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Hoch CC, Knoedler L, Knoedler S, Bashiri Dezfouli A, Schmidl B, Trill A, Douglas JE, Adappa ND, Stögbauer F, Wollenberg B. Integrated Molecular and Histological Insights for Targeted Therapies in Mesenchymal Sinonasal Tract Tumors. Curr Oncol Rep 2024; 26:272-291. [PMID: 38376625 PMCID: PMC10920452 DOI: 10.1007/s11912-024-01506-9] [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] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE OF REVIEW This review aims to provide a comprehensive overview of mesenchymal sinonasal tract tumors (STTs), a distinct subset of STTs. Despite their rarity, mesenchymal STTs represent a unique clinical challenge, characterized by their rarity, often slow progression, and frequently subtle or overlooked symptoms. The complex anatomy of the sinonasal area, which includes critical structures such as the orbit, brain, and cranial nerves, further complicates surgical treatment options. This underscores an urgent need for more advanced and specialized therapeutic approaches. RECENT FINDINGS Advancements in molecular diagnostics, particularly in next-generation sequencing, have significantly enhanced our understanding of STTs. Consequently, the World Health Organization has updated its tumor classification to better reflect the distinct histological and molecular profiles of these tumors, as well as to categorize mesenchymal STTs with greater accuracy. The growing understanding of the molecular characteristics of mesenchymal STTs opens new possibilities for targeted therapeutic interventions, marking a significant shift in treatment paradigms. This review article concentrates on mesenchymal STTs, specifically addressing sinonasal tract angiofibroma, sinonasal glomangiopericytoma, biphenotypic sinonasal sarcoma, and skull base chordoma. These entities are marked by unique histopathological and molecular features, which challenge conventional treatment approaches and simultaneously open avenues for novel targeted therapies. Our discussion is geared towards delineating the molecular underpinnings of mesenchymal STTs, with the objective of enhancing therapeutic strategies and addressing the existing shortcomings in the management of these intricate tumors.
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Affiliation(s)
- Cosima C Hoch
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Samuel Knoedler
- Institute of Regenerative Biology and Medicine, Helmholtz Zentrum Munich, Munich, Germany
| | - Ali Bashiri Dezfouli
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
- Central Institute for Translational Cancer Research, Technical University of Munich (TranslaTUM), Department of Radiation Oncology, Klinikum rechts der Isar, Munich, Germany
| | - Benedikt Schmidl
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
| | - Anskar Trill
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany
- Central Institute for Translational Cancer Research, Technical University of Munich (TranslaTUM), Department of Radiation Oncology, Klinikum rechts der Isar, Munich, Germany
| | - Jennifer E Douglas
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Fabian Stögbauer
- Institute of Pathology, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany
| | - Barbara Wollenberg
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich (TUM), Ismaningerstrasse 22, 81675, Munich, Germany.
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Abdullah B, Snidvongs K, Poerbonegoro NL, Sutikno B. Reshaping the Management of Allergic Rhinitis in Primary Care: Lessons from the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013632. [PMID: 36294211 PMCID: PMC9603682 DOI: 10.3390/ijerph192013632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/15/2022] [Accepted: 10/16/2022] [Indexed: 05/04/2023]
Abstract
The COVID-19 pandemic presented unique challenges to the delivery of healthcare for patients with allergic rhinitis (AR) following its disruption and impact on the healthcare system with profound implications. Reliance on self-care for AR symptom management was substantial during the pandemic with many patients encouraged to only seek in-person medical care when necessary. The advantage of digital technology becomes apparent when patients and healthcare providers had to change and adapt their method of interaction from the regular physical face-to-face consultation to telehealth and mobile health in the provision of care. Despite the pandemic and the ever-evolving post pandemic situation, optimal management of AR remains paramount for both patients and healthcare professionals. A reshaping of the delivery of care is essential to accomplish this goal. In this paper, we present what we have learned about AR management during the COVID-19 pandemic, the role of digital technology in revolutionizing AR healthcare, screening assessment in the identification and differentiation of common upper respiratory conditions, and a framework to facilitate the management of AR in primary care.
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Affiliation(s)
- Baharudin Abdullah
- Department of Otorhinolaryngology—Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: or
| | - Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | | | - Budi Sutikno
- Faculty of Medicine, Universitas Airlangga, Jl. Mayjen. Prof. Dr. Moestopo No. 6-8, Surabaya 60286, Indonesia
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Sharma RK, Del Signore A, Govindaraj S, Iloreta A, Overdevest JB, Gudis DA. Impact of Socioeconomic Status on Paranasal Sinus Cancer Disease-Specific and Conditional Survival. Otolaryngol Head Neck Surg 2021; 166:1070-1077. [PMID: 34281443 DOI: 10.1177/01945998211028161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Socioeconomic status (SES) is often used to quantify social determinants of health. This study uses the National Cancer Institute SES index to examine the effect of SES on disease-specific survival and 5-year conditional disease-specific survival (CDSS; the change in life expectancy with increasing survivorship) in paranasal sinus cancer. STUDY DESIGN Cross-sectional analysis. SETTING National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program. METHODS A study of adults with sinus cancer between 1973 and 2015 was performed. The Yost index, a census tract-level composite score of SES, was used to categorize patients. Kaplan-Meier analysis and Cox regression for disease-specific survival were stratified by SES. CDSS was calculated with simplified models. Logistic regression was conducted to identify risk factors for advanced stage at diagnosis, multimodal therapy, and diagnosis of squamous cell carcinoma. RESULTS There were 3437 patients analyzed. In Cox models adjusting for patient-specific factors, the lowest SES tertile exhibited worse mortality (hazard ratio, 1.22; 95% CI, 1.07-1.39; P < .01). After addition of treatment and pathology, SES was not significant (P = .07). The lowest SES tertile was more often diagnosed at later stages (odds ratio [OR], 1.52; 95% CI, 1.12-2.06; P < .01). For those with regional/distant disease, the middle tertile (OR, 0.75; 95% CI, 0.63-0.90; P < .01) and lowest tertile (OR, 0.75; 95% CI, 0.62-0.91; P < .01) were less likely to receive multimodal therapy. SES tertiles primarily affected 5-year CDSS for regional/distant disease. CDSS for all stages converged over time. CONCLUSION Lower SES is associated with worse outcomes in paranasal sinus cancer. Research should be devoted toward understanding factors that contribute to such disparities, including tumor pathology and treatment course.
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Affiliation(s)
- Rahul K Sharma
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Anthony Del Signore
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine. New York, New York, USA
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine. New York, New York, USA
| | - Alfred Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine. New York, New York, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
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Sharma RK, Schlosser RJ, Beswick DM, Suh JD, Overdevest J, McKinney K, Gudis DA. Racial and ethnic disparities in paranasal sinus malignancies. Int Forum Allergy Rhinol 2021; 11:1557-1569. [PMID: 34096200 DOI: 10.1002/alr.22816] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/15/2021] [Accepted: 04/29/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Racial and ethnic disparities in cancer outcomes have been demonstrated for several different malignancies. In this study we aimed to quantify disease-specific survival (DSS) and the 5-year conditional disease-specific survival (CDSS, the change in life expectancy with increasing survivorship) for paranasal sinus cancer by race and ethnicity. METHODS Patients with sinus cancer between 1973 and 2015 were extracted from the Surveillance, Epidemiology, End Results (SEER) registry. Kaplan-Meier analysis for DSS was stratified by race and ethnicity. Cox regression models of DSS were generated controlling for stage, age, race, and ethnicity. CDSS was calculated using Cox models. Logistic regression was conducted to identify risk factors for younger age at diagnosis, late-stage at diagnosis, and likelihood of receiving surgical intervention when recommended. RESULTS The analysis included a total of 5202 patients. DSS was significantly different when stratified by race (p < 0.01). Compared with White patients, Black patients (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.13-1.45; p < 0.001) and American Indian/Alaskan Natives (HR, 1.94; 95% CI, 1.37-2.74, p < 0.001) exhibited increased mortality when controlling for other factors. Black patients had worse CDSS for regional and distant staged cancer compared with other races; American Indian/Alaskan Native patients had worse CDSS for cancers of all stages. Hispanic patients were more likely to present with advanced disease (odds ratio [OR], 1.47; 95% CI, 1.07-2.07; p = 0.020). American Indian/Alaskan Native patients were less likely than White patients to receive surgical intervention when recommended (OR, 0.42; 95% CI, 0.21-0.04; p = 0.024). Nonwhite patients were more likely to be diagnosed at a younger age. Variations in racial and ethnic disparities were observed over time. CONCLUSION Race and ethnicity significantly impact paranasal sinus cancer outcome metrics. Disparities in outcomes are likely multifactorial.
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Affiliation(s)
- Rahul K Sharma
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Daniel M Beswick
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA
| | - Jonathan Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY
| | - Kibwei McKinney
- Department of Head and Neck Surgery, University of Oklahoma, Oklahoma City, OK
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY
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Sharma RK, Irace AL, Schlosser RJ, Overdevest JB, Rowan NR, Troob SH, Gudis DA. Conditional and Overall Disease-Specific Survival in Patients With Paranasal Sinus and Nasal Cavity Cancer: Improved Outcomes in the Endoscopic Era. Am J Rhinol Allergy 2021; 36:57-64. [PMID: 34000835 DOI: 10.1177/19458924211019158] [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: 11/16/2022]
Abstract
BACKGROUND The management of paranasal sinus and nasal cavity malignancies has evolved significantly with the development of advanced endoscopic techniques and improvements in adjuvant therapy. We sought to characterize both disease-specific survival (DSS) and 5-year conditional disease-specific survival (CDSS, the change in life expectancy with increasing survivorship) for sinus malignancies diagnosed before and after the year 2000. METHODS Patients diagnosed with sinus and nasal cavity cancer between 1973-2015 were extracted from the Surveillance, Epidemiology, End Results (SEER) registry. Kaplan-Meier analysis for DSS was stratified by year of diagnosis before and after 2000. Cox-proportional hazards models of DSS controlling for stage, age, and year of diagnosis were generated. CDSS was calculated using Cox-regression models stratified by stage. RESULTS We analyzed 10,535 patients. Diagnosis after the year 2000 was independently associated with improved DSS (HR:0.81, 95% CI: 0.75-0.87, P < .001) after controlling for age and stage. After stratifying by stage, diagnosis after year 2000 was associated with improved DSS for localized (HR:0.71, 0.59-0.86, P < .001) malignancies, regional (HR: 0.86, 0.78-0.94, P = .001) and distant malignancies (HR 0.74, 0.63-0.87, P < .001). CDSS improved with increasing survivorship for all stages of sinus and nasal cavity cancer, and those diagnosed after 2000 had improved CDSS compared to those diagnosed before 2000. Descriptively, the association of year of diagnosis with CDSS diminished with increasing survivorship for localized cancers, but was consistent for other stages. CONCLUSION For paranasal sinus and nasal cavity malignancies, year of diagnosis independently influences both DSS and CDSS. Improved survival is likely due to advances in both surgical and adjuvant treatments. To our knowledge, this study is the first to examine CDSS for these malignancies.
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Affiliation(s)
- Rahul K Sharma
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Alexandria L Irace
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University Medical Center, Baltimore, Maryland
| | - Scott H Troob
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York
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Zhang H, Wang H, Hao D, Ge Y, Wan G, Zhang J, Liu S, Zhang Y, Xu D. An MRI-Based Radiomic Nomogram for Discrimination Between Malignant and Benign Sinonasal Tumors. J Magn Reson Imaging 2020; 53:141-151. [PMID: 32776393 DOI: 10.1002/jmri.27298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Preoperative discrimination between malignant and benign sinonasal tumors is important for treatment plan selection. PURPOSE To build and validate a radiomic nomogram for preoperative discrimination between malignant and benign sinonasal tumors. STUDY TYPE Retrospective. POPULATION In all, 197 patients with histopathologically confirmed 84 benign and 113 malignant sinonasal tumors. FIELD STRENGTH/SEQUENCES Fast-spin-echo (FSE) T1 -weighted and fat-suppressed FSE T2 -weighted imaging on a 1.5T and 3.0T MRI. ASSESSMENT T1 and fat-suppressed T2 -weighted images were selected for feature extraction. The least absolute shrinkage selection operator (LASSO) algorithm was applied to establish a radiomic score. Multivariate logistic regression analysis was applied to determine independent risk factors, and the radiomic score was combined to build a radiomic nomogram. The nomogram was assessed in a training dataset (n = 138/3.0T MRI) and tested in a validation dataset (n = 59/1.5T MRI). STATISTICAL TESTS Independent t-test or Wilcoxon's test, chi-square-test, or Fisher's-test, univariate analysis, LASSO, multivariate logistic regression analysis, area under the curve (AUC), Hosmer-Lemeshow test, decision curve, and the Delong test. RESULTS In the validation dataset, the radiomic nomogram could differentiate benign from malignant sinonasal tumors with an AUC of 0.91. There was no significant difference in AUC between the combined radiomic score and radiomic nomogram (P > 0.05), and the radiomic nomogram showed a relatively higher AUC than the combined radiomic score. There was a significant difference in AUC between each two of the following models (the radiomic nomogram vs. the clinical model, all P < 0.001; the combined radiomic score vs. the clinical model, P = 0.0252 and 0.0035, respectively, in the training and validation datasets). The radiomic nomogram outperformed the radiomic scores and clinical model. DATA CONCLUSION The radiomic nomogram combining the clinical model and radiomic score is a simple, effective, and reliable method for patient risk stratification. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Han Zhang
- The Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hexiang Wang
- The Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dapeng Hao
- The Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Guangyao Wan
- The Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jun Zhang
- The Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shunli Liu
- The Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu Zhang
- The Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Deguang Xu
- Huangdao Hospital of Traditional Chinese Medicine, Qingdao, China
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Gomes P, Gomes A, Salvador P, Lombo C, Caselhos S, Fonseca R. Clinical assessment, diagnosis and management of patients with unilateral sinonasal disease. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gomes P, Gomes A, Salvador P, Lombo C, Caselhos S, Fonseca R. Clinical assessment, diagnosis and management of patients with unilateral sinonasal disease. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 71:16-25. [PMID: 31349894 DOI: 10.1016/j.otorri.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Unilateral sinonasal disease is commonly encountered in practice and represents an issue of major concern since neoplasms may mimic inflammatory conditions. This paper aims to describe the demographic, clinical and radiological patterns of unilateral pathologies and, accordingly, to establish a guiding algorithm for diagnosis and management. MATERIAL AND METHODS We conducted a retrospective review of medical records of patients with unilateral sinus opacification on CT scan who underwent endoscopic nasal surgery in our department from January 2011 to December 2017. RESULTS Of the 150 patients included, 97(64.7%) and 53(35.3%) had inflammatory and neoplastic pathology, respectively. In the neoplastic group, malignancy was present in 35% of patients. Neoplastic conditions were more common in males (p=0.02) and older patients (56±18 years vs. 38±18, p<.01). Nasal mass or polyp was observed in 56.7% patients. Chronic sinusitis was the most prevalent inflammatory condition, whereas inverted papilloma and osteoma were the most frequent neoplasms. Facial neuralgia, paraesthesia, epistaxis and, on CT scan, superior Lund-Mackay scores, bone remodelling and erosion were significantly more common in neoplastic conditions. Excellent agreement between punch biopsy and postoperative histological results was obtained (k=.883, p<.001). CONCLUSION A sequential and careful management of unilateral lesions is mandatory. Based on our experience, we propose that, as routine, physical examination should be complemented with nasal endoscopy, CT scan and punch biopsy, in case of visible mass. Although clinical and radiological information might raise suspicion of some conditions, final diagnosis can only be established with histological examination of the surgical specimen.
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Affiliation(s)
- Patrícia Gomes
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal.
| | - Alexandra Gomes
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Pedro Salvador
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Catarina Lombo
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Sérgio Caselhos
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Rui Fonseca
- Department of Otorhinolaryngology, Hospital Senhora da Oliveira, Guimarães, Portugal
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Affiliation(s)
- Mohit Agarwal
- Department of Radiology, Division of Neuroradiology, Medical College of Wisconsin, Milwaukee, WI.
| | - Bruno Policeni
- Department of Radiology, Division of Neuroradiology, University of Iowa, Iowa City, IA
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Jain S, Li Y, Kuan EC, Tajudeen BA, Batra PS. Prognostic Factors in Paranasal Sinus Squamous Cell Carcinoma and Adenocarcinoma: A SEER Database Analysis. J Neurol Surg B Skull Base 2018; 80:258-263. [PMID: 31143568 DOI: 10.1055/s-0038-1669420] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 07/07/2018] [Indexed: 12/12/2022] Open
Abstract
Background Outcome studies on sinonasal malignancy are limited to retrospective case series, often with inclusion of diverse histology and short follow-up. The objective of this study was to identify key predictive variables that independently impact survival for paranasal sinus squamous cell carcinoma (SCC) and adenocarcinoma (AC) and to compare these variables in the context of these two distinct clinicopathologic entities. Methods: Analysis was conducted using the Surveillance, Epidemiology, and End Results database from 1973 to 2012 to identify key variables that impact survival for SCC and AC. Results A total of 3,714 cases were included. There were 2,895 SCC cases and 819 AC cases. The mean age at diagnosis was 64.1 years. The male to female ratio for SCC and AC was 1.85 and 1.04, respectively. Patients with SCC and AC were most often diagnosed with stage IV disease in 61.8 and 63.4% of cases, respectively. The majority of patients received combined surgery and radiation (52% for SCC and 43.1% for AC). For SCC, increased age ( p < 0.001) and stage ( p < 0.001) were negative predictors, and surgery improved survival ( p < 0.001) on multivariate analysis. For AC, prognostic factors associated with worse survival include increased age ( p < 0.001) and grade ( p < 0.001) on multivariate analysis. Overall survival was significantly higher in AC compared with SCC at 5 years ( p = 0.001). Conclusion SCC and AC of the paranasal sinuses are both aggressive malignancies with poor survival. For both histological subtypes, increased age predicts worse survival and grade also closely links to survival in AC. These data have important potential implications for treatment planning and pretreatment counseling.
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Affiliation(s)
- Sumit Jain
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois, United States
| | - Yan Li
- Department of Otolaryngology, Rush University, Chicago, Illinois, United States
| | - Edward C Kuan
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology - Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Pete S Batra
- Department of Otorhinolaryngology - Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, United States
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Byrd JK, Clair JMS, El-Sayed I. AHNS Series: Do you know your guidelines? Principles for treatment of cancer of the paranasal sinuses: A review of the National Comprehensive Cancer Network guidelines. Head Neck 2018; 40:1889-1896. [PMID: 29952099 DOI: 10.1002/hed.25143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/02/2018] [Indexed: 11/08/2022] Open
Abstract
This article is a continuation of the "Do You Know Your Guidelines" series. This was launched as an initiative of the American Head and Neck Society to increase the awareness of current best practices pertaining to head and neck cancer. The National Comprehensive Cancer Network (NCCN) guidelines for managing cancer of the paranasal sinuses are reviewed in a systematic fashion. These guidelines outline the workup, treatment, and surveillance of patients with cancer of the maxillary and ethmoid sinuses.
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Affiliation(s)
- J Kenneth Byrd
- Department of Otolaryngology, Medical College of Georgia at Augusta University, Augusta, Georgia
| | | | - Ivan El-Sayed
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California
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Perri F, Addeo R, Conson M, Faiella A, Scarpati GDV, Torre G, Di Biase A, Romanelli P, Buonerba C, Di Lorenzo G, Daponte A, Caponigro F, Pisconti S, Pacelli R, Ravo V, Muto P, Solla R. Locally advanced paranasal sinus carcinoma: A study of 30 patients. Oncol Lett 2017; 13:1338-1342. [PMID: 28454258 PMCID: PMC5403341 DOI: 10.3892/ol.2017.5598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 05/23/2016] [Indexed: 12/13/2022] Open
Abstract
Sinonasal carcinomas (SNcs) are rare neoplasms arising from the paranasal sinuses and nasal cavity. Although these tumours have a heterogeneous histology, they are commonly diagnosed as a locally advanced disease and are associated with a poor prognosis. The present retrospective study reviewed 30 patients with locally advanced SNc, who were treated with surgery followed by chemoradiotherapy or radiotherapy, or radiotherapy with or without concomitant chemotherapy between January 1999 and January 2013 at the Department of Radiation Therapy, University of Naples 'Federico II' (Naples, Italy). A total of 19 patients were treated with upfront surgery followed by adjuvant radio- or chemoradiotherapy (group A), while the remaining 11 patients received exclusive radiotherapy with or without concomitant chemotherapy (group B). Concurrent cisplatin-based chemotherapy (100 mg/m2, days 1, 22 and 43 for 3 cycles) was administered to 34% of patients in group A and 55% of patients in group B. At a median follow-up of 31 months, 33.3% of patients were alive. Cause-specific survival (CSS) and progression-free survival (PFS) times were 32 and 12 months, respectively. No difference in CSS rate was observed between the two treatment groups. Univariate analysis determined that disease stage was the only factor that significantly affected CSS (P=0.002) and PFS (P=0.0001) rates. Acute and chronic toxicities were mild, with only 23.3% of patients reporting G1-2 side effects and no treatment-related blindness. The present study reported moderate activity and efficacy of surgery followed by adjuvant radio- or chemoradiotherapy, and exclusive radiotherapy with or without chemotherapy in this poor prognosis category of patients.
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Affiliation(s)
- Francesco Perri
- Medical Oncology Unit, ‘Santissima Annunziata’ Hospital, I-74100 Taranto, Italy
| | - Raffaele Addeo
- Oncology Unit, ‘ASL Napoli 2 Nord’, San Giovanni di Dio Hospital, I-80027 Naples, Italy
| | - Manuel Conson
- Department of Radiation Therapy, University of Naples ‘Federico II’, I-80131 Naples, Italy
| | - Adriana Faiella
- Department of Radiation Therapy, University of Naples ‘Federico II’, I-80131 Naples, Italy
| | | | - Gabriella Torre
- Department of Radiation Therapy, University of Naples ‘Federico II’, I-80131 Naples, Italy
| | - Angela Di Biase
- Department of Radiation Therapy, University of Naples ‘Federico II’, I-80131 Naples, Italy
| | - Paola Romanelli
- Department of Radiation Therapy, University of Naples ‘Federico II’, I-80131 Naples, Italy
| | - Carlo Buonerba
- Oncological Referral Center of Basilicata, The Institute for Research, Hospitalization and Health Care, Rionero in Vulture, I-85028 Potenza, Italy
| | - Giuseppe Di Lorenzo
- Department of Endocrinology and Molecular and Clinical Oncology, University of Naples ‘Federico II’, I-80131 Naples, Italy
| | - Antonio Daponte
- Head and Neck Medical Oncology Unit, National Tumour Institute of Naples, The Institute for Research, Hospitalization and Health Care ‘Fondazione Giovanni Pascale’, I-80131 Naples, Italy
| | - Francesco Caponigro
- Head and Neck Medical Oncology Unit, National Tumour Institute of Naples, The Institute for Research, Hospitalization and Health Care ‘Fondazione Giovanni Pascale’, I-80131 Naples, Italy
| | - Salvatore Pisconti
- Medical Oncology Unit, ‘Santissima Annunziata’ Hospital, I-74100 Taranto, Italy
| | - Roberto Pacelli
- Oncology Unit, ‘ASL Napoli 2 Nord’, San Giovanni di Dio Hospital, I-80027 Naples, Italy
| | - Vincenzo Ravo
- Department of Radiotherapy, The Foundation Institute for Research, Hospitalization and Health Care ‘Istituto Nazionale dei Tumori’, I-80131 Naples, Italy
| | - Paolo Muto
- Department of Radiotherapy, The Foundation Institute for Research, Hospitalization and Health Care ‘Istituto Nazionale dei Tumori’, I-80131 Naples, Italy
| | - Raffaele Solla
- Institute of Biostructure and Bioimaging, National Council of Research, I-80128 Naples, Italy
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13
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Patel ZM, Li J, Chen AY, Ward KC. Determinants of racial differences in survival for sinonasal cancer. Laryngoscope 2016; 126:2022-8. [PMID: 26915596 DOI: 10.1002/lary.25897] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/24/2015] [Accepted: 01/04/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS Racial differences in survival are present across multiple cancer types, including sinonasal cancer. Thus far in the literature, reasons for this have been theorized but not proven. We aimed to examine proposed potential factors and understand the true determinants in racial differences for survival in sinonasal cancer. STUDY DESIGN Utilizing the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2000-2008), we analyzed multiple demographic, tumor-related, and treatment-related factors. Use of the Medicare subset allows much deeper examination of patient and treatment factors than the usual SEER database study. METHODS Univariate analysis and multivariate Cox proportional hazard regression models were used. RESULTS Eight hundred and forty-five patients remained after exclusion criteria. Five-year cause-specific survival (CSS) was 62%, with a racial difference confirmed because non-Hispanic whites (NHW) and blacks and Hispanic whites (B/HW) demonstrated 64% and 52% CSS, respectively. After multivariate analysis, factors significantly determining racial survival were age, stage, histology, grade, comorbidity status, and standard of care. CONCLUSION This study confirms the difference in racial survival in sinonasal cancer. In opposition to popular theories of access to care and education level- and poverty level-determining outcomes, those factors were not significant on multivariate analysis, whereas stage and receiving standard of care, determined by unimodality versus multimodality treatment appropriate to stage, were the two most important prognostic factors. LEVEL OF EVIDENCE 2c. Laryngoscope, 126:2022-2028, 2016.
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Affiliation(s)
- Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Juan Li
- Rollins School of Public Health, Department of Epidemiology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Amy Y Chen
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Kevin C Ward
- Rollins School of Public Health, Department of Epidemiology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
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14
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Deckard NA, Harrow BR, Barnett SL, Batra PS. Comparative analysis of quality-of-life metrics after endoscopic surgery for sinonasal neoplasms. Am J Rhinol Allergy 2016; 29:151-5. [PMID: 25785758 DOI: 10.2500/ajra.2015.29.4137] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the postoperative quality of life (QOL) after endoscopic resection of sinus and skull base neoplasms using validated outcomes measures and to perform correlation of the various metrics to better discern their efficacy. Prospective QOL data collection and retrospective chart review were performed. METHODS QOL data were collected using the 20-item Sino-Nasal Outcome Test (SNOT-20), Anterior Skull Base Questionnaire (ASBQ), European Quality-of-Life-5 Dimension (EQ-5D) questionnaire, and Lund-Kennedy endoscopic (LKE) score in 71 patients with sinonasal and skull base tumors. RESULTS The mean age was 53 years and mean follow-up was 14.5 months at the time QOL data were collected. Benign and malignant tumors represented 39 (54.9%) and 32 (45.1%) cases, respectively. Twenty malignancies (62.5%) were stage T3 or T4, and 23 required postoperative chemotherapy and radiation (CRT). Factors indicating worsened postoperative QOL included malignant histopathology, T3 or T4 tumors, and the use of postoperative CRT (p < 0.05). There was a strong correlation of ASBQ with EQ-5D and SNOT-20 scores (r < -0.5) and a moderate correlation between the SNOT-20 and EQ-5D (r > 0.3), and the LKE had moderate correlation with SNOT-20 (r > 0.3) and weak correlation to the ASBQ (r > -0.3) and EQ-5D (r < 0.3). CONCLUSION Patients who have undergone endoscopic resection of sinonasal tumors have quantifiable QOL changes as measured by various validated metrics. This study shows that concurrent use of these instruments may better discern QOL outcomes after endoscopic tumor surgery.
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Affiliation(s)
- Nathan A Deckard
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, USA
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15
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Gras-Cabrerizo JR, León-Vintró X, Tarruella MM, Sarria GP, Gonzalez CB, Montserrat-Gili JR, Kolanczak K, Massegur-Solench H. Management of sinonasal mucosal melanomas and comparison of classification staging systems. Am J Rhinol Allergy 2015; 29:e37-40. [PMID: 25590317 DOI: 10.2500/ajra.2015.29.4128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to describe treatment results in patients with sinonasal mucosal melanomas (SMMs) and to compare three different classification staging systems. MATERIALS AND METHODS From 1988 to 2013, we performed a retrospective study of 20 patients with primary sinonasal melanomas. The median age at diagnosis was 71 years. There were 10 males and 10 females. RESULTS Nine SMMs (45%) were originated in the ethmoidal sinus complex, four (20%) in the inferior turbinate, three (15%) in the nasal septum, two (10%) in the maxillary sinus, and two (10%) in the nasal vestibule. Local recurrence was diagnosed in eight patients (40%), and six out of 20 patients (30%) developed distant metastasis during the course of their disease. The adjusted survival rates at three and five years were 47% and 34%, respectively. The adjusted three-year survival rate according to the sinonasal staging system 7th edition for SMM (TNM-SMM) was 60% in T3 stage, 50% in T4a stage, and 34% in T4b stage (p = 0.05). According to Thompson's staging system, survival was 33% for group one, 58% for group two, and 0% for group three (p = 0.006). With the sinonasal staging system 7th edition for carcinoma (TNM-CAR) survival was 33% in T1, 100% in T2 and T3, 0% in T4a, and 34% in T4b (p = 0.006). CONCLUSIONS Our experience confirms the distribution of patients according to survival rates was better with the TNM-SMM than with Thompson's or the TNM-CAR systems.
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Affiliation(s)
- Juan R Gras-Cabrerizo
- Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
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16
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Paz Silva M, Pinto JM, Corey JP, Mhoon EE, Baroody FM, Naclerio RM. Diagnostic algorithm for unilateral sinus disease: a 15-year retrospective review. Int Forum Allergy Rhinol 2015; 5:590-6. [PMID: 25880633 DOI: 10.1002/alr.21526] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 01/30/2015] [Accepted: 02/08/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients presenting with unilateral sinus symptoms or nasal polyps raise concerns about sinister pathology. Yet despite the relatively common occurrence of this presentation, and its potential severity, an organized diagnostic approach to unilateral sinus disease (USD) has never been defined. The purpose of this work was to propose a diagnostic algorithm for managing patients with USD based on prior experience. METHODS We performed a retrospective review of the medical records of all patients with USD who underwent surgical intervention and had pathological specimens during a 15-year period at an urban academic center. Nasal endoscopy and computed tomography (CT) scan findings, demographic characteristics, presenting symptoms, medical histories, and previous treatments were analyzed. RESULTS A total of 191 patients met the inclusion criteria, 153 of whom were initially diagnosed at our center. Among the latter group, 51 (33%) presented with a nasal mass or polyp observed by endoscopy. Inverted papilloma was present in 16% of those cases, and malignant tumors comprised 14%. In contrast, of patients without an obvious nasal polyp (n = 102), 2% had inverted papilloma and 3% had malignancies. Overall, chronic rhinosinusitis was the most common diagnosis both in patients with polyps (67%) and those without nasal polyps (69%). CONCLUSION Although USD is most likely to represent chronic inflammation, there exists a fair likelihood of finding malignant pathology, particularly in cases where patients have a unilateral polyp. Based on this review, we propose a strategy for the management of new presentations of USD.
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Affiliation(s)
- Marianella Paz Silva
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Jacquelynne P Corey
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Ernest E Mhoon
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Fuad M Baroody
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Robert M Naclerio
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, IL
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Barrios AW, Sanchez Quinteiro P, Salazar I. The nasal cavity of the sheep and its olfactory sensory epithelium. Microsc Res Tech 2014; 77:1052-9. [PMID: 25213000 DOI: 10.1002/jemt.22436] [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: 07/15/2014] [Accepted: 08/31/2014] [Indexed: 11/11/2022]
Abstract
Macro and microdissection methods, conventional histology and immunohistochemical procedures were used to investigate the nasal cavity and turbinate complex in fetal and adult sheep, with special attention to the ethmoturbinates, the vestibular mucosa, and the septal mucosa posterior to the vomeronasal organ. The ectoturbinates, which are variable in number and size, emerge and develop later than the endoturbinates. The olfactory sensory epithelium is composed of basal cells, neurons, and sustentacular cells organized in strata, but numerous different types are distinguishable on the basis of their thickness and other properties; all variants are present on the more developed turbinates, endoturbinates II and III. Mature neurons and olfactory nerve bundles express olfactory marker protein. We found no structure with the characteristics that in mouse define the septal organ or the ganglion of Grüneberg. Our results thus suggest that in sheep olfactory sensory neurons are exclusively concentrated in the main olfactory epithelium and (to a lesser extent) in the vomeronasal organ.
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Affiliation(s)
- Arthur William Barrios
- Department of Anatomy and Animal Production, Unit of Anatomy and Embryology, Faculty of Veterinary, University of Santiago de Compostela, 27002, Lugo, Spain
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Pelikan Z. Cytological changes in nasal secretions accompanying delayed nasal response to allergen challenge. Am J Rhinol Allergy 2014; 27:1. [PMID: 24119599 DOI: 10.2500/ajra.2013.27.3933] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patients with allergic rhinitis when challenged with allergen develop various types of nasal response, such as an immediate nasal response (INR), late nasal response (LNR), dual late nasal response (DLNR), or delayed nasal response (DYNR), probably because of different hypersensitivity mechanisms. This study was designed to investigate the cytological changes in the nasal secretions (NSs) during the DYNR, beginning 24-32 hours, reaching maximum at 32-36 hours, and resolving within 56 hours after the nasal provocation tests (NPTs) with allergens. METHODS In 45 allergic rhinitis patients developing 45 positive DYNRs (p < 0.01), the NPTs and the phosphate-buffered saline (PBS) controls were repeated and supplemented with cytological examination of the NSs and determination of interferon (IFN) γ and IL-4 in nasal lavage fluid (NLF). RESULTS The repeated DYNR (p < 0.001) was accompanied by significant changes (p < 0.05) in the counts of neutrophils, monocytes, lymphocytes, epithelial and goblet cells, and, to a limited extent, of plasma cells and platelets in the NSs and increased concentrations of IFN-γ but not of IL-4, in NLF between 24 and 48 hours after the NPT. No significant cytological changes were found in NSs during the PBS controls (p > 0.1). CONCLUSION The DYNR is associated with cytological profiles in the NS different from those observed during the INR or LNR. The significant count changes of neutrophils, monocytes, lymphocytes, epithelial and goblet cells in NSs, and increased IFN-γ but not of IL-4 concentrations in the NLF, suggest a possible involvement of the cell-mediated hypersensitivity in the DYNR. These results also emphasize the diagnostic value of NPTs combined with cytological examination of the NSs in patients with nasal allergy.
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Abstract
Nasal polyps occur in 1-4% of the population, usually occurring in the setting of an underlying local or systemic disease. The most common associated condition is chronic rhinosinusitis (CRS). A high prevalence of nasal polyps is also seen in allergic fungal rhinosinusitis, aspirin-exacerbated respiratory disease, Churg-Strauss syndrome, and cystic fibrosis. In the setting of CRS, nasal polyps are not likely to be cured by either medical or surgical therapy; however, control is generally attainable. The best medical evidence supports the use of intranasal corticosteroids for maintenance therapy and short courses of oral corticosteroids for exacerbations. The evidence for short- and long-term antibiotics is much less robust. For patients with symptomatic nasal polyposis nonresponsive to medical therapies, functional endoscopic sinus surgery provides an adjunctive therapeutic option.
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Affiliation(s)
- Russell A Settipane
- Department of Medicine, Warren Alpert Medical School of Brown University Providence, Rhode Island, USA.
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