was observed in all 11 cases with RMS. Expansive growth was predominant in three alveolar and three embryonal RMS cases, and creeping growth was predominant in two alveolar, two embryonal and one pleomorphic RMS cases. Signs of residual mucosa were observed in all 11 cases, and 10 cases showed involvement of multiple sinus cavities and orbital cavities. All cases exhibited mild-to-intermediate enhancement. CONCLUSION Sinonasal RMSs have the following characteristic MRI features: ethmoid sinuses and middle nasal conchae are the prevalent sites; lesions are mainly of mild enhancement; tumours exhibit signs of residual mucosa, mild-to-intermediate enhancement and frequent orbital involvement; bone invasion and bone destruction are frequently observed; and haematogenous metastasis is not as common as lymphatic metastasis. RMSs of various pathological subtypes were not significantly distinct by imaging.
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Affiliation(s)
- Junjie Zeng
- Department of Radiology, Hunan Children's Hospital, Changsha, China
| | - Lan Liu
- Department of Radiology, NanChang University cancer hospital, Nanchang, China
| | - Jiayong Li
- Department of Radiology, People's Hospital of Heyuan City, Heyuan, China
| | - Qiling Huang
- Department of Radiology, People's Hospital of Heyuan City, Heyuan, China
| | - Leiming Pi
- Department of Radiology, People's Hospital of Heyuan City, Heyuan, China
| | - Ke Jin
- Department of Radiology, Hunan Children's Hospital, Changsha, China
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14
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Maxillary Sinus Natural Killer/T-Cell Extranodal Lymphoma Mimicking a Dentoalveolar Abscess. Case Rep Dent 2019; 2019:6701783. [PMID: 30937196 PMCID: PMC6415291 DOI: 10.1155/2019/6701783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/16/2019] [Accepted: 02/06/2019] [Indexed: 11/17/2022] Open
Abstract
Extranodal natural killer/T-cell lymphoma (ENKL) is an aggressive and infrequent malignant neoplasm. Early sinonasal ENKL clinical symptomatology is often not specific which can mimic several clinical odontogenic processes such as dentoalveolar abscesses. A 41-year-old female was referred to our institution due to facial pain with skin rash, fever, and intraoral swelling in the left side of the maxillary region. Computed tomography (CT) revealed a soft tissue hypodense area in the left side with bone discontinuity in anterior and lateral maxillary sinuses. Initial laboratorial tests showed no alterations on hemogram, coagulation profile, and immune phenotype (CD3+/CD4+). However, the lesion progressed fastly showing an evident growth, so it was decided that an intraoral biopsy should be performed. The diagnosis was sinonasal ENKLs. This case is an example that the rare T-cell lymphoma can mimic an odontogenic lesion, thus puzzling the clinician. Fortunately, the rapid growth of the lesion prompted the correct diagnosis and early treatment.
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15
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Guan P, Chen Z, Chu L, Zhen L, Zhang L, Pan L, Liu W, Liu R. Extranodal NK/T-cell lymphoma in adolescents: imaging findings of a consecutive 7-year case series. J Int Med Res 2019; 47:1210-1220. [PMID: 30727780 PMCID: PMC6421368 DOI: 10.1177/0300060518822406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives Extranodal NK/T-cell lymphoma is reportedly a rare but emerging type of
lymphoma in adolescents. The present study was performed to specify its
imaging characteristics. Methods Our hospital’s picture archiving and communication systems were searched from
January 2009 to December 2016. We identified 13 patients aged <18 years
with pathologically confirmed extranodal NK/T-cell lymphoma in the head and
neck region. The computed tomography and magnetic resonance images were
reviewed to summarize the imaging characteristics of extranodal NK/T-cell
lymphoma in adolescents. Results The mean age at onset was 15.2 ± 1.46 years (range, 12–17 years) with a
male:female ratio of 1.17:1.00. Most of the patients (n = 10) displayed
nasal cavity and/or paranasal involvement. The tumor was homogeneous in both
computed tomography and magnetic resonance images and showed slight
enhancement. No calcification or liquefactive necrosis was observed.
Adjacent structures were usually involved. Conclusion Suggestive imaging characteristics could acquaint specialists with extranodal
NK/T-cell lymphoma in adolescents, facilitating improved early recognition
of the diagnosis and helping to improve the patient’s outcome.
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Affiliation(s)
- Pujun Guan
- 1 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,*These authors contributed equally to this work
| | - Zihang Chen
- 2 Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.,3 Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.,*These authors contributed equally to this work
| | - Lei Chu
- 1 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhen
- 4 Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Li Zhang
- 3 Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Pan
- 3 Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Weiping Liu
- 2 Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Rongbo Liu
- 1 Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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16
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Jiang M, Lu H, Lu C, Geng X, Jia Y, Wang P, Qian W, Huang H, Shan X. Specific Soft-Tissue Invasion and LMP1 Expression Are Potential Indicators of Extranodal NK/T Cell Lymphoma, Nasal Type. Med Sci Monit 2018; 24:7603-7613. [PMID: 30356034 PMCID: PMC6213871 DOI: 10.12659/msm.909152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/21/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Extranodal NK/T cell lymphoma, nasal type (ENKTL-NT) is difficult to distinguish from nasal polyps and inverted papilloma, leading to its high misdiagnosis ratio. The aim of this study was to investigate its potential prognostic indicators. MATERIAL AND METHODS Kaplan-Meier method was used to calculate overall survival (OS) rate. Cox proportional hazards regression was used to analyze risk ratios (ORs) with 95% confidence intervals (CIs). RESULTS Nasal ala infiltration and nasal floor thickness >2.0 mm or nasal septum thickness >2.5 mm were potential prognostic factors for OS (p=0.0323 and 0.0072, respectively). Cox proportional-hazards regression indicated that high LMP1 expression and the nasal floor thickness >2.0 mm or nasal septum thickness >2.5 mm were the independent risk factors for poor OS of ENKTL-NT (HR=3.0655, p=0.028; HR=2.3650, p=0.0452, respectively). In the subgroup analysis, the OS rate was lower when the nasal floor thickness >2.0 mm or nasal septum thickness >2.5 mm in the patients who had high expression of LMP1 (p=0.0651), whereas high LMP1 expression increased the risk of worse prognostic outcome in patients with deep infiltration thickness. Thus, high LMP1 expression may contribute to the tissue invasion of ENKTL-NT. CONCLUSIONS Any patient with nasal ala soft-tissue invasion, nasal floor thickness >2.0 mm/nasal septum thickness >2.5 mm on CT imaging or high LMP1 expression should prompt immediate histopathologic diagnosis to rule out ENKTL-NT in clinical practice.
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Affiliation(s)
- Min Jiang
- Department of Medical Imaging, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China
| | - Haoyue Lu
- School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, P.R. China
| | - Chao Lu
- Department of Medical Imaging, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China
| | - Xingdong Geng
- Department of Medical Imaging, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China
| | - Yingjun Jia
- Department of Medical Imaging, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China
| | - Peng Wang
- Department of Medical Imaging, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China
| | - Wei Qian
- Department of Otorhinolaryngology, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China
| | - Hao Huang
- Department of Medical Imaging, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China
| | - Xiuhong Shan
- Department of Medical Imaging, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, P.R. China
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17
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Kim SH, Mun SJ, Kim HJ, Kim SL, Kim SD, Cho KS. Differential Diagnosis of Sinonasal Lymphoma and Squamous Cell Carcinoma on CT, MRI, and PET/CT. Otolaryngol Head Neck Surg 2018; 159:494-500. [PMID: 29661053 DOI: 10.1177/0194599818770621] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective The purpose of this study was to analyze computed tomography (CT) and magnetic resonance (MR) images and to evaluate the maximum standardized uptake value (SUV max) of positron emission tomography (PET)/CT parameters between sinonasal non-Hodgkin's lymphoma (NHL) and squamous cell carcinoma (SCC), knowing the imaging features that distinguish sinonasal NHL from SCC. Study Design Case series with chart review. Setting University tertiary care facility. Subjects and Methods We analyzed the features on CT, MR imaging, and PET/CT of 78 patients diagnosed with sinonasal NHL or SCC histopathologically. The CT (n = 34), MRI (n = 25), and PET/CT (n = 33) images of 39 patients with sinonasal NHL and the CT (n = 38), MR (n = 28), and PET/CT (n = 31) images of 39 patients with SCC were evaluated. The sinonasal NHL was diagnosed as natural killer/T-cell lymphoma (n = 28) and diffuse large B-cell lymphoma (n = 11). Results Patients with sinonasal NHL had a larger tumor volume and higher tumor homogeneity than patients with SCC on T2-weighted and postcontrast MR images. Most of the sinonasal NHL and SCC showed a high degree of enhancement. The apparent diffusion coefficient (ADC) values and adjacent bone destruction were significantly lower in sinonasal NHL than in SCC. However, cervical lymphadenopathy, Waldeyer's ring involvement, and PET/CT SUV max showed no significant differences between sinonasal NHL and SCC. Conclusion CT and MR images of sinonasal masses showing a bulky lesion, marked homogeneity, and low ADC values without adjacent bone destruction are more suggestive of sinonasal NHL than SCC.
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Affiliation(s)
- Seok-Hyun Kim
- 1 Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Sue-Jean Mun
- 1 Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hak-Jin Kim
- 2 Department of Radiology, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Seon Lin Kim
- 1 Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Sung-Dong Kim
- 1 Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Kyu-Sup Cho
- 3 Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
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18
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Watal P, Bathla G, Thaker S, Sato TS, Moritani T, Smoker WRK. Multimodality Imaging Spectrum of the Extranodal Lymphomas in the Head and Neck-A Pictorial Review. Curr Probl Diagn Radiol 2017; 47:340-352. [PMID: 29174137 DOI: 10.1067/j.cpradiol.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/14/2017] [Accepted: 07/26/2017] [Indexed: 02/06/2023]
Abstract
Lymphoma is the second most common malignant neoplasm of the head and neck region, involving the nodal and/or extranodal sites or both in a variable fashion. Lymphoma may mimic a variety of tumors in this region depending on the subsite involved. The usual presentation of lymphomatous disease is presence of multiple enlarged, often conglomerate, lymph nodes without significant necrosis. Extranodal lymphomas demonstrate more complex radiologic features, but careful evaluation can identify distinct imaging patterns to suggest extranodal lymphomatous disease from other more common lesions. Knowledge of these imaging features can help raise suspicion for lymphoma as a differential consideration. This can be of critical importance since further work-up and management can be vastly different between lymphomatous disease and other disease entities. The authors present a pictorial review of the spectrum of imaging findings in extranodal head and neck lymphomas.
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Affiliation(s)
- Pankaj Watal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Girish Bathla
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Siddharth Thaker
- Department of Radiology, M P Shah Government Medical College & Government General Hospital, Jamnagar, Gujarat, India
| | - T Shawn Sato
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Toshio Moritani
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Wendy R K Smoker
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
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Mangrio SA, Dhanani R, Ikram M, Tariq MU. Lethal midline granuloma: a case report. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2017. [DOI: 10.4103/1012-5574.199415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Mikhail M, Michel RP, Chankowsky J, Arthurs B. Epiphora as first presenting sign of primary extranodal NK/T-cell lymphoma of the lacrimal sac. Orbit 2017; 36:19-21. [PMID: 28146362 DOI: 10.1080/01676830.2017.1279649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 28-year-old Caucasian female presented with a six-month history of epiphora of the right eye. Diagnostic lacrimal syringing revealed obstruction of the right nasolacrimal duct. During external dacryocystorhinostomy (DCR), the lacrimal sac had an unusual papillary appearance. Frozen sections suggested malignant lymphoid cells. Pathologic examination revealed extranodal NK/T-cell lymphoma, nasal type. Imaging revealed a mass lesion centered on the lacrimal sac. The authors describe the youngest Caucasian patient with a primary NK/T-cell lymphoma of the lacrimal sac, as well as the first case presenting with epiphora as the sole presenting symptom, reported in the literature. Extranodal NK/T-cell lymphomas rarely occur in the orbit, and are known to be rapidly growing, aggressive lesions. Despite chemotherapy, the patient succumbed to her disease twelve months after diagnosis. Lacrimal surgeons should maintain a high index of suspicion in all cases of primary nasolacrimal duct obstruction. Pre- or intra-operative clinical suspicion of malignancy in the lacrimal sac necessitates biopsy.
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Affiliation(s)
- Mikel Mikhail
- a Department of Ophthalmology and Visual Sciences , McGill University , Montreal , Quebec , Canada
| | - René P Michel
- b Department of Pathology , McGill University , Montreal , Quebec , Canada
| | - Jeffrey Chankowsky
- c Department of Diagnostic Radiology , McGill University , Montreal , Quebec , Canada
| | - Bryan Arthurs
- a Department of Ophthalmology and Visual Sciences , McGill University , Montreal , Quebec , Canada
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21
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Abstract
Natural killer T-cell lymphoma (NKTCL) is a rare and aggressive condition with a high mortality rate. It is most commonly seen in the nasal sinuses, generally affecting the orbit by direct extension. Primary orbital NKTCL is even more rare, with only a few published cases with occasional secondary nasal involvement. This malignancy can present as a "masquerade syndrome," delaying proper diagnosis and treatment. Biopsy is required for diagnosis, which shows specific histopathological characteristics. Radiation and chemotherapy are the mainstay of treatment. Newer chemotherapies show improved prognosis.
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Affiliation(s)
- Juan C Jiménez-Pérez
- a Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| | - Michael K Yoon
- a Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
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22
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Wu RY, Liu K, Wang WH, Jin J, Song YW, Wang SL, Liu YP, Ren H, Fang H, Liu QF, Yang Y, Chen B, Qi SN, Lu NN, Tang Y, Tang Y, Li N, Ouyang H, Li YX. Patterns of Primary Tumor Invasion and Regional Lymph Node Spread Based on Magnetic Resonance Imaging in Early-Stage Nasal NK/T-cell Lymphoma: Implications for Clinical Target Volume Definition and Prognostic Significance. Int J Radiat Oncol Biol Phys 2016; 97:50-59. [PMID: 27816363 DOI: 10.1016/j.ijrobp.2016.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/06/2016] [Accepted: 09/10/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to determine the pathways of primary tumor invasion (PTI) and regional lymph node (LN) spread based on magnetic resonance imaging (MRI) in early-stage nasal NK/T-cell lymphoma (NKTCL), to improve clinical target volume (CTV) delineation and evaluate the prognostic value of locoregional extension patterns. METHODS AND MATERIALS A total of 105 patients with newly diagnosed early-stage nasal NKTCL who underwent pretreatment MRI were retrospectively reviewed. All patients received radiation therapy with or without chemotherapy. RESULTS The incidences of PTI and regional LN involvement were 64.7% and 25.7%, respectively. Based on the incidence of PTI, involved sites surrounding the nasal cavity were classified into 3 risk subgroups: high-risk (>20%), intermediate-risk (5%-20%), and low-risk (<5%). The most frequently involved site was the nasopharynx (35.2%), followed by the maxillary (21.9%) and ethmoid (21.9%) sinuses. Local disease and regional LN spread followed an orderly pattern without LN skipping. The retropharyngeal nodes (RPNs) were most frequently involved (19.0%), followed by level II (11.4%). The 5-year overall survival (OS), progression-free survival (PFS), and locoregional control (LRC) rates for all patients were 72.8%, 65.2%, and 90.0%, respectively. The presence of PTI and regional LN involvement based on MRI significantly and negatively affected PFS and OS. CONCLUSIONS Early-stage nasal NKTCL presents with a high incidence of PTI but a relatively low incidence of regional LN spread. Locoregional spread followed an orderly pattern, and PTI and regional LN spread are powerful prognostic factors for poorer survival outcomes. CTV reduction may be feasible for selected patients.
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Affiliation(s)
- Run-Ye Wu
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Liu
- Department of Imaging Diagnosis, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei-Hu Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hua Ren
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing-Feng Liu
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Yang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Ouyang
- Department of Imaging Diagnosis, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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23
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Abstract
INTRODUCTION Extranodal NK/T-cell lymphoma nasal type is a distinct clinicopathologic entity. The most common initial site of presentation is the nasopharyngeal area, but non-nasals sites including the skin and the gastrointestinal tract may be affected. AREAS COVERED The diagnosis and management of NK/T-cell lymphoma is discussed, based on a literature search on PubMed. NK/T-cell lymphoma are typically positive for CD3 (cytoplasmic), CD56, cytotoxic markers (granzyme B, TIA1) and Epstein Barr virus (EBV). Plasma EBV DNA is an accurate surrogate biomarker for lymphoma load. For stage I/II nasal lymphoma, a combination of chemotherapy and radiotherapy yields the best results. Concomitant chemoradiotherapy and sequential chemotherapy and radiotherapy give similar response rates and survivals. For stage III/IV nasal lymphoma and non-nasal lymphomas, chemotherapy is the mainstay of treatment. Conventional anthracycline-based regimens are ineffective. Recommended chemotherapy protocols are based on the use of L-asparaginase combined with other effective drugs. Durable remission can be expected in at least 60% of patients irrespective of stage. Prognostically models based on clinicopathologic parameters and EBV DNA load are useful in stratification of patients for therapy. Expert commentary: Current treatment leads to long-term survival in a significant proportion of patients. For relapsed patients, novel strategies are needed.
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Affiliation(s)
- Eric Tse
- a Department of Medicine , Queen Mary Hospital , Hong Kong , China
| | - Yok-Lam Kwong
- a Department of Medicine , Queen Mary Hospital , Hong Kong , China
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24
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Abstract
Imaging evaluation of sinonasal tumors is most often conducted with computed tomography, which excels at identifying the effects of these masses on adjacent osseous structures, and magnetic resonance imaging that is ideal for distinguishing pathologic masses from mucosal thickening and fluid that are common in the sinonasal spaces and depicting extension into the surrounding soft tissues, orbits, and intracranial compartment. Accordingly, the two studies are complementary exams and both are commonly utilized in the assessment of these masses. Less commonly, positron emission tomography can provide additional metabolic evaluation of potential metastatic disease in patients with malignant disease. While these imaging modalities are excellent for the portrayal of an abnormality, there is considerable overlap in the imaging appearance of these tumors and specific imaging manifestations linked to a particular tumor are frequently lacking. Therefore, while the mass may be readily identified, narrowing the differential diagnosis to a single specific entity is rare. Nevertheless, cross-sectional imaging plays an essential role in patient management and valuable guidance for successful biopsy or surgical resection in virtually all cases. This review emphasizes essential imaging manifestations that correlate with sinonasal tumors in general and highlight certain features that may implicate a specific disease process.
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Affiliation(s)
- Kelly K. Koeller
- Department of Radiology, Neuroradiology Section, American Institute for Radiologic Pathology, Silver Spring, MD USA ,Mayo Clinic, 200 First Street SW, Rochester, MN USA
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25
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Yan Z, Huang HQ, Wang XX, Gao Y, Zhang YJ, Bai B, Zhao W, Jiang WQ, Li ZM, Xia ZJ, Lin SX, Xie CM. A TNM Staging System for Nasal NK/T-Cell Lymphoma. PLoS One 2015; 10:e0130984. [PMID: 26098892 PMCID: PMC4476596 DOI: 10.1371/journal.pone.0130984] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/26/2015] [Indexed: 12/14/2022] Open
Abstract
Ann Arbor stage has limited utility in the prognostication and treatment decision making in patients with NK/T-cell lymphoma (NKTCL), as NKTCL is almost exclusively extranodal and the majority is localized at presentation for which radiotherapy is the most important treatment and local invasiveness is the most important prognostic factor. In this study, we attempted to establish a TNM (Tumor-Node-Metastasis) staging system for nasal NKTCL (N-NKTCL). The staging rules of other head and neck cancers were used as reference along with the data of our 271 eligible patients. The primary tumor was classified into T1 to T4, and cervical lymph node metastasis was classified into N0 to N2 according to the extent of involvement. Any lesions outside the head and neck were classified as M1. N-NKTCL thereby was classified into four stages: stage I comprised T1-2N0M0; stage II comprised T1-2N1M0 and T3N0M0; stage III comprised T3N1M0, T1-3N2M0, and T4N0-2M0; and stage IV comprised TanyNanyM1. This staging system showed excellent performance in prognosticating survival. In the current series, the 5-year survival rates of patients with stages I, II, III, and IV N-NKTCL were 92%, 64%, 23%, and 0, respectively. Moreover, the predictive value of several currently used factors was abrogated in the presence of the TNM stage. The TNM staging system is highly effective in stratifying tumor burden and survival risk, which may have significant implications in the treatment decision making for patients with N-NKTCL.
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Affiliation(s)
- Zheng Yan
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Stage Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Hui-qiang Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Stage Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
- * E-mail:
| | - Xiao-xiao Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Stage Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Yan Gao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Stage Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Yu-jing Zhang
- Stage Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Bing Bai
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Stage Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Wei Zhao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Stage Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Wen-qi Jiang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Stage Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Zhi-ming Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- Stage Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Zhong-jun Xia
- Stage Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
- Department of Hematology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Su-xia Lin
- Stage Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Chuan-miao Xie
- Stage Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
- Medical Imaging Department, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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Cho HJ, Jang MS, Hong SD, Kim SJ, Ahn YC, Oh D, Ko YH, Kim HY, Dhong HJ, Chung SK, Kim WS. Nasal endoscopic evaluation and its impact on survival in patients with stage I/II extranodal natural killer/T-cell lymphoma, nasal type. Int Forum Allergy Rhinol 2015; 5:960-6. [PMID: 26039707 DOI: 10.1002/alr.21564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 04/22/2015] [Accepted: 05/02/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Endoscopic findings of extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, are heterogeneous, but not fully understood. The objective of this study was to evaluate the role of nasal endoscopic examination and its implications for treatment of stage I/II ENKTL. METHODS This retrospective study included 60 consecutive patients diagnosed with stage I/II ENKTL, nasal type, from 2000 to 2011. RESULTS The endoscopic findings were classified into early (45%) and advanced (55%) lesions. Furthermore, the primary tumor extent assessed by endoscopy was significantly correlated with the radiologic imaging (p < 0.001). The results of univariate analysis showed that the patients with advanced lesions had worse overall survival (p = 0.004) and disease-free survival (p = 0.001) than those with early lesions. In multivariate analysis, advanced lesions on nasal endoscopy was an independent prognostic factor (p = 0.024; hazard ratio 5.29; 95% confidence interval, 1.25-22.39). CONCLUSION We found that nasal endoscopic findings were important prognostic factors in stage I/II ENKTL, nasal type, suggesting that comprehensive endoscopic evaluation of primary tumor should be performed in this setting.
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Affiliation(s)
- Hyun-Jin Cho
- Department of Otorhinolaryngology, Gyeongsang National University Hospital, Jinju, Korea
| | - Min-Seok Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hun-Jong Dhong
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Kyu Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Deshpande SS, Kane S, Arya S. Extramedullary plasmacytoma in the carotid space: Expanding the differential diagnosis. Indian J Radiol Imaging 2014; 24:410-4. [PMID: 25489135 PMCID: PMC4247511 DOI: 10.4103/0971-3026.143905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Plasma cell neoplasms have been classified into various types, with a range of clinical and radiological presentations. Extramedullary plasmacytoma (EMP) is a subset of plasma cell neoplasms which presents as an isolated non-osseous soft tissue mass. Though carotid space neoplasms are commonly encountered, EMP in the carotid space is rare and seldom considered in the initial differential diagnosis of a carotid space mass. These tumors can be treated by surgery or radiotherapy. On the other hand, the commonly encountered tumors in the carotid space are treated surgically. Also, it is mandatory to exclude multiple myeloma in the patients presenting with EMP. Hence, accurate and early diagnosis has therapeutic and prognostic implications. We report a rare case of EMP of the carotid space, describing the imaging features and the differential diagnoses with clues pointing to this rare entity.
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Affiliation(s)
| | - Shubhada Kane
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Supreeta Arya
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Hsu YP, Chang PH, Lee TJ, Hung LY, Huang CC. Extranodal natural killer/T-cell lymphoma nasal type: detection by computed tomography features. Laryngoscope 2014; 124:2670-5. [PMID: 25124693 DOI: 10.1002/lary.24876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/16/2014] [Accepted: 07/21/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Nasal natural killer/T-cell lymphoma (NKTL) often has an infiltrative pattern in computed tomography that makes them difficult to distinguish from benign inflammatory diseases. This study aimed to design a method of measuring the thickness of the nasal floor and nasal septum, determine the critical value of mucosal thickness that may implicate these NKTL cases from benign inflammatory disease, and finally make a complete flowchart to detect NKTL with minimal mistake. STUDY DESIGN Thirty-two patients with nasal NKTL and 173 patients with severe chronic rhinosinusitis with or without polyposis were enrolled. The patients' data were collected retrospectively. METHODS All patients underwent standard computed tomography of the paranasal sinuses. The coronal section near the vertical part of the ground lamina was chosen for measurement, and the thickest points along the nasal floor and septum were measured. RESULTS Patients with NKTL had thicker nasal floors and/or septa than those with chronic rhinosinusitis, recurrent sinusitis, or pansinusitis (P < .001). If the cutoff points of the nasal floor and nasal septum thickness were set at 2.0 mm and 2.5 mm, respectively, the probability of being thicker than the corresponding points in the CRS group was <2%, and the possibility of other diagnoses should be considered. CONCLUSIONS Nasal floor mucosal thickness >2.0 mm or nasal septum mucosal thickness >2.5 mm may be indicators serving as one of several important hints for implicit NKTL. Finally, we established a diagnostic flowchart to include all of these important hints. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Yin-Ping Hsu
- Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
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Wang X, Zhang Z, Chen Q, Li J, Xian J. Effectiveness of 3 T PROPELLER DUO diffusion-weighted MRI in differentiating sinonasal lymphomas and carcinomas. Clin Radiol 2014; 69:1149-56. [PMID: 25115306 DOI: 10.1016/j.crad.2014.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/22/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
Abstract
AIM To evaluate the value of 3 T Periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) DUO diffusion-weighted MRI (DW-MRI) in differentiating sinonasal lymphomas from carcinomas. MATERIALS AND METHODS PROPELLER DUO DW-MRI was performed in 23 patients with sinonasal lymphomas and 28 patients with carcinomas histologically confirmed at 3 T MRI. Apparent diffusion coefficients (ADCs) were obtained with two different b-values (b = 0 and 700 s/mm(2), b = 0 and 1000 s/mm(2)) and two different regions of interest (ROIs) sampling strategies [whole section (WS), partial section (PS)], respectively. Difference in ADCs between sinonasal lymphomas and carcinomas was evaluated using the independent samples t-test or Mann-Whitney U-test. The utility of ADC thresholds for discriminating between them was evaluated by receiver operating characteristic analysis. RESULTS ADCs of sinonasal lymphomas (WS ADCb0,700, 0.838 × 10(-3) mm(2)/s) were significantly (p < 0.001) lower than those of carcinomas (WS ADCb0,700, 1.396 × 10(-3) mm(2)/s). Using a WS ADC b0,700 value of 1.040 × 10(-3) mm(2)/s as the threshold value effectively differentiated sinonasal lymphomas from carcinomas with 100% sensitivity, 82.1% specificity, and 82.1% positive and 100% negative predictive values and 90.2% accuracy (b = 0, 700 s/mm(2)). There was no significant difference in diagnostic ability between different b-values settings (p > 0.05) and different sampling strategies of ROIs (p > 0.05), respectively. Additionally, there was significant differences in the ADCs between diffuse large B-cell lymphomas and natural killer (NK)/T-cell lymphomas (p < 0.05). CONCLUSION PROPELLER DUO DW-MRI can effectively differentiate sinonasal lymphomas from carcinomas.
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Affiliation(s)
- X Wang
- From the Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Z Zhang
- From the Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Q Chen
- From the Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - J Li
- From the Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - J Xian
- From the Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Nasal Diseases, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Bianchi FA, Gerbino G, Tosco P, Tanteri G, Gatti G, Ramieri G. Progressive midfacial bone erosion and necrosis: case report and differential diagnosis. J Craniomaxillofac Surg 2014; 42:1698-703. [PMID: 25048049 DOI: 10.1016/j.jcms.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/31/2014] [Accepted: 06/03/2014] [Indexed: 11/26/2022] Open
Abstract
A 31-year-old woman presented with a large oro-nasal communication (ONC), loss of vomer and significant nasal cartilage and nose deformity. Physical examination of the patient revealed a typical midline destructive lesion (MDL) with nasal septum and hard/soft palate perforation with a friable granular surface and a large amount of necrotic tissues. Medical history was unremarkable and the patient denied previous local trauma, including surgical procedures or drug assumption. Pathological examination revealed the presence of necrosis and chronic inflammation. MDLs have numerous etiologies. Signs and symptoms of MDLs can be similar and an accurate diagnosis may be elusive. We hereby present detailed clinicopathological findings.
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Affiliation(s)
- Francesca Antonella Bianchi
- Department of Surgical Sciences (Head: Prof. G. Ramieri), Maxillofacial Surgery Section, San Giovanni Battista Hospital, University of Turin, Corso A.M. Dogliotti 14, Turin 10126, Italy.
| | - Giovanni Gerbino
- Department of Surgical Sciences (Head: Prof. G. Ramieri), Maxillofacial Surgery Section, San Giovanni Battista Hospital, University of Turin, Corso A.M. Dogliotti 14, Turin 10126, Italy
| | - Paolo Tosco
- Department of Surgical Sciences (Head: Prof. G. Ramieri), Maxillofacial Surgery Section, San Giovanni Battista Hospital, University of Turin, Corso A.M. Dogliotti 14, Turin 10126, Italy
| | - Giulia Tanteri
- Department of Surgical Sciences (Head: Prof. G. Ramieri), Maxillofacial Surgery Section, San Giovanni Battista Hospital, University of Turin, Corso A.M. Dogliotti 14, Turin 10126, Italy
| | - Gaia Gatti
- Department of Pathology (Head: Prof. G. Inghirami), San Giovanni Battista Hospital, University of Turin, Corso A.M. Dogliotti 14, Turin 10126, Italy
| | - Guglielmo Ramieri
- Department of Surgical Sciences (Head: Prof. G. Ramieri), Maxillofacial Surgery Section, San Giovanni Battista Hospital, University of Turin, Corso A.M. Dogliotti 14, Turin 10126, Italy
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Riet FG, Canova CH, Gabarre J, Ben Hassine S, Kamsu Kom L, Mazeron JJ, Feuvret L. [Radiation therapy of sinonasal natural killer/T-cell lymphoma]. Cancer Radiother 2014; 18:147-53; quiz 161, 163. [PMID: 24462054 DOI: 10.1016/j.canrad.2013.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 11/22/2013] [Accepted: 11/27/2013] [Indexed: 11/18/2022]
Abstract
Natural killer (NK)/T-cell lymphoma are part of lymphoproliferative diseases, they are rare in Europe and the United States but relatively common in Asia and South America. Natural killer (NK)/T-cell lymphoma present clinically as destructive lesions of the upper aerodigestive tract with perforation of deep structures of the face, destruction of the palate or an invasion of orbits. Treatment modalities of these lymphomas are still discussed because of the lack of available studies and the rarity of this disease. Radiotherapy provides a rapid control of the disease and is positioned as a major treatment of localized stages of NK/T-cell lymphoma of the nasal cavity. We therefore studied the different forms of radiation therapy in the early stages of nasal NK/T-cell lymphoma.
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Affiliation(s)
- F-G Riet
- Service d'oncologie radiothéapie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - C-H Canova
- Service d'oncologie radiothéapie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - J Gabarre
- Service d'hépatologie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - S Ben Hassine
- Service d'oncologie radiothéapie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - L Kamsu Kom
- Service d'oncologie radiothéapie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - J-J Mazeron
- Service d'oncologie radiothéapie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - L Feuvret
- Service d'oncologie radiothéapie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Liu CH, Wang HH, Perng CL, Peng CK, Chian CF, Shen CH. Primary extranodal NK/T-cell lymphoma of the lung: Mimicking bronchogenic carcinoma. Thorac Cancer 2014; 5:93-6. [PMID: 26766981 DOI: 10.1111/1759-7714.12021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 12/10/2012] [Indexed: 11/30/2022] Open
Abstract
Primary extranodal natural killer/T- cell lymphoma, nasal type (NK/TCL) in the lung is extremely rare and associated with Epstein-Barr virus (EBV) infection. An 80-year-old male presented with hemoptysis, which had lasted three days. Physical examination revealed inspiratory crackles at the left lung base and massive splenomegaly. Chest radiograph shows a mass-like lesion in the left lower lung but no active lesion six months earlier. Computed tomography demonstrated a soft tissue mass (size: 6.6 × 5.1 cm) with increased ground-glass opacities in the left lower lobe, several pulmonary nodules, and mediastinal lymphadenopathy. Transthoracic needle biopsy of the left-lower-lobe lung mass was performed. The pathology revealed atypical lymphoid cell infiltration, which is immunoreactive for cytoplasmic CD3, CD30 and CD56, but not reactive for CK and CD20. EBV-encoded RNA (EBER) was also detected in these atypical lymphoid cells. The serum EBV DNA level was 7.03 × 10(6) copies/mL and subtype 1 EBV was identified. No evidence of lymphoma involvement was found in the extrathoracic site. Primary pulmonary lymphoma showing nasal-type NK/T-cell subtype was diagnosed. Chemotherapy with cyclophosphamide and prednisolone was initiated immediately but the patient deteriorated and died three weeks later. In conclusion, patients presenting with rapidly growing lung mass and massive splenomegaly raise the possibility of aggressive pulmonary lymphoma. Extranodal NK/T-cell lymphoma with high baseline plasma EBV DNA levels signifies poor prognosis. Identifying young high-risk patients may have benefits for early aggressive and successful treatment.
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Affiliation(s)
- Chia-Hsin Liu
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Hong-Hau Wang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Cherng-Lih Perng
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital Taipei, Taiwan; Graduate Institute of Pathology, National Defense Medical Center Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Chih-Feng Chian
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
| | - Chih-Hao Shen
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan
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Delayed diagnosis of nasal natural killer/t-cell lymphoma. Case Rep Otolaryngol 2013; 2013:918132. [PMID: 24396622 PMCID: PMC3874948 DOI: 10.1155/2013/918132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/22/2013] [Indexed: 11/17/2022] Open
Abstract
Midline destructive lesions of the face have multiple possible etiologies. The majority of these cases are found to be due to an extranodal lymphoma of natural killer/T-cell-type non-Hodgkins lymphoma (NKTL). Unfortunately, diagnosis is often delayed. With variable presenting complaints, including nonspecific issues like chronic rhinosinusitis or nasal congestion, initial treatments are aimed at these presumed diagnoses. Only as the lesion progresses do overt signs of destruction occur. As with our patient, who was initially treated for presumed infection and abscess, final diagnosis often does not occur until several months, and several antibiotic courses, from initial presentation. As such, it is important for this rare entity to remain in the clinician's differential diagnosis for nasal lesion.
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Abstract
PURPOSE OF REVIEW Extranodal natural killer (NK)/T-cell lymphoma, nasal-type is a highly aggressive disease more frequent in Asia than in Western countries. There is no consensus treatment. The outcome depends on disease stage. Localized NK/T-cell lymphomas often respond to radiotherapy. In contrast, patients who have extensive disease or who relapse after radiotherapy have a very poor prognosis. Overall, long-term survival in these lymphomas tends to be inferior to that for other aggressive lymphomas. This review focuses on the new management modalities in light of advances in risk stratification, patient monitoring and treatment strategies. RECENT FINDINGS Many parameters have been reported to correlate with prognosis and new staging systems have been elaborated. Detecting Epstein-Barr virus (EBV) in the bone marrow is important for staging and measuring EBV DNA in the serum improved monitoring response to therapy. Radiation modalities have been precised and new strategies combining radiation and chemotherapy have been proposed for patients with localized disease. The particular efficacy of L-asparaginase in this disease has been confirmed and L-asparaginase-based regimens have been studied in prospective trials for patients with refractory, relapsing or disseminated disease with good results. Laboratory studies may point the way toward new therapeutic approaches. SUMMARY Early-stage disease is treated by involved-field radiotherapy with adjuvant chemotherapy. L-Asparaginase-containing regimens are the mainstay of treatment for advanced or disseminated disease. The role of targeted therapies, autologous and allogeneic haematopoietic stem cell transplantation is yet to be clearly defined.
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Lima M. Aggressive mature natural killer cell neoplasms: from epidemiology to diagnosis. Orphanet J Rare Dis 2013; 8:95. [PMID: 23816348 PMCID: PMC3770456 DOI: 10.1186/1750-1172-8-95] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 06/21/2013] [Indexed: 12/12/2022] Open
Abstract
Mature natural killer (NK) cell neoplasms are classified by the World Health Organization into NK/T cell lymphoma, nasal type (NKTCL), aggressive NK-cell leukemia (ANKCL) and chronic lymphoproliferative disorders of NK-cells, the latter being considered provisionally. NKTCL and ANKCL are rare diseases, with higher prevalence in Asia, Central and South America. Most NKTCL present extranodal, as a destructive tumor affecting the nose and upper aerodigestive tract (nasal NKTCL) or any organ or tissue (extranasal NKTCL) whereas ANKCL manifests as a systemic disease with multiorgan involvement and naturally evolutes to death in a few weeks. The histopathological hallmark of these aggressive NK-cell tumors is a polymorphic neoplastic infiltrate with angiocentricity, angiodestruction and tissue necrosis. The tumor cells have cytoplasmatic azurophilic granules and usually show a CD45(+bright), CD2(+), sCD3(-), cytCD3epsilon(+), CD56(+bright), CD16(−/+), cytotoxic granules molecules(+) phenotype. T-cell receptor genes are in germ-line configuration. Epstein-Barr virus (EBV) -encoded membrane proteins and early region EBV RNA are usually detected on lymphoma cells, with a pattern suggestive of a latent viral infection type II. Complex chromosomal abnormalities are frequent and loss of chromosomes 6q, 11q, 13q, and 17p are recurrent aberrations. The rarity of the NK-cell tumors limits our ability to standardize the procedures for the diagnosis and clinical management and efforts should be made to encourage multi-institutional registries.
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Affiliation(s)
- Margarida Lima
- Department of Hematology, Laboratory of Cytometry, Hospital de Santo António, Centro Hospitalar do Porto, Rua D. Manuel II, s/n, 4099-001, Porto, Portugal.
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Huang Y, de Leval L, Gaulard P. Molecular underpinning of extranodal NK/T-cell lymphoma. Best Pract Res Clin Haematol 2013; 26:57-74. [DOI: 10.1016/j.beha.2013.04.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tlholoe MM, Kotu M, Khammissa RAG, Bida M, Lemmer J, Feller L. Extranodal natural killer/T-cell lymphoma, nasal type: 'midline lethal granuloma.' A case report. Head Face Med 2013; 9:4. [PMID: 23327615 PMCID: PMC3564726 DOI: 10.1186/1746-160x-9-4] [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] [Received: 09/13/2012] [Accepted: 01/11/2013] [Indexed: 11/10/2022] Open
Abstract
Extranodal natural killer/T cell lymphoma, nasal type, is a non-Hodgkin lymphoma, most commonly affecting the nasal cavity, paranasal sinuses and nasopharynx. Clinically it is characterised by destruction of facial tissues, commencing in the midline. In most cases it arises from malignant transformation of natural killer cells (NK); sometimes from malignant transformation of cytotoxic T cells.Extranodal NK/T cell lymphoma, nasal type, is rare, but even more rare in black persons. The purpose of this article is to report a severe case of extranodal NK/T cell lymphoma, nasal type, in an elderly black male.
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Affiliation(s)
- Martha M Tlholoe
- Department of Maxillofacial and Oral Surgery, University of Limpopo, Medunsa Campus, South Africa
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Ribeiro BNDF, Bahia PRV, Oliveira ALVSDM, Marchon Júnior JL. Síndrome do granuloma letal da linha média: um dilema diagnóstico. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000600013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A rara síndrome do granuloma letal da linha média apresenta difícil diagnóstico, em razão da grande variedade de doenças que podem causá-la e um desconhecimento pela maioria da classe médica. No presente artigo relatamos caso de paciente com esta doença, provocada por carcinoma epidermoide, chamando a atenção para os diagnósticos diferenciais e aspectos clínico-radiológicos que podem auxiliar no diagnóstico.
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Sandner A, Surov A, Bach AG, Kösling S. Primary extranodal Non-Hodgkin lymphoma of the orbital and paranasal region-a retrospective study. Eur J Radiol 2012; 82:302-8. [PMID: 23092540 DOI: 10.1016/j.ejrad.2012.03.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 03/11/2012] [Accepted: 03/12/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE Primary extranodal lymphomas of the orbit and sinonasal region are rare and occur almost only as Non-Hodgkin lymphoma (NHL). The purpose of this study was to determine the frequency of different subtypes of NHL in these regions and to describe their radiological features. MATERIALS AND METHODS Between January 2005 and January 2010, 567 patients with malignant immunoproliferative diseases (MID) were treated at our institution. Primary sinonasal and orbital manifestation was diagnosed in 36 cases. There were 13 women and 23 men with a median age of 67 years. CT and MRI were performed in 14 and 24 patients, respectively. Imaging was re-interpretated and histological subtypes were listed. RESULTS Among all MID primary sinonasal and orbital NHL occurred with a frequency of 6%. Diffuse large cell lymphoma was identified in 11 cases (30%), marginal cell lymphoma in 6 (16%), and extranodal plasmacytoma in 5 (14%). Other subtypes were rare. On CT, lesions of soft tissue attenuation with homogeneous moderate contrast enhancement were seen in all cases. On T2-weighted fat saturated images 52% of the lesions were slightly hyperintense in comparison to unaffected musculature, 41% were isointense, and 7% slightly hypointense. On T1-weighted sequences most lesions (81%) were homogeneously isointense. After contrast administration marked enhancement was seen in 41%, moderate in 52%, and slight enhancement in 7%. CONCLUSION The identified radiological features should be included in the differential analysis of lesions in the orbital and sinonasal regions, but they are not specific enough. For exact therapeutic planning histopathological diagnosis of the subtype is required.
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Affiliation(s)
- Annett Sandner
- Department of Otorhinolaryngology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097 Halle, Germany.
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Hung LY, Chang PH, Lee TJ, Hsu YP, Chen YW, Fu CH, Huang CC. Extranodal natural killer/T-cell lymphoma, nasal type: clinical and computed tomography findings in the head and neck region. Laryngoscope 2012; 122:2632-9. [PMID: 22965840 DOI: 10.1002/lary.23531] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 05/18/2012] [Accepted: 05/30/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS In patients with nasal natural killer/T-cell lymphoma (NKTL), it is commonly without an obvious mass found in the nasal cavity by clinical or computed tomography (CT) findings. As a result, it takes longer to make a definite diagnosis when compared with other nasal malignancy. This study was designed to investigate clinical and CT findings of nasal NKTL. STUDY DESIGN Forty-three patients with nasal NKTL were enrolled. The patients' data were collected retrospectively. METHODS All patients underwent contrast-enhanced CT scans and endoscopic examinations. Symptoms were noted and recorded in detail. RESULTS Patients with lymphoma limited to their nasal cavity or paranasal sinus (N/PN) presented symptoms similar to chronic rhinosinusitis, such as nasal obstruction and purulent nasal discharge. Patients with lymphoma of the nasopharynx or oropharynx (NPx/OPx) tended to present more frequently with epistaxis or blood-tinged sputum. On CT, NKTL was usually nonenhanced (79.1%), homogenous (100%), unilateral (61.9%), infiltrative (67.4%), and without central necrosis. Only 30.2% of the patients presented with a prominent mass. One disease-specific sign, different from patients with chronic rhinosinusitis, was that the mucosa of the nasal cavity was thickened without involvement of the mucosa of the paranasal sinus (40.6%). CONCLUSIONS The thickening of the mucosa of the nasal cavity without similar involvement of the paranasal sinuses is easily overlooked in patients with NKTL. In addition, the imaging findings of thickened mucosa of the nasal floor and/or nasal septum near the inferior meatus, a prominent mass, and bony destruction should raise suspicion of this diagnosis.
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Affiliation(s)
- Liang-Yueh Hung
- Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Li DM, Lun LD. Mucor irregularis infection and lethal midline granuloma: a case report and review of published literature. Mycopathologia 2012; 174:429-39. [PMID: 22744721 DOI: 10.1007/s11046-012-9559-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/28/2012] [Indexed: 12/16/2022]
Abstract
Mucor irregularis (Rhizomucor variabilis) infection and lethal midline granuloma (LMG) are characterized by progressive swelling, ulceration, and destruction of the central face that is usually fatal. Pathological features are inflammation, necrosis, and granulation. LMG has been called by various names, and in recent years, it has been known as NK/T cell lymphoma. However, diagnosis still relies on the progressive necrosis course rather than malignancy in histology. The disease has long challenged physicians, particularly when it worsens with radiotherapy or chemotherapy but sometimes achieves total remission without anti-malignancy therapies. We describe a 35-year-old man who had typical clinical-pathological symptoms of LMG, which turned out to be primary M. irregularis infection; that was diagnosed by positive tissue culture and fungal elements in histology. The patient was successfully treated with antifungal therapy (liposomal amphotericin B, total 4,600 mg and amphotericin B total 277 mg, over a duration of 70 days). We hereby review current knowledge about the epidemiology, clinical manifestations, radiographic characteristics, and pathologic features of LMG with those of M. irregularis infection and their associations. We conclude that primary M. irregulars infection can mimic the clinico-pathological symptoms of LMG and the condition responds favorably to aggressive antifungal therapy.
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Affiliation(s)
- Dong Ming Li
- Department of Dermatology, Research Center for Medical Mycology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China.
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Song JY, Lee SK, Kim SG, Rotaru H, Baciut M, Dinu C. Angiomatoid fibrous histiocytoma on the hard palate: case report. Oral Maxillofac Surg 2012; 16:237-242. [PMID: 21965132 DOI: 10.1007/s10006-011-0297-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 09/19/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Angiomatoid fibrous histiocytoma (AFH) is a rare, soft tissue sarcoma, which is slow growing with low metastatic potential. We recently had a patient present with AFH, which had a palatal perforation and it looked like a cyst in the occlusal view. Therefore, the radiological and histological features of AFH are reported herein. In addition, the differential diagnosis for this lesion is also discussed with a review of the literature. CASE REPORT A 23-year-old woman presented with a spontaneous perforation of the palate. Clinically, a painless and ulcerative lesion was shown on the mid-palate area. Radiological findings revealed a well-demarcated, homogeneous, oval-shaped radiolucent lesion in the occlusal view. Histological examination with incisional biopsy, showed a relatively well-defined cystic-like mass including tumor cells. Taking into consideration the histological and immunohistochemical findings, the presented lesion was diagnosed as AFH. Under general anesthesia, the patient underwent a modified cylindrical partial maxillectomy including safety margins. DISCUSSION In the present case, clinically differential diagnosis can be made with various diseases that have palatal perforations such as trauma, infection, neoplasia, collagen vascular disease, and idiopathic conditions. The treatment recommended in the literature has been radial excision. The prognosis of the tumor has been favorable.
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Affiliation(s)
- Ji-Young Song
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Gangwon-do, 210-702, South Korea
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Beasley M. Lymphoma of the Thyroid and Head and Neck. Clin Oncol (R Coll Radiol) 2012; 24:345-51. [DOI: 10.1016/j.clon.2012.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 01/31/2012] [Accepted: 02/29/2012] [Indexed: 01/08/2023]
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Liu W, Shu Q, Ren J, Yin T, Wang Y, Chen X, Li L. Primary nasal natural killer/T-cell lymphoma presenting as simultaneous bilateral proptosis in a child. Pediatr Hematol Oncol 2012; 29:166-9. [PMID: 22292509 DOI: 10.3109/08880018.2011.639044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sachse F, Stoll W. Nasal surgery in patients with systemic disorders. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2011; 9:Doc02. [PMID: 22073106 PMCID: PMC3199829 DOI: 10.3205/cto000066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Multisystemic disorders represent a heterogenous group of diseases which can primarily manifest at the nose and paranasal sinuses as limited disease or secondarily as part of systemic involvement. Rhinologists therefore play an important role in the diagnostic but also therapeutic process. Although therapy of multisystemic disorders is primary systemic, additional rhinosurgery may become necessary. The spectrum of procedures consists of sinus surgery, surgery of the orbit and lacrimal duct, septorhinoplasty and closure of nasal septal perforation. Since the prevalence of most systemic diseases is very rare, recommendations are based on the analysis of single case reports and case series with a limited number of patients only. Although data is still limited, experiences published so far have shown that autologous cartilage or bone grafts can be used in nasal reconstruction of deformities caused by tuberculosis, leprosy, Wegener’s granulomatosis, sarcoidosis and relapsing polychondritis. Experiences gained from these diseases support the concept that well-established techniques of septorhinoplasty can be used in systemic diseases as well. However, a state of remission is an essential condition before considering any rhinosurgery in these patients. Even under these circumstances revision surgery has to be expected more frequently compared to the typical collective of patients undergoing septorhinoplasty. In addition, experiences gained from saddle nose reconstruction may in part be of value for the treatment of nasal septal perforations since implantation of cartilage grafts often represents an essential step in multilayer techniques of closure of nasal septal perforations. Aside from the treatment of orbital complications sinus surgery has been proven beneficial in reducing nasal symptoms and increasing quality of life in patients refractory to systemic treatment.
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Affiliation(s)
- Florian Sachse
- University of Münster, Department of Otorhinolaryngology Head and Neck Surgery, Münster, Germany
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Extranodal natural-killer/t-cell lymphoma, nasal type. Adv Hematol 2010; 2010:627401. [PMID: 21234094 PMCID: PMC3018635 DOI: 10.1155/2010/627401] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 12/20/2010] [Indexed: 12/16/2022] Open
Abstract
The World Health Organization (WHO) classification recognizes 2 main categories of natural killer (NK) cell-derived neoplasms, namely, extranodal NK/T-cell lymphoma, nasal type, and aggressive NK-cell leukaemia. Extranodal nasal NK/T-cell lymphoma is more frequent in the Far East and Latin America. Histopathological and immunophenotypical hallmarks include angiocentricity, angiodestruction, expression of cytoplasmic CD3 epsilon (ε), CD56, and cytotoxic molecules and evidence of Epstein-Barr virus (EBV) infection. Early stage disease, in particular for localized lesion in the nasal region, is treated with chemotherapy and involved-field radiotherapy. On the other hand, multiagent chemotherapy is the mainstay of treatment for advanced or disseminated disease. L-asparaginase-containing regimens have shown promise in treating this condition. The role of autologous hematopoietic stem cell transplantation is yet to be clearly defined. Allogeneic hematopoietic stem cell transplantation, with the putative graft-versus-lymphoma effect, offers a potentially curative option in patients with advanced disease.
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Paik YS, Liess BD, Scheidt TD, Ingram EA, Zitsch RP. Extranodal nasal-type natural killer/T-cell lymphoma masquerading as recalcitrant sinusitis. Head Neck 2010; 32:268-73. [PMID: 19360743 DOI: 10.1002/hed.21068] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Extranodal nasal-type natural killer (NK)/T-cell lymphoma is a very uncommon disease process often mimicking refractory sinusitis. The diagnosis may be discovered after an extensive exclusion process. Careful immunohistochemical evaluation is crucial to differentiate NK/T-cell lymphoma from other malignancies. METHODS AND RESULTS We describe a 46-year-old white man presenting with a 4-month history of refractory sinusitis and new onset visual field loss in his right eye, right facial tingling, and pain. Examination revealed right periorbital edema and scleritis, and necrotic appearing turbinates with purulence and fibrinous debris. CT/MRI delineated extensive paranasal sinus involvement. Immunohistopathology demonstrated extranodal nasal-type NK/T-cell lymphoma. Additional radiography revealed widespread involvement. CONCLUSION Severe recalcitrant sinusitis with orbital involvement may be the initial presentation of NK/T-cell lymphoma. Ulcerative or necrotic lesions in the midline of the head and neck should raise concern for this disease. In addition to radiographic and laboratory testing, large biopsies should be taken for immunohistochemical analysis to achieve diagnosis and guide further management.
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Affiliation(s)
- Young S Paik
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri-School of Medicine, Columbia, Missouri, USA
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Liang R. Advances in the management and monitoring of extranodal NK/T-cell lymphoma, nasal type. Br J Haematol 2009; 147:13-21. [PMID: 19604234 DOI: 10.1111/j.1365-2141.2009.07802.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Extranodal natural killer (NK)/T-cell lymphoma, nasal type, has a unique geographic distribution. Its pathology is characterized by marked angio-invasion and tissue necrosis. A typical NK-cell phenotype is usually present: CD2(+), CD3 epsilon+, CD56(+), cytotoxic molecules+ and Epstein-Barr virus (EBV)+. Magnetic Resonance Imaging helps to clearly define the local involvement. Positron Emission Tomography helps to demonstrate system spread. Various prognostic variables (International Prognostic Index or the Korean Prognostic Index) should be documented. This may include quantification of plasma EBV DNA. For localized nasal disease, radiotherapy is important, although chemotherapy is often added. Sustainable remission is observed in over half of these patients. For extra-nasal or disseminated disease, systemic chemotherapy becomes the mainstay and the prognosis is usually poor. Doxorubicin-containing regimens are not entirely satisfactory and L-asparaginase containing regimens are being investigated. Patients with poor prognostic features may be considered for an early autologous haematopoietic stem cell transplant. Allogeneic transplantation is efficacious but is associated with high transplant-related mortality.
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Affiliation(s)
- Raymond Liang
- Department of Medicine and Centre of Cancer Research, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China.
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Spectrum of Epstein-Barr virus-related diseases: a pictorial review. Jpn J Radiol 2009; 27:4-19. [PMID: 19373526 DOI: 10.1007/s11604-008-0291-2] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Accepted: 10/14/2008] [Indexed: 12/11/2022]
Abstract
Epstein-Barr virus (EBV) prevails among more than 90% of the adult population worldwide. Most primary infections occur during young childhood and cause no or only nonspecific symptoms; then the virus becomes latent and resides in lymphocytes in the peripheral blood. Inactive latent EBV usually causes no serious consequences, but once it becomes active it can cause a wide spectrum of malignancies: epithelial tumors such as nasopharyngeal and gastric carcinomas; mesenchymal tumors such as follicular dendritic cell tumor/sarcoma; and lymphoid malignancies such as Burkitt lymphoma, lymphomatoid granulomatosis, pyothorax-associated lymphoma, immunodeficiency-associated lymphoproliferative disorders, extranodal natural killer (NK) cell/T-cell lymphoma, and Hodgkin's lymphoma. The purpose of this article is to describe the spectrum of EBV-related diseases and their key imaging findings. EBV-related lymphoproliferative disorders and lymphomas are especially common in immunocompromised patients. Awareness of their clinical settings and imaging spectrum contributes to early detection and early treatment of possibly life-threatening disorders.
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Chua SC, Rozalli FI, O'Connor SR. Imaging features of primary extranodal lymphomas. Clin Radiol 2008; 64:574-88. [PMID: 19414080 DOI: 10.1016/j.crad.2008.11.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 10/18/2008] [Accepted: 11/02/2008] [Indexed: 12/14/2022]
Abstract
Lymphomas are generally considered tumours of lymph nodes, but up to 40% arise extranodally. This group shows distinctive pathological, radiological, and clinical features. Different subtypes of extranodal lymphoma may show sufficiently specific radiological features to be of significant value in both establishing a diagnosis of lymphoma and ascertaining the exact subtype. Rapidly evolving lymphoma classifications and emergence of new entities have, however, hampered the accurate description of these features in the literature. In this review, we discuss the radiological appearances, using a variety of imaging methods, of the full spectrum of primary extranodal lymphomas, categorized according to the current World Health Organisation classification.
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Affiliation(s)
- S C Chua
- Department of Nuclear Medicine, PET, and Radiology, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
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