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Agrawal S, Deora A, Sen S, Gupta S, Das D. Small cell neuroendocrine carcinoma with primary orbital involvement - The unseen, and a review of literature. INDIAN J PATHOL MICR 2023; 66:155-158. [PMID: 36656229 DOI: 10.4103/ijpm.ijpm_1144_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Neuroendocrine neoplasms are derived from the epithelial lineages mainly of respiratory tract, with predominant neuroendocrine differentiation. There are only a handful of documented cases of paranasal small cell neuroendocrine carcinomas (SNEC) with primary orbital involvement. Here, the authors describe a 33-year-old male patient with rapidly progressive swelling of the right lower lid with proptosis since 4 weeks. On contrast-MRI orbit, an ill-defined multilobulated mass measuring 3.6 × 3.1 cm with intense homogenous enhancement was seen in the right retrobulbar space involving the right ethmoid sinus. On incisional biopsy, a poorly differentiated mass containing numerous small round blue cells and scanty intervening stroma with prominent necrosis and apoptosis was seen. Immunohistochemistry was strongly positive for synaptophysin. He was diagnosed as a case of SNEC and received chemotherapy, with good response till date of 9 months of follow up. The authors present a literature review and describe challenges in management of a primary orbital SNEC.
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Affiliation(s)
- Sahil Agrawal
- Oculoplasty and Paediatric Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Aarush Deora
- Oculoplasty and Paediatric Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Seema Sen
- Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Saloni Gupta
- Department of Ophthalmology, Northern Railway Central Hospital, New Delhi, India
| | - Deepsekhar Das
- Oculoplasty and Paediatric Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Keilin CA, VanKoevering KK, McHugh JB, McKean EL. Sinonasal Neuroendocrine Carcinoma: 15 Years of Experience at a Single Institution. J Neurol Surg B Skull Base 2022; 84:51-59. [PMID: 36743710 PMCID: PMC9897894 DOI: 10.1055/s-0041-1740968] [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: 10/20/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023] Open
Abstract
Objectives Sinonasal neuroendocrine carcinomas (SNECs) are among the rarest paranasal sinus cancers. Consensus guidelines for therapy are difficult to develop due to limited data regarding the natural history and successful treatment of these tumors. This study presents 15 years of experience treating SNEC at a single institution and a review of the literature. Design Retrospective review. Setting Academic medical center in the United States. Participants Patients diagnosed with primary SNEC. Main Outcome Measures Overall survival. Results Thirteen patients were identified and included. Overall estimated survival was 74.6% at 5 years. Ten of 13 (76.9%) patients were diagnosed with high-grade neuroendocrine carcinoma and three (23.1%) with intermediate or low grade. All three patients with low- or intermediate-grade cancer survived more than 10 years from their initial diagnosis (median survival: 11.6 years) and are currently alive. The four patients who died had high-grade carcinoma, and estimated overall 5-year survival for all patients with high-grade carcinomas was 65.6%. Five patients, all with high-grade carcinoma, of seven who completed primary chemoradiation therapy (CRT) required salvage resection, and 60% are alive without disease. Conclusion This cohort has a higher overall rate of survival than many recent case series and reviews. There is consensus that multimodal therapy is preferred over monotherapy, but approaches to treatment vary widely. Our approach of surgical resection as primary therapy for low-grade tumors and primary CRT for high-grade SNEC has been successful, and could indicate hope for improved survival among these patients.
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Affiliation(s)
- Charles A. Keilin
- University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Kyle K. VanKoevering
- Division of Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, United States,Department of Neurosurgery, The Ohio State University, Columbus, Ohio, United States
| | - Jonathan B. McHugh
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan, United States
| | - Erin L. McKean
- Division of Skull Base Surgery and Rhinology, Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, United States,Department of Neurosurgery, Michigan Medicine, Ann Arbor, Michigan, United States,Address for correspondence Erin L. McKean, MD, MBA Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine1500 E. Medical Center Drive, Ann Arbor, MI 48109United States
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Mao CP, Zhang M, Niu C, Li M, Wang Y. Radiographic findings of a well-differentiated sinonasal neuroendocrine neoplasm: Case report and review of the literature. EAR, NOSE & THROAT JOURNAL 2016. [PMID: 26214676 DOI: 10.1177/014556131509400720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Typical carcinoid is a rare tumor among other neuroendocrine neoplasms that occur in the nasal cavity. Only a few cases of typical carcinoids in the nasal cavity have been reported. We report a case of typical carcinoid of the nasal cavity in a 61-year-old man who had a history of persistent nasal obstruction and epistaxis for approximately 17 years. Computed tomography revealed a huge, lobulated mass in the nasal cavity with extension into the posterior sphenoid sinus. Extensive bone destruction could be seen in the neighboring sphenoid sinus. MR imaging suggested that the tumor was close to the dura. The final histologic evaluation of the excised biopsy specimen yielded a diagnosis of a well-differentiated neuroendocrine neoplasm (typical carcinoid). In this article, the relevant reports in the literature are reviewed, and the role of radiographic findings on tumor diagnosis and on the establishment of a surgery plan is emphasized.
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Affiliation(s)
- Cui Ping Mao
- Department of Medical Imaging, First Affiliated Hospital of Xi'An Jiaotong University College of Medicine, Xi'An, Shaan'Xi, China 710061
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Ozturk K, Midilli R, Veral A, Ertan Y, Karci B. Primary thyroid-like papillary adenocarcinoma of the nasal septum: a case report. EAR, NOSE & THROAT JOURNAL 2016; 94:E19-21. [PMID: 25651353 DOI: 10.1177/014556131509400213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally originate in the nasopharynx. We report the case of a 24-year-old woman who was diagnosed with a thyroid-like papillary adenocarcinoma that originated in the nasal septum. The tumor was surgically removed, and the patient showed no evidence of local recurrence during 4 years of follow-up.
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Affiliation(s)
- Kerem Ozturk
- Department of Otolaryngology, Ege Universitesi Tip Fakultesi Kulak Burun Bogaz Anabilim Dali, 35100, Bornova, Izmir, Turkey.
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van der Laan TP, Iepsma R, Witjes MJH, van der Laan BFAM, Plaat BEC, Halmos GB. Meta-analysis of 701 published cases of sinonasal neuroendocrine carcinoma: The importance of differentiation grade in determining treatment strategy. Oral Oncol 2016; 63:1-9. [PMID: 27938993 DOI: 10.1016/j.oraloncology.2016.10.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 09/19/2016] [Accepted: 10/02/2016] [Indexed: 12/27/2022]
Abstract
The aim of this meta-analysis was to provide treatment guidelines for sinonasal neuroendocrine carcinoma (SNC) by combining all available data in the literature. A literature search for all studies concerning SNC was performed against the MEDLINE and EMBASE databases. Available clinical data was normalized, pooled, and statistically analyzed. A total of 701 cases of SNC were available for analysis, comprising 127 well or moderately differentiated sinonasal neuroendocrine carcinomas (SNEC), 459 sinonasal undifferentiated carcinoma (SNUC) and 115 sinonasal small cell carcinoma (SmCC). Tumor type was the most important predictor of survival, with a 5-year disease-specific survival (DSS) of 70.2% for SNEC, 35.9% for SNUC and 46.1% for SmCC. Tumor stage on presentation was of limited value in predicting survival or response to treatment. Overall, the application of surgery yielded significantly better results (5-year DSS 52.2% versus 30.1%, p<0.001). In SNUC, radiotherapy was a beneficial supplement to surgery (5-year DSS 54.7% versus 15.7%, p=0.027), while radiotherapy as monotherapy performed poorly (5-year DSS 17.9%). Chemotherapy did not appear to contribute to survival. Based on these findings, we can conclude that the most important predictors of survival in SNC are differentiation grade and the associated choice of treatment modality. In contrast to other head and neck cancers, tumor staging appears of limited value in predicting survival or deciding on a treatment strategy. Surgery should be the cornerstone of treatment, supplemented by radiotherapy in poorly differentiated subtypes (SNUC, SmCC). Chemotherapy does not appear to contribute to survival.
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Affiliation(s)
- Tom P van der Laan
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology/Head and Neck Surgery, The Netherlands; University of Groningen, Graduate School of Medical Sciences (Damage and Repair in Cancer Development and Cancer Treatment), The Netherlands
| | - René Iepsma
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology/Head and Neck Surgery, The Netherlands
| | - Max J H Witjes
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, The Netherlands
| | - Bernard F A M van der Laan
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology/Head and Neck Surgery, The Netherlands; University of Groningen, Graduate School of Medical Sciences (Damage and Repair in Cancer Development and Cancer Treatment), The Netherlands
| | - Boudewijn E C Plaat
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology/Head and Neck Surgery, The Netherlands
| | - Gyorgy B Halmos
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology/Head and Neck Surgery, The Netherlands.
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Kaur S. Sinonasal Neuroendocrine Tumor With Head Lump and Seizures. Am J Med Sci 2016; 352:438. [PMID: 27776730 DOI: 10.1016/j.amjms.2016.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 02/25/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Supreet Kaur
- Division of Internal Medicine, St. Joseph׳s Regional Medical Center, Paterson, New Jersey.
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Rivero A, Liang J. Sinonasal small cell neuroendocrine carcinoma: a systematic review of 80 patients. Int Forum Allergy Rhinol 2016; 6:744-51. [PMID: 26880574 DOI: 10.1002/alr.21734] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/27/2015] [Accepted: 12/31/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of this study was to review the published literature related to sinonasal small cell neuroendocrine carcinomas (SCNECs). Clinical presentation, demographics, treatment, and outcomes of this uncommon disease are reported. METHODS A systematic review of studies for sinonasal SCNECs in PubMed and Ovid databases from 1970 to 2014 was conducted. Bibliographies of selected articles were also examined. Articles were examined for patient data that reported disease outcome. RESULTS Thirty-four articles were included in this analysis, comprising a total of 80 cases. The mean age of presentation was 53.0 years. Nasal obstruction (53.8%) and epistaxis (48.8%) were the most common presenting symptoms. The nasal cavity and septum (32.5%) was the most common site of involvement. Seventy percent of patients presented with American Joint Committee on Cancer (AJCC) stage IV disease. Combination chemotherapy and radiation therapy was the most common treatment modality, used in 21 cases (26.3%). The second and third most common treatment modalities was combination surgery and chemoradiation therapy (21.3%), and surgery alone (18.8%), respectively. A total of 37 patients (46.3%) were alive after a mean follow-up of 30.8 months (median 15.5 months), independent of treatment modality. Of the treatment modalities, multimodality therapy remained the most common therapy. CONCLUSION This review contains the largest pool of sinonasal SCNEC patients to date. Sinonasal SCNEC is a rare and aggressive neoplasm, and there is currently no standard of care for treatment. Various treatment modalities have been employed. Our systematic review suggests that multimodality therapy remains the most common treatment of sinonasal SCNEC.
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Paranasal sinus neuroendocrine carcinoma: a case report and review of the literature. Case Rep Oncol Med 2013; 2013:728479. [PMID: 23476846 PMCID: PMC3586447 DOI: 10.1155/2013/728479] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/13/2013] [Indexed: 11/18/2022] Open
Abstract
Neuroendocrine neoplasms are defined as epithelial neoplasms with predominant neuroendocrine differentiation. They can arise in almost every organ of the body although they are most commonly found in the gastrointestinal tract and respiratory system. Nasal cavity and paranasal sinuses are a rare site for neuroendocrine carcinoma. In contrast to the other regions, neuroendocrine tumours of the sinuses have been reported to be recurrent and locally destructive. Very few cases of paranasal sinus neuroendocrine carcinoma have been reported till date. Difficulty in pathologic diagnosis and rarity of this malignancy have hindered the progress in understanding the clinical course and improving outcomes. We herein report a case of poorly differentiated neuroendocrine tumour of ethmoid and sphenoid sinus with invasion of orbit and intracranial extension. The patient had complete response at the end of chemoradiation and he was disease-free for 9 months duration after which he developed bone metastasis without regional recurrence.
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Artiko V, Sobic-Saranovic D, Pavlovic S, Petrovic M, Zuvela M, Antic A, Matic S, Odalovic S, Petrovic N, Milovanovic A, Obradovic V. The clinical value of scintigraphy of neuroendocrine tumors using (99m)Tc-HYNIC-TOC. Clin Imaging 2012; 52:365-369. [PMID: 23033296 DOI: 10.1016/j.clinimag.2018.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the value of whole body scintigraphy using (99m)Tc-HYNIC-TOC (Tektrotyd) and with single photon emission computerized tomography (SPECT) in the detection of primary and metastatic neuroendocrine tumors (NETs). METHODS Thirty patients with different neuroendocrine tumors, mainly gastroenteropancreatic (GEP), were investigated. Whole body scintigraphy was performed 2 h (if necessary 10 min and 24h) after i.v. administration of 740 Mbq (99m)Tc-Tektrotyd, Polatom. In cases of unclear findings obtained by whole body scintigraphy, investigation was followed by SPECT. RESULTS From 12 patients with NETs of unknown origin, there were 10 true positive (TP), and 2 false negative (FN) findings. Diagnosis was made with SPECT in 6 patients. From 8 patients with gut carcinoids, there were 4 TP, 2 true negative (TN), one FN, and one false positive (FP) finding. Diagnosis was made with SPECT in 2 patients. From 7 patients with neuroendocrine pancreatic carcinomas there were 4 TP and 3 TN findings. Diagnosis was made with SPECT in 2 patients. From 3 patients with gastrinomas there were 2 TP findings and one TN findings. Diagnosis was made with SPECT findings in 2 patients. Sensitivity of (99m)Tc-HYNIC-TOC was 87%, specificity 86%, positive predictive value 95%, negative predictive value 67% and accuracy 87%. CONCLUSION We concluded that scintigraphy with (99m)Tc-Tektrotyd is an useful method for diagnosis, staging and follow up of the patients with NETs.
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Affiliation(s)
- V Artiko
- Faculty of Medicine, University of Belgrade, Serbia.
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Abstract
INTRODUCTION Malignancies of the nasal septum are rare diseases and fewer than 400 cases were reported. The understanding of the disease is limited due to its rarity. METHODS We present a series of patients with nasal septum malignancies, who were referred to the Princess Alexandra Hospital, Ear, Nose and Throat Department from 2007 to 2010. RESULTS Seventeen patients were found to have nasal septum malignancies. The average age was 59.5 years old (range: 36 to 83 years old). The commonest initial symptom on presentation was nasal obstruction (nine out of 17, 53%), seconded by epistaxis (eight out of 17, 47%). The average time from the initial onset of symptoms to presentation averaged 18.8 months (range: 1 to 48 months). The commonest physical finding on presentation was nasal masses (11 out of 17, 65%), followed by nasal septum ulcers (four out of 17, 24%). The histology of the lesions was predominantly squamous cell carcinoma. The mean duration of follow-up was 24.7 months. The overall 3-year survival was 81.9% with the relapse free survival 66.7%. DISCUSSION Nasal septum malignancies are highly treatable with good prognoses when in early stages. They required high degree of suspicion to be detected early. Treatment options include surgical resection and radiotherapy and they offered similar 3-year survival rate. Combined therapy is adopted in larger tumours; however, it is not verified with randomized trials. Vigilant follow-up is vital to detect early recurrence, which is common in advanced stage lesions.
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Affiliation(s)
- Yiu M Ho
- Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Queensland, Australia.
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