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Sakai A, Ebisumoto K, Iijima H, Yamauchi M, Maki D, Fukuzawa T, Okami K. Abscopal effect in maxillary sinus cancer: Insights from two case reports and a literature review. Cancer Rep (Hoboken) 2024; 7:e1994. [PMID: 38351554 PMCID: PMC10864721 DOI: 10.1002/cnr2.1994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/07/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The abscopal effect is a rare phenomenon in which localized radiation therapy triggers tumor reduction in nontargeted areas. Although this phenomenon has been observed in various cancer types, it remains infrequent and not fully understood. CASE Two patients with maxillary sinus cancer with distant metastases were treated with radiotherapy after immune checkpoint inhibitor (ICI) therapy. The patients demonstrated abscopal effects following ICI therapy and radiotherapy, showing shrinkage in metastatic areas not directly targeted by radiation. CONCLUSION This report was reviewed to examine the synergistic effects of ICI and radiotherapy and to identify optimal strategies to enhance the abscopal effect in clinical practice. It has also touched on various ongoing debates and clinical trials aimed at understanding and exploiting this effect to improve cancer treatment. The exact mechanisms and optimal treatment protocols remain areas for future research.
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Affiliation(s)
- Akihiro Sakai
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Koji Ebisumoto
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Hiroaki Iijima
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Mayu Yamauchi
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Daisuke Maki
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Tsuyoshi Fukuzawa
- Department of Radiation OncologyTokai University, School of MedicineIseharaJapan
| | - Kenji Okami
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
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See ASY, Chu C, Lim ICZY, Tan BKJ, Ang SXQ, Xu S, Teo NWY, Charn TC. Meta-analysis of multi-modality therapies in sinonasal undifferentiated carcinoma-A timely update. Clin Otolaryngol 2024; 49:29-40. [PMID: 37859617 DOI: 10.1111/coa.14100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/10/2023] [Accepted: 09/09/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Sinonasal undifferentiated carcinoma (SNUC) is a rare but aggressive tumour with very poor prognosis. There are currently no well-established clinical trials to guide therapy and the impact of various treatment modalities on survival is not well defined. We aim to provide an updated systematic review on current treatment modalities on survival outcomes. DESIGN AND SETTING Individual patient data were extracted, and survival data pooled in a one-stage meta-analysis. Descriptive statistics were analysed using the Kaplan-Meier method. Patient-level comparisons stratified by treatment modalities, adjusted for demographics, were conducted using shared-frailty Cox regression. PARTICIPANTS AND MAIN OUTCOME MEASURES Participants include all patients diagnosed with SNUC based on histological evidence. We looked at the overall cumulative survival outcome for different treatment modalities and overall survival by treatment modality in low versus high stage SNUC patients. RESULTS AND CONCLUSION Seventeen studies were identified, comprising 208 patients from 1993 to 2020. There was no significant difference in cumulative overall survival in low versus high stage patients, and no significant difference in outcomes by treatment modality. The overall cumulative survival of SNUC is 30% at 95 months. Among patients treated with various combinations of treatment modalities, patients with chemoradiotherapy had the highest cumulative survival of 42% at 40 months. Definitive chemoradiotherapy was associated with improved disease survival rate. Regardless of tumour stage, patients should be treated early and aggressively, with no superiority of one treatment regimen over another. Trimodality treatment does not confer survival advantage over bimodality treatment.
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Affiliation(s)
- Alicia Su Yun See
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarisse Chu
- Department of Otolaryngology-Head & Neck Surgery, Sengkang General Hospital, Singapore, Singapore
| | | | - Benjamin Kye Jyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sheryl Xiu Qi Ang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shuhui Xu
- Department of Otolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Neville Wei Yang Teo
- Department of Otolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Tze Choong Charn
- Department of Otolaryngology-Head & Neck Surgery, Sengkang General Hospital, Singapore, Singapore
- Department of Otolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
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3
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Trinh JQ, Acosta C, Easwar A, Galamaga R, Tan A. Durable and dramatic response to checkpoint inhibition combined with COX-2 inhibitor celecoxib in a patient with p16+ metastatic sinonasal undifferentiated carcinoma: A case study. Cancer Rep (Hoboken) 2024; 7:e1915. [PMID: 37867289 PMCID: PMC10809189 DOI: 10.1002/cnr2.1915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Sinonasal undifferentiated carcinoma (SNUC) is an exceedingly rare head and neck malignancy. No consensus exists on treatment for metastatic disease. CASE A 56-year-old female was diagnosed with SNUC after endorsing sinus congestion, diplopia, and right orbital pain. Initially treated with surgery and radiation, she later developed significant metastatic disease. She demonstrated progression of her hepatic metastases under pembrolizumab therapy. However, the addition of ipilimumab and a COX-2 inhibitor resulted in significant improvement in her lesions as well as an ongoing durable response. Her regimen was complicated by immune-related adverse events successfully treated with steroids. CONCLUSION Dual checkpoint inhibition deserves consideration when treating metastatic SNUC, especially after single agent therapy has failed. The positive effect of this treatment may be augmented by IDO1 inhibition.
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Affiliation(s)
- Jonathan Q. Trinh
- Department of Internal MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Cassaundra Acosta
- Department of Medical Oncology and HematologyCity of HopeGoodyearArizonaUSA
| | - Arti Easwar
- Department of Pathology and Laboratory MedicineCity of HopeGoodyearArizonaUSA
| | - Robert Galamaga
- Department of Medical Oncology and HematologyCity of HopeGoodyearArizonaUSA
| | - Alan Tan
- Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
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Ramesh U, Contrera KJ, Shakibai N, Su SY, Brahimaj B, Roberts D, Williams MD, Ferrarotto R, Phan J, Gunn GB, Raza S, DeMonte F, Hanna EY. Sinonasal NUT carcinoma: A consecutive case series and systematic review. Head Neck 2024; 46:29-36. [PMID: 37853958 DOI: 10.1002/hed.27553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Sinonasal NUT carcinoma is an extremely rare, lethal malignancy with limited literature. METHODS A case series was conduction of all patients with sinonasal NUT carcinoma at a single institution between 2010 and 2022. Survival and associated were evaluated. A systematic review of the literature was performed. RESULTS In 12 patients, followed for a median of 1.5 years, the median overall survival (OS) and disease-specific survival (DSS) were both 14.6 months. Patients with maxillary sinus tumors were 91% more likely to survive (hazard ratio [HR]: 0.094, 95% confidence interval [CI]: 0.011-0.78, p = 0.011). Patients with higher-stage disease stage had worse OS (stage IVb-c vs. III-IVa, p = 0.05). All three patients who were alive with no evidence of disease received induction chemotherapy. CONCLUSION For patients with sinonasal NUT carcinoma, the median survival was 15 months but better with lower-stage and maxillary tumors. Induction chemotherapy may be beneficial.
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Affiliation(s)
- Uma Ramesh
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Kevin J Contrera
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Nasim Shakibai
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Bledi Brahimaj
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Dianna Roberts
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Michelle D Williams
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Thoracic-Head & Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Gary Brandon Gunn
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Shaan Raza
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Pouvreau P, Coelho J, Rumeau C, Malard O, Garrel R, Michel J, Righini C, Vergez S, Baudouin R, Bastit V, Marie JP, Villepelet A, Moya-Plana A, Philouze P, Saroul N, Digue L, Daste A, Renard S, Moriniere S, Carsuzaa F, Verillaud B, Poissonnet G, Schultz P, Brenet E, Mouawad F, Thariat J, Vulquin N, Castain C, de Gabory L, Dupin C. Management of 80 sinonasal undifferentiated carcinomas. Retrospective multicentre study of the French Network of Rare Head and Neck Cancers (REFCOR). Eur J Surg Oncol 2023; 49:107108. [PMID: 37866154 DOI: 10.1016/j.ejso.2023.107108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/13/2023] [Accepted: 10/02/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES Sinonasal undifferentiated carcinoma (SNUC) is a rare and aggressive disease requiring multimodal treatment, and multiple new entities once included in the spectrum of SNUC, such as SWI/SNF-deficient carcinomas, are emerging. We aimed to provide new data regarding the role of chemotherapy and surgery and the prognostic factors of disease-free survival. METHODS This study was based on data from the REFCOR database and included patients with SNUC treated with curative intent from 2007 to 2021 across 22 centres in France. RESULTS A total of 80 patients were included in the analysis. Among the entire cohort, the 5-year disease-free survival (DFS) and overall survival (OS) rates were 58% and 63%, respectively. Of 100% of the patients treated with irradiation, 29% underwent surgery, 56% neoadjuvant chemotherapy (82% had either a partial or a complete response) and 76% chemoradiotherapy. No treatment modality was associated with a better OS or DFS, including surgery (p = 0.34). There was a trend for a better DFS for the patients treated with chemotherapy (neoadjuvant or concomitant, p = 0.062). Overall survival at 3 years was 58% for SWI/SNF deficient group and 86% for non deficient group (p = 0.14). The locoregional relapse rate without distant metastases was 21% in the exclusive radiotherapy group and 26% in the surgery group. Grade 3 or higher toxicities concerned 9%, 32% and 29% of patients for surgery, radiotherapy and chemotherapy respectively. CONCLUSION In the management of localised SNUC among all patients treated with irradiation, surgery yielded no benefit, whereas the addition of chemotherapy tended to improve disease-free survival.
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Affiliation(s)
- Pierre Pouvreau
- Department of Radiation Oncology, Bordeaux University Hospital, F33000, Bordeaux, France
| | - Julien Coelho
- Bordeaux University, na unit, UMR 6033, F-33000, Bordeaux, France
| | - Cécile Rumeau
- Department of Head and Neck Surgery, Nancy University Hospital, Vandoeuvre les Nancy, France
| | - Olivier Malard
- Department of Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Renaud Garrel
- Department of Head and Neck Surgery, Montpellier University Hospital, Montpellier, France
| | - Justin Michel
- Department of Head and Neck Surgery, La Conception University Hospital, Marseille, France
| | - Christian Righini
- Department of Head and Neck Surgery, Grenoble University Hospital, Grenoble, France
| | - Sebastien Vergez
- Department of Head and Neck Surgery, Toulouse University Hospital, Toulouse, France
| | - Robin Baudouin
- Department of Head and Neck Surgery, Foch Hospital, Suresnes, France
| | - Vianney Bastit
- Department of Head and Neck Surgery, Caen University Hospital, Caen, France
| | - Jean-Paul Marie
- Department of Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Aude Villepelet
- Department of Head and Neck Surgery, Créteil Intercommunal Hospital, Créteil, France
| | - Antoine Moya-Plana
- Department of Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France
| | - Pierre Philouze
- Department of Head and Neck Surgery, Hospital Group of lyon, Lyon, France
| | - Nicolas Saroul
- Department of Head and Neck Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Laurence Digue
- Department of Oncology, Bordeaux University Hospital, F33000, Bordeaux, France
| | - Amaury Daste
- Department of Oncology, Bordeaux University Hospital, F33000, Bordeaux, France
| | - Sophie Renard
- Department of Head and Neck Surgery, Nancy University Hospital, Vandoeuvre les Nancy, France
| | - Sylvain Moriniere
- Department of Head and Neck Surgery, Tours University Hospital, Tours, France
| | - Florent Carsuzaa
- Department of Head and Neck Surgery, Poitiers University Hospital, Poitiers, France
| | - Benjamin Verillaud
- Department of Head and Neck Surgery, Lariboisière Hospital, Paris, France
| | - Gilles Poissonnet
- Department of Head and Neck Oncologic Surgery, Antoine Lacassagne Center, Nice, France
| | - Philippe Schultz
- Department of Head and Neck Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Esteban Brenet
- Department of Head and Neck Surgery, Reims University Hospital, Reims, France
| | - François Mouawad
- Department of Head and Neck Surgery, Lille University Hospital, Lille, France
| | - Juliette Thariat
- Department of Radiation Oncology, François Baclesse Center, Caen, France
| | - Noémie Vulquin
- Department of Radiation Oncology, Georges François Leclerc Center, Dijon, France
| | - Claire Castain
- Department of Pathology, Bordeaux University Hospital, Bordeaux, France
| | - Ludovic de Gabory
- Department of Head and Neck Surgery, Bordeaux University Hospital, F33000, Bordeaux, France
| | - Charles Dupin
- Department of Radiation Oncology, Bordeaux University Hospital, F33000, Bordeaux, France; Bordeaux University, na unit, UMR 6033, F-33000, Bordeaux, France; BRIC (BoRdeaux Institute of OnCology), UMR1312, INSERM, University of Bordeaux, F-33000, Bordeaux, France.
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6
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Kong KA, Thorp BD, Sheth SH. The Role of Induction Therapy for Sinonasal Cancers. Curr Treat Options Oncol 2023; 24:162-169. [PMID: 36696082 DOI: 10.1007/s11864-022-01046-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/26/2023]
Abstract
OPINION STATEMENT The role of induction chemotherapy in sinonasal cancers is promising; however, prospective studies with higher grades of evidence are needed. With the currently available literature, the authors would advocate for the use of induction chemotherapy (IC) in locally advanced sinonasal squamous cell carcinoma (T3-T4) for organ preservation and potentially for improved survival outcomes. In sinonasal undifferentiated carcinoma (SNUC), IC should be considered in all patients given its tendency for aggressive invasion and poor outcomes. In SNUC, response to IC may direct the modality of definitive treatment to follow. In responders (partial or complete), chemoradiation therapy should be strongly considered. In non-responders or in those with progression of disease, surgical therapy is favored. For esthesioneuroblastoma, surgical resection with negative margins and adjuvant radiation therapy remains the gold standard. However, IC may be considered for locally advanced disease especially with orbital invasion or in recurrent/distant disease. There is no definite indication for IC in sinonasal adenoid cystic carcinoma or sinonasal adenocarcinoma. Recommendations are summarized in Table 1.
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Affiliation(s)
- Keonho A Kong
- Department of Otolaryngology/Head & Neck Surgery, University of Mississippi Medical Center, Jackson, USA
| | - Brian D Thorp
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina, Chapel Hill, USA
| | - Siddharth H Sheth
- Division of Oncology, Department of Medicine, University of North Carolina, Houpt Building, 3rd Floor, 170 Manning Drive, CB# 7305, Chapel Hill, NC, 27599, USA.
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Wang L, Wang J, Tang T, Yan L, Song X. Definitive-intent (chemo)radiotherapy for sinonasal undifferentiated carcinoma. Br J Radiol 2023; 96:20220244. [PMID: 36317997 PMCID: PMC10997022 DOI: 10.1259/bjr.20220244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The current study aimed to investigate the value of definitive-intent (chemo)radiotherapy in treating sinonasal undifferentiated carcinoma (SNUC) in a single institution. METHODS The medical records of 21 patients with SNUC treated with definitive-intent (chemo)radiotherapy between 2011 and 2021 in one single institution were retrospectively reviewed. We analyzed the treatment efficiency and long-term survivals. RESULTS A total of 21 patients were included in this cohort, 12 patients presented with T4 stage at diagnosis, and 6 in T1/T2, 3 in T3 stage. Nine patients (42.9%, 9/21) showed cervical lymph node metastases. All the patients were scheduled to receive definitive (chemo)radiotherapy and five patients had been performed surgery for residual tumor after (chemo)radiotherapy. 66.7% (14/21) of patients had a complete response after the completion of treatment, 23.8% (5/21) of partial response, one of stable disease, and one of progressed disease. The 3-year overall survival of the entire group were 86.2%, and the 3-year progress-free survival were 66.3%, respectively. 52.4% of the patients (11/21) presented orbit invasion, compared with patients without orbit invasion, the patients who had orbit invasion were not found to have significantly poor 3-year overall survival (87.5% vs 83.3%, p = 0.38) and 3-year progression-free survival (75.0% vs 55.3%, p = 0.59). CONCLUSION Definitive-intent (chemo)radiotherapy could be the preferred treatment for patients with advanced SNUC, and salvage surgery should be performed for the lesions showing stable disease, progressed disease, or residual tumor. ADVANCES IN KNOWLEDGE The value of definitive chemoradiotherapy in treating sinonasal undifferentiated carcinoma.
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Affiliation(s)
- Li Wang
- Department of Radiation Oncology, Ear, Nose & Throat
Hospital of Fudan University, 83 Fenyang Road, Shanghai,
China
| | - Jie Wang
- Department of Radiation Oncology, Ear, Nose & Throat
Hospital of Fudan University, 83 Fenyang Road, Shanghai,
China
| | - Tianci Tang
- Department of Radiation Oncology, Ear, Nose & Throat
Hospital of Fudan University, 83 Fenyang Road, Shanghai,
China
| | - Li Yan
- Department of Radiation Oncology, Ear, Nose & Throat
Hospital of Fudan University, 83 Fenyang Road, Shanghai,
China
| | - Xinmao Song
- Department of Radiation Oncology, Ear, Nose & Throat
Hospital of Fudan University, 83 Fenyang Road, Shanghai,
China
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Pérez-Sayáns M, Suárez Peñaranda JM, Quintanilla JAS, Chamorro Petronacci CM, García AG, Carrión AB, Vila PG, Sánchez YG. Clinicopathological features of 214 maxillary sinus pathologies. A ten-year single-centre retrospective clinical study. Head Face Med 2020; 16:24. [PMID: 33050926 PMCID: PMC7552481 DOI: 10.1186/s13005-020-00239-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diagnosis of maxillary sinus pathology must include the clinical radiological study (CRS) and histopathological analysis. The aim of this study is 1) to describe the clinicopathological features of maxillary sinus lesions, obtained successively in a single medical centre over the last 10 years and 2) to determine the sensitivity and specificity for the diagnosis of malignant lesions based exclusively on the CRS. METHODS It is a single-centre observational retrospective clinical study on patients who attended the University Hospital Complex of Santiago de Compostela (CHUS) with sinus pathologies during the period of 2009-2019. RESULTS The sample consisted of 133 men (62.1%) and 81 women (37.9%), with an average age of 46.9 years (SD = 18.8). In terms of frequency, the most frequent pathology was the unspecified sinusitis (44.4%), followed by polyps (18.2%), malignant tumours (9.8%), inverting papilloma (7.5%), fungal sinusitis (4.7%), cysts (3.7%), benign tumours (2.3%), mucocele (2.3%) and other lesions (1.9%). Cysts and benign tumours were diagnosed earliest Vs malignant tumours (65.2 years (SD = 16.1)) were diagnosed the latest (p < 0.001). Based only on the CRS for malignancies, diagnostic indexes were 71.4% sensitivity and 97.9% specificity, with a Kappa value of 0.68 with (p < 0.001). CONCLUSION Maxillary sinus pathology is very varied with therapeutic and prognostic repercussions. CRS is sometimes insufficient and histopathological confirmation is essential.
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Affiliation(s)
- Mario Pérez-Sayáns
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain.
| | - José M Suárez Peñaranda
- Pathological Anatomy Service, University Hospital Complex of Santiago (CHUS), C.P. 15782, Santiago de Compostela, Spain
| | - Juan Antonio Suárez Quintanilla
- Area of Human Anatomy and Embryology, Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | - Cintia M Chamorro Petronacci
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | - Abel García García
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | - Andrés Blanco Carrión
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | - Pilar Gándara Vila
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
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Takahashi D, Demizu Y, Park SC, Matsuo Y, Sulaiman NS, Terashima K, Tokumaru S, Akashi M, Okimoto T. Phase I dose-escalation trial of S-1 combined with carbon-ion radiotherapy for sinonasal squamous cell carcinoma. J Radiat Res 2020; 61:733-739. [PMID: 32642753 PMCID: PMC7482161 DOI: 10.1093/jrr/rraa037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/19/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to determine the maximum tolerance dose (MTD) and to estimate the recommended dose (RD) of concomitant S-1 with carbon-ion radiotherapy (RT) for sinonasal squamous cell carcinoma (SCC). Nine patients with sinonasal SCC received carbon-ion RT with escalating doses of S-1 according to phase I methods. Doses of 40, 60 and 80 mg/m2/day were administered twice daily in dose levels 1, 2 and 3, respectively, from days 1 to 14 and 22 to 35. Carbon-ion RT was administered at a dose of 70.4 Gy (relative biological effectiveness) in 32 fractions, 5 days a week. Two patients developed grade 3 acute dermatitis. However, none developed dose-limiting toxicities. Therefore, the MTD of S-1 could not be determined; the RD was estimated to be 80 mg/m2/day with concurrent carbon-ion RT. Partial response and stable disease were noted in 5 and 4 patients, respectively. The 2-year overall survival and local control rates were 56 and 74%, respectively. Overall, 2 patients developed ≥grade 3 late toxicities; among them, 1 patient developed grade 3 cataract and the other developed grade 4 cataract, optic nerve disorder and hearing impairment. To the best of our knowledge, this phase I study is the first clinical trial to evaluate concomitant S-1 with carbon-ion RT for sinonasal SCC. The MTD of S-1 could not be determined, and the RD was estimated to be 80 mg/m2/day. This study demonstrated a manageable safety profile for this combination. The observed outcomes may facilitate further evaluation of this novel therapy.
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Affiliation(s)
- Daiki Takahashi
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, 1-6-8 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Sung Chul Park
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Yoshiro Matsuo
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Nor Shazrina Sulaiman
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Kazuki Terashima
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Sunao Tokumaru
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan, 650-0017
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
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Brown RE, Roy S, McGuire MF. Morphoproteomics and Biomedical Analytics Identify the c-Myc, EZH2, Sirt1 and CXCR4 Pathways as Potential Blocks to Differentiation Leading to Proliferation and Metastatic Potential in Sinonasal Undifferentiated Carcinoma (SNUC) and Provide Therapeutic Options: A Case Study. Ann Clin Lab Sci 2018; 48:659-664. [PMID: 30373873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED Sinonasal undifferentiated carcinoma (SNUC) is a highly malignant tumor in the nasal cavity or paranasal sinuses. Morphoproteomics has defined its biology to some degree, allowing the identification of targeted therapeutic options with clinical efficacy [1]. This study's objective was to identify putative SNUC pathways that are known to pose a block in differentiation both in early embryogenesis and in tumorigenesis or that might promote metastasis and recurrent disease. DESIGN Morphoproteomic analysis of SNUC from a case study of this patient included immunohistochemical probes to detect c-Myc, EZH2, Sirt1 and CXCR4 protein analytes. Biomedical analytics schematically showed the interactions of these analytes with the morphoproteomic findings and illustrated targeted therapeutic options. RESULTS Representative sections of this patient's tumor displayed plasmalemmal expression for CXCR4 and nuclear immunopositivity for c-Myc, EZH2, and Sirt1. This coincided with their block in differentiation and their proliferative state with progression into the mitotic phase. Biomedical analytics integrated the morphoproteomic findings with the undifferentiated and proliferative state of SNUC and depicted pharmacogenomic and other related factors that target the c-Myc, EZH2, Sirt1 and CXCR4 pathways. CONCLUSION Morphoproteomics and biomedical analytics have identified c-Myc, EZH2, Sirt1 and CXCR4 pathways that collectively could contribute to the block in differentiation and increase the propensity for recurrence and metastasis in SNUC. This suggests that combinatorial therapies modulating these pathways could be used in a maintenance mode to minimize the risk of recurrent disease.
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Affiliation(s)
- Robert E Brown
- Department of Pathology and Laboratory Medicine, UT Health McGovern Medical School at Houston and TX, USA
| | - Suvra Roy
- Department of Pathology and Laboratory Medicine, UT Health McGovern Medical School at Houston and TX, USA
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Abstract
INTRODUCTION Rhabdomyosarcoma is uncommon in adults. Adult and maxillary rhabomyosarcoma with direct orbital extension has been rarely reported. To our knowledge, there is no reported case about adult patient with alveolar maxillary rhabdomyosarcoma and orbital extension survived 1 year with intact ocular function. CASE PRESENTATION A 21-year-old female presented with protrusion of the right eye and an obstructed nasal passage for the past month. Her symptoms were not relieved by oral antibiotic or irrigation. She was referred to our clinic. Computed tomography and magnetic resonance imaging showed a large homogenous well-enhanced mass with surrounding bony erosion and remodeling. The mass extended to the ipsilateral nasal cavity and orbit. Endoscopic biopsy of the nasal cavity confirmed alveolar rhabdomyosarcoma. The maxillary mass was excised using the Caldwell-Luc approach, and the orbital mass was excised using a transconjuctival and transcaruncular approach. A systemic work-up confirmed ipsilateral lymph node metastasis. The patient received 6 cycles of chemotherapy with vincristine, dactinomycin, and cyclophosphamide, as well as 5120 cGy radiotherapy. Her ocular function was intact 1 year after treatment, and magnetic resonance imaging showed complete regression of the tumor. CONCLUSION Rhabdomyosarcoma, which is usually an aggressive malignancy, should be considered in the differential diagnosis of a rapidly growing orbital mass. Aggressive treatment, including surgery, chemotherapy, and radiation therapy, can increase local remission rates and improve the prognosis.
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Affiliation(s)
- Jin-Ho Joo
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine
| | - Ji Sang Han
- Department of Ophthalmology, Kangbuk Samsung Hospital, College of Medicine, Sungkyun kwan University
| | - Shin-Myeong Choi
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine
| | - In-Ki Park
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae-Ho Shin
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine
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12
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de Bonnecaze G, Verillaud B, Chaltiel L, Fierens S, Chapelier M, Rumeau C, Malard O, Gavid M, Dufour X, Righini C, Uro-Coste E, Rives M, Bach C, Baujat B, Janot F, de Gabory L, Vergez S. Clinical characteristics and prognostic factors of sinonasal undifferentiated carcinoma: a multicenter study. Int Forum Allergy Rhinol 2018; 8:1065-1072. [PMID: 29935059 DOI: 10.1002/alr.22143] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/06/2018] [Accepted: 04/18/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Sinonasal undifferentiated carcinoma (SNUC) is a very rare entity with a poor prognosis. Due to the lack of studies on the subject, evidence is lacking concerning its management. METHODS A multicenter collaborative study was conducted to assess treatment strategy, oncological outcome, and prognostic factors. RESULTS Definitive analyses focused on 54 patients with a majority of advanced stage; the 3-year overall survival (OS) and 3-year recurrence-free survival (RFS) rates were, respectively, 62.4% and 47.8%. During the follow-up, 18 patients (33.3%) died, 10 (18.5%) developed metastases, 7 had lymph-node involvement (13%), and 12 (22.2%) showed recurrence or local progression. In univariate analyses, treatment modalities associated with improved RFS were induction chemotherapy (p = 0.02) and intensity-modulated radiotherapy (p = 0.007). In the multivariate analyses, only induction chemotherapy (p = 0.047, hazard ratio [HR] = 0.39) was significantly associated with improved RFS. CONCLUSION Multimodal therapies including induction chemotherapy and intensity-modulated radiotherapy may improve the prognosis of SNUC; surgery might improve local control. Further multicenter studies are required.
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Affiliation(s)
- Guillaume de Bonnecaze
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Rangueil-Larrey, Toulouse, France
| | - Benjamin Verillaud
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Lariboisière, Paris, France
| | - Leonor Chaltiel
- Biostatistics Department, L'Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-Oncopole), Cancer Institute, Toulouse, France
| | - Sylvestre Fierens
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Pellegrin, Bordeaux, France
| | - Mark Chapelier
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Rangueil-Larrey, Toulouse, France
| | - Cécile Rumeau
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Nancy, Nancy, France
| | - Olivier Malard
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Nantes, Nantes, France
| | - Marie Gavid
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Xavier Dufour
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Poitiers, Poitiers, France
| | - Christian Righini
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Grenoble, Grenoble, France
| | | | - Michel Rives
- Radiation Oncology Department, IUCT-Oncopôle, Cancer Institute, Toulouse, France
| | - Christine Bach
- Department of Otorhinolaryngology-Head and Neck Surgery, Hopital Foch, Suresnes, France
| | - Bertrand Baujat
- Department of Otorhinolaryngology-Head and Neck Surgery, Tenon Hospital, Paris-Est University, Paris, France
| | - François Janot
- Department of Otorhinolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France
| | - Ludovic de Gabory
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Pellegrin, Bordeaux, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Rangueil-Larrey, Toulouse, France
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Abstract
Esthesioneuroblastoma is a rare malignant tumor of the nasal cavity that originates from the olfactory epithelium. In this paper a very rare clinical presentation of this tumor is described. The tumor originated from the maxillary sinus and alveolar process, and was independent of the olfactory region. The patient was a 14-year-old girl presenting with facial swelling and nasal obstruction. Paranasal computed tomography showed a mass filling the right nasal cavity, infiltrating the alveolar process, eroding the anterior wall of the maxilla and invading the subcutaneous tissues of the cheek. Fine-needle aspiration and incisional biopsies identified an esthesioneuroblastoma. After neoadjuvant chemotherapy, we performed a right subtotal and left inferior maxillectomy and reconstructed the maxillary defect with a permanent obturator. At 2 years’ follow-up the patient is free of recurrence.
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Affiliation(s)
- Adnan Unal
- First Otorhinolaryngology Clinic, Ankara Numune Education and Research Hospital, Ankara, Turkey
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14
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Affiliation(s)
- B Liu
- Department of Radiation Oncology, The First Hospital, Jilin University, 71 Xinmin Street, Changchun 130021, China
| | - L Dong
- Department of Radiation Oncology, The First Hospital, Jilin University, 71 Xinmin Street, Changchun 130021, China
| | - W Shi
- Department of Radiation Oncology, The First Hospital, Jilin University, 71 Xinmin Street, Changchun 130021, China
| | - J Lv
- Department of Radiation Oncology, The First Hospital, Jilin University, 71 Xinmin Street, Changchun 130021, China
| | - L Guo
- Department of Pathology, The First Hospital, Jilin University, 71 Xinmin Street, Changchun 130021, China
| | - M Liu
- Department of Radiation Oncology, The First Hospital, Jilin University, 71 Xinmin Street, Changchun 130021, China
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15
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Kondo A, Kurose M, Obata K, Yamamoto K, Murayama K, Shirasaki H, Himi T. A Clinical Study of Maxillary Sinus Squamous Cell Carcinoma. Adv Otorhinolaryngol 2016; 77:83-7. [PMID: 27115153 DOI: 10.1159/000441879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report a retrospective study of 26 patients with maxillary sinus squamous cell carcinoma who were treated at the Sapporo Medical University between January 2002 and December 2008. The 5-year local control rate was 85.7% in patients with stage T2-3 disease and 61.0% in patients with stage T4a disease. The overall 5-year survival rate was 71.3% and the 5-year disease-specific survival rate was 79.9%. The 5-year disease-specific survival rate was 100% in patients with T2-3 disease and 44.4% in patients with T4 disease. The 5-year disease-specific survival rate was 76.3% in patients with N0 disease and 87.5% in patients with N+ disease. Five patients died of stage T4a disease. Two died of uncontrolled tumors at the primary site and 3 patients died of lung metastasis. We should consider another approach for the treatment of patients with advanced maxillary sinus carcinoma in the future.
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16
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Yoshifuku K, Nishimoto K, Matsuzaki T, Matsushita S. [A Case of Stevens-Johnson Syndrome Developing during Chemoradiotherapy for Maxillary Sinus Cancer]. ACTA ACUST UNITED AC 2016; 118:1436-42. [PMID: 26964396 DOI: 10.3950/jibiinkoka.118.1436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Herein, we report a case of drug-induced Stevens Johnson syndrome. (SJS). A 56-year old female visited our hospital complaining of right cheek pain. Local examination revealed that the right ostium of the maxillary sinus was open and that the maxillary sinus mucosa was invaded by tumor. Biopsy revealed a histopathological diagnosis of squamous cell carcinoma. We therefore diagnosed the patient as a case of maxillary sinus carcinoma (T3N0M0) based on the CT, MRI and FDG-PET findings. During chemoradiotherapy for maxillary sinus cancer, the patient developed oral mucosal inflammation of progressively worsening severity; we initially thought that the symptom was a side effect of the treatment; however, several days later, skin lesions appeared throughout the body. We consulted a dermatologist, who suspected SJS. The patient was initiated on high-dose steroid therapy (steroid pulse therapy), and the symptoms improved. Because of SJS is a fatal drug eruption, early diagnosis and prompt treatment are important. In patients receiving chemoradiotherapy showing severe oral mucosal inflammation outside the irradiation area or oral mucosal inflammation associated with skin lesions throughout the body, it is necessary to bear in mind the possibility of SJS.
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17
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Tuşaliu M, Zainea V, Mogoantă CA, Dragu AA, GoanŢă CM, NiŢescu M, OŢelea MR, Budu VA. Diagnostic and therapeutic aspects in malignant sinonasal lymphoma. Rom J Morphol Embryol 2016; 57:233-236. [PMID: 27151713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Among head and neck malignancies, lymphoma is the second most frequent cause. They can develop in the head and neck lymph nodes or as extranodal determinations. The onset of malignant lymphoma outside of lymph node registers increasingly frequent, currently over 30% of malignant lymphoma are diagnosed as taking place outside the lymph nodes. The aim of this paper is bringing in discussion and the presentation of current elements on the diagnosis and treatment in case of malignant sinonasal lymphoma, a pathological entity with a growing incidence. This study is a retrospective one, from January 2008 through December 2013, and included 31 patients admitted to "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT (Ear, Nose & Throat) Surgery, Bucharest, Romania, and diagnosed with malignant sinonasal lymphoma. Despite progress in terms of immunological techniques, cytogenetic and molecular histological outlining of malignant lymphomas, correct diagnosis and appropriate therapy of malignant sinonasal lymphoma is still a problem for the clinician and pathologist, as multidisciplinary collaboration of ENT-Hematology-Pathology-Radiotherapy being essential in this regard.
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Affiliation(s)
- Mihail Tuşaliu
- "Prof. Dr. Dorin Hociota" Institute of Phonoaudiology and Functional ENT Surgery, Bucharest, Romania;
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18
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Zielinski V, Laban S, Tribius S, Schafhausen P, Veldhoen S, Knecht R, Clauditz T, Muenscher A. Management of sinonasal undifferentiated carcinoma with intracerebral invasion: Clinical experience at a single institution and review of the literature. Ear Nose Throat J 2016; 95:23-28. [PMID: 26829682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Sinonasal undifferentiated carcinoma (SNUC) represents less than 1% of all malignancies. Most of the tumors are diagnosed at an advanced stage, when they have already invaded neighboring tissue structures. We describe the cases of 2 patients with a substantial intracerebral extension of SNUC who were treated at our institution. One was treated with surgery followed by chemoradiotherapy. The other was primarily treated with induction chemotherapy with a combination of docetaxel, cisplatin, and 5-fluorouracil followed by concurrent chemo- and radiotherapy. In view of the rarity of SNUC, no prospective clinical trials have been performed and a gold standard for treatment has not yet been established. Therefore, treatment recommendations are based on level IV evidence. These recommendations are diverse and controversial. In our 2 cases, the patient who was treated with induction chemotherapy had a better outcome. In cases of intracerebral extension, radical surgery is necessary and induction chemotherapy should be considered.
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Affiliation(s)
- Valerie Zielinski
- Department of Otorhinolaryngology-Head and Neck Surgery, Krankenhaus Rudolfstiftung, Juchgasse 25, 1030 Vienna, Austria.
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Abstract
BACKGROUND The management of sinonasal undifferentiated carcinoma (SNUC) remains unclear. Low incidence and poor outcomes make treatment standardization difficult. The objective of this study was to review the used treatment and our outcomes. METHODS From 2001 to 2013, 17 cases of SNUC were treated at our department. Charts were reviewed for standard demographic, tumour size and extension, histological features, treatment strategies, surgical approach, adjuvant therapies, outcomes and complications. RESULTS All patients presented with extensive local disease and 2 patients also had neck metastases. All patients were treated using a multimodality approach: 10 patients underwent surgery and postoperative chemoradiation, 1 patient was treated with surgery and adjuvant radiotherapy, 3 patients were treated with neoadjuvant chemotherapy, surgery and postoperative chemoradiation and the remaining 3 patients were treated with chemoradiotherapy. After median follow-up of 39 months 6 patients developed recurrences. The 3-year local control rate was 76% and the 5-year rate of overall survival was 58%. CONCLUSIONS Management and outcomes of SNUC have improved due to advances in surgery and radiotherapy. Gross tumour resection followed by postoperative radiotherapy should be the standard of care in patients with SNUC. High-precision high-dose radiotherapy should be implemented to try to improve the outcomes.
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20
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Abstract
BACKGROUND The management of sinonasal undifferentiated carcinoma (SNUC) remains unclear. Low incidence and poor outcomes make treatment standardization difficult. The objective of this study was to review the used treatment and our outcomes. METHODS From 2001 to 2013, 17 cases of SNUC were treated at our department. Charts were reviewed for standard demographic, tumour size and extension, histological features, treatment strategies, surgical approach, adjuvant therapies, outcomes and complications. RESULTS All patients presented with extensive local disease and 2 patients also had neck metastases. All patients were treated using a multimodality approach: 10 patients underwent surgery and postoperative chemoradiation, 1 patient was treated with surgery and adjuvant radiotherapy, 3 patients were treated with neoadjuvant chemotherapy, surgery and postoperative chemoradiation and the remaining 3 patients were treated with chemoradiotherapy. After median follow-up of 39 months 6 patients developed recurrences. The 3-year local control rate was 76% and the 5-year rate of overall survival was 58%. CONCLUSIONS Management and outcomes of SNUC have improved due to advances in surgery and radiotherapy. Gross tumour resection followed by postoperative radiotherapy should be the standard of care in patients with SNUC. High-precision high-dose radiotherapy should be implemented to try to improve the outcomes.
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21
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Dutta M, Ghatak S, Biswas G, Sen A. Primary soft tissue Ewing's sarcoma of the maxillary sinus in elderly patients: presentation, management and prognosis. Singapore Med J 2015; 55:e96-100. [PMID: 24442190 DOI: 10.11622/smedj.2013263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nonosseous or soft tissue Ewing's sarcoma is a rare form of Ewing's sarcoma/primitive neuroectodermal tumour that seldom affects the head and neck region. Involvement of the nose and paranasal sinuses is extremely uncommon, with only eight of such patients being reported to date, mostly affecting adolescents and young adults. To our knowledge, this study is the first comprehensive report of primary soft tissue Ewing's sarcoma involving the paranasal sinuses in an elderly patient who successfully completed treatment. We herein discuss the pathogenesis, management and factors affecting the prognosis of this rare group of tumours involving the nose and paranasal sinuses, in relation to the available literature.
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22
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Sakashita T, Homma A, Hatakeyama H, Kano S, Mizumachi T, Furusawa J, Yoshida D, Fujima N, Onimaru R, Tsuchiya K, Yasuda K, Shirato H, Suzuki F, Fukuda S. Salvage operations for patients with persistent or recurrent cancer of the maxillary sinus after superselective intra-arterial infusion of cisplatin with concurrent radiotherapy. Br J Oral Maxillofac Surg 2014; 52:323-8. [PMID: 24582012 DOI: 10.1016/j.bjoms.2014.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 01/11/2014] [Indexed: 11/19/2022]
Abstract
Our aim was to evaluate the feasibility of salvage operations for patients with persistent or recurrent cancer of the maxillary sinus after superselective intra-arterial infusion of cisplatin with concurrent radiotherapy. We retrospectively analysed the records of 61 patients with cancer of the maxillary sinus who were treated in this way. Chemotherapy comprised 100-120 mg/m(2) superselective intra-arterial infusions of cisplatin given a median of 4 times weekly (range 2-5). Concurrent radiotherapy was given in a median dose of 65 Gy (range 24-70 Gy). Persistent or recurrent cancer of the maxillary sinus was found in 17 patients, of whom 11 had salvage surgery. The disease was controlled in 8 of the 11, and 7 of the 11 survived with no evidence of disease. Their 5-year overall survival was 61%. Two of the 11 developed serious operative complications. Salvage surgery for patients with persistent or recurrent cancer of the maxillary sinus treated by superselective chemoradiotherapy is both safe and successful. Salvage surgery is a good option when this sort of persistent or recurrent cancer is followed up after the regimen of chemoradiotherapy described.
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Affiliation(s)
- Tomohiro Sakashita
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Akihiro Homma
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Hiromitsu Hatakeyama
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Satoshi Kano
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Takatsugu Mizumachi
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Jun Furusawa
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Daisuke Yoshida
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Noriyuki Fujima
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Rikiya Onimaru
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Kazuhiko Tsuchiya
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Koichi Yasuda
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Hiroki Shirato
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Fumiyuki Suzuki
- Department of Otolaryngology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan.
| | - Satoshi Fukuda
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Abstract
Langerhans cell histiocytosis (LCH) is an intriguing disorder characterized by the accumulation of specialized dendritic cells called Langerhans cells in several diverse tissues and body sites. It has been cited in numerous case reports to be associated with a wide variety of malignant neoplasms. Although many hypotheses have been suggested, the basis for such associations remains essentially unknown. We describe another association here that to our knowledge has not been reported thus far: a solitary plasmacytoma occurring at a site of previous involvement by LCH. This constitutes a new addition to the now fairly lengthy list of malignant neoplasms that have been reported to occur in the setting of LCH. The possible reasons for such an association are discussed along with a brief review of LCH.
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Affiliation(s)
- Vivek R Sharma
- University of Louisville, Medical Oncology/Hematology, 529 S. Jackson Street, Louisville, KY 40202, USA
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Ansari M, Guo S, Fakhri S, Citardi MJ, Blanco A, Patino M, Buryanek J, Amato R, Karni R, Brown RE. Sinonasal undifferentiated carcinoma (SNUC): morphoproteomic-guided treatment paradigm with clinical efficacy. Ann Clin Lab Sci 2013; 43:45-53. [PMID: 23462605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Sinonasal undifferentiated carcinoma (SNUC) is a rare and highly malignant tumor that occurs in the nasal cavity and/or paranasal sinuses. Prognosis is poor despite multimodality treatment. Currently, there is no optimal standard of treatment, partially due to a lack of research defining the biology of such tumors. This report discusses two SNUC cases where patients received a novel chemotherapeutic approach using cisplatin, etoposide, Adriamycin (doxorubicin), metformin, and adjuvant melatonin therapies based on morphoproteomic-guidance, followed by consolidation with chemoradiation therapy. This resulted in excellent and objective tomographic and magnetic resonance imaging and clinical responses including complete responses in the induction phase utilizing morphoproteomic-guided therapies. Later, endoscopic excision of the tumor bed failed to reveal any residual tumor. Morphoproteomics helped to define the biology of these SNUC tumors and provided targets for the agents employed, creating a new treatment paradigm for such tumors. This treatment regimen poses a new effective regimen to treat SNUC.
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Affiliation(s)
- Maria Ansari
- Division of Oncology, Department of Internal Medicine, University of Texas Medical School at Houston and Memorial Hermann Cancer Center, Houston, TX 77030, USA
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25
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Arora S, Korn RL, Lenkiewicz E, Cherni I, Beach TG, Hostetter G, Barrett MT, Weiss GJ. Clonal evolution of a case of treatment refractory maxillary sinus carcinoma. PLoS One 2012; 7:e45614. [PMID: 23029135 PMCID: PMC3460998 DOI: 10.1371/journal.pone.0045614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 08/23/2012] [Indexed: 01/16/2023] Open
Abstract
Background Maxillary sinus carcinoma (MSC) is a rare cancer of the head and neck region. Patients are treated with surgery, radiation therapy, and chemotherapy and the treatment regimen is based on patient’s age, general health condition, disease stage, and its extent of spread. There is very little information available on the genetics of this disease. DNA content based flow sorting of tumor cells followed by array comparative genomic hybridization allows for high definition global assessment of distinct clonal changes within tumor populations. Methods We applied this technique to primary and metastatic samples collected from a patient with radio- and chemotherapy refractory maxillary sinus carcinoma to gauge the progression of this disease. Results A clonal KIT amplicon was present in aneuploid populations sorted from the primary tumor and in divergent subclones arising in metastatic foci found in the brain, lung, and jejunum. The evolution of these subclones was associated with distinct genetic aberrations and DNA ploidies. Conclusion The information presented here paves the path to understanding the development and progression of this disease.
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Affiliation(s)
- Shilpi Arora
- The Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Ronald L. Korn
- Scottsdale Medical Imaging, LLC, Scottsdale, Arizona, United States of America
| | - Elizabeth Lenkiewicz
- The Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Irene Cherni
- The Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Thomas G. Beach
- Sun Health Research Institute at Banner Healthcare, Phoenix, Arizona, United States of America
| | - Galen Hostetter
- The Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Michael T. Barrett
- The Translational Genomics Research Institute, Phoenix, Arizona, United States of America
| | - Glen J. Weiss
- The Translational Genomics Research Institute, Phoenix, Arizona, United States of America
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare, Scottsdale, Arizona, United States of America
- * E-mail:
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Bhaumik G, Chatterjee K. Spindle cell sarcoma of the maxillary antrum. J Indian Med Assoc 2012; 110:657-658. [PMID: 23741844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Maxillary antral malignancies are mostly squamous cancers. Sarcomas in this region are rare. The head and neck region houses around 8.9% of all sarcomas and spindle cell sarcomas of the maxillary antrum had rarely been reported.The presentation, pathology, clinical findings, management and short term response to treatment of a left maxillary antral spindle cell sarcoma, in a Muslim, male tobacco chewer is reported here.
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Affiliation(s)
- Gautam Bhaumik
- RMO cum Clinical Tutor of Surgery, RG Kar Medical College, Kolkata 700004
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Abstract
Adenoid cystic carcinoma (ACC) is a rare malignant neoplasm, arising from glandular tissues, found mainly in the head and neck. Generally, it presents insidiously but can behave aggressively making its course unpredictable. Surgery and adjuvant radiotherapy continue to be the cornerstone for its treatment. ACC remains extremely difficult to treat. The authors report a case of a 37-year-old woman with bloody rhinorrhea for 6 months. She was diagnosed with a left nasal cavity lesion that was biopsied, and the anatomopathological result showed ACC. The patient was submitted to a left extended maxillectomy, microsurgical reconstruction and radiotherapy.
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Affiliation(s)
| | - Hugo Sequeira
- Department of Plastic, Reconstructive and Maxillofacial Surgery, CHVNG/E, EPE, Gaia, Portugal
| | - Gustavo Coelho
- Department of Plastic, Reconstructive and Maxillofacial Surgery, CHVNG/E, EPE, Gaia, Portugal
| | - Horácio Costa
- Department of Plastic, Reconstructive and Maxillofacial Surgery, CHVNG/E, EPE, Gaia, Portugal
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Hamdan AL, Kahwaji G, Mahfoud L, Husseini S. Cavernous hemagioma of the maxillary sinus: a rare cause of epistaxis. Middle East J Anaesthesiol 2012; 21:757-760. [PMID: 23265045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND A case of cavernous hemangioma of the maxillary. METHOD A 25 year old lady presented with history of nasal obstruction, recurrent epistaxis and headache. On exam she had a mass in the left osteomeatal complex that was friable and bled easily on palpation. Computerized tomography of the paranasal sinuses 2mm coronal cuts showed complete opacification of the left maxillary sinus and magnetic resonance imaging revealed a 1.5 x 3 x 2.5 cm lobulated soft tissue mass lesion that enhanced with intravenous gadolinium administration, but no flow-void signals were present. Histologically, the mass was made up of dilated and anastomosing blood vessels. RESULT The radiologic findings may be attributed to a malignant lesion especially when extensive bone erosion is present. CONCLUSION Cavernous hemangioma of the maxillary sinus is a very rare benign entity that presents with recurrent epistaxis and nasal obstruction.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology, American University of Beirut Medical Center, P.O. Box: 11-236, Beirut, Lebanon.
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Al-Mamgani A, van Rooij P, Mehilal R, Tans L, Levendag PC. Combined-modality treatment improved outcome in sinonasal undifferentiated carcinoma: single-institutional experience of 21 patients and review of the literature. Eur Arch Otorhinolaryngol 2012; 270:293-9. [PMID: 22476411 PMCID: PMC3535397 DOI: 10.1007/s00405-012-2008-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 03/19/2012] [Indexed: 11/25/2022]
Abstract
The optimal treatment of sinonasal undifferentiated carcinoma (SNUC) remains unclear. We report our results on the outcome and toxicity of patients with SNUC treated by a combined modality and attempt to define the optimal treatment strategies by reviewing the literature. Between 1996 and 2010, 21 consecutive patients with SNUC were treated by any combination of surgery, chemotherapy and radiotherapy. End points were local control (LC), regional control (RC), disease-free (DFS), cause-specific (CSS) overall survival (OS), and late toxicity. Organ preservation was defined as visual preservation without orbital exenteration. After median follow-up of 54 months, the 5-year actuarial rates of LC, RC, DFS, CSS, and OS were 80, 90, 64, 74, and 74 % respectively. On multivariate analysis, T-stage and multimodality treatment approach correlated significantly with LC. Elective nodal irradiation was given to 42 % of high-risk node-negative patients. None of them developed regional failure. The overall 5-year incidence of grade ≥2 late toxicity was 30 %. Treatment-related blindness was significantly decreased in patients treated with intensity-modulated radiotherapy (IMRT), compared to 2D and 3D-conformal radiotherapy (3DCRT), with organ preservation rates of 86 and 14 % respectively (p = 0.006). We concluded that combined-modality treatment with three, or at least two, modalities resulted in good LC, but with high overall rate of late toxicity. However, the incidence of late toxicity and permanent visual impairment were decreased over time by the introduction of IMRT. Because of the improvement in therapeutic ratio achieved by using IMRT, this highly conformal radiation technique should be the standard of care in patients with SNUC.
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Affiliation(s)
- Abrahim Al-Mamgani
- Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands.
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Rytkönen AE, Hirvikoski PP, Salo TA. Lymphoepithelial carcinoma: two case reports and a systematic review of oral and sinonasal cases. Head Neck Pathol 2011; 5:327-34. [PMID: 21698444 PMCID: PMC3210216 DOI: 10.1007/s12105-011-0278-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 06/13/2011] [Indexed: 11/25/2022]
Abstract
Lymphoepithelial carcinoma (LEC) is a rare malignancy. Histologically, it is an undifferentiated carcinoma with an intermixed reactive lymphoplasmacytic infiltrate. Herein, we report two cases of LEC in the head and neck region that presented to Oulu University Hospital. Our first case is a 30-year-old man with LEC in the left maxillary sinus. The second case is a 49-year-old man with LEC in the soft palate and uvula with regional lymph node metastases at diagnosis. In addition, a systematic review of the literature from 1980 to 2010 was performed with MEDLINE and cross-references were searched manually. Case reports and clinical series of oral, oropharyngeal, nasal, and paranasal sinus LECs were reviewed revealing a total of 110 cases. Most of the oral cases were found in the tonsils (n = 29), oropharynx (n = 19), and in oral mucosa (n = 18), while sinonasal cases (n = 40) were mainly in the paranasal sinuses and nasal cavity. From 37 case reports, including ours, the median age was 58 and 62 years for sinonasal and oral/oropharyngeal LECs, respectively. Oral and oropharyngeal LECs have a 70.0% tendency to metastasize and 16.6% spread locally. In contrast, none of the nasal and paranasal LECs metastasized, but 60% spread locally. Epstein-Barr virus (EBV) had been detected in 87.5% of all tested LEC cases. Treatment of LECs, during the last decade, has largely consisted of surgery, combined with radiotherapy or chemoradiation. Although local spread or nodal metastases are fairly common at the time of diagnosis, the mortality rate of adequately treated LEC patients is low.
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Affiliation(s)
- Aleksi E. Rytkönen
- Department of Diagnostics and Oral Medicine, Institute of Dentistry, Oulu University Hospital, University of Oulu, PO Box 5281, 90014 Oulu, Finland
| | - Pasi P. Hirvikoski
- Department of Pathology, Oulu University Hospital, Oulu, Finland
- Länsi-Pohja Central Hospital, Kemi, Finland
| | - Tuula A. Salo
- Department of Diagnostics and Oral Medicine, Institute of Dentistry, Oulu University Hospital, University of Oulu, PO Box 5281, 90014 Oulu, Finland
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Liu WS, Xu ZG, Gao L, Tang PZ, Xu GZ, Zhang GF. [Adenoid cystic carcinoma of maxillary sinus: diagnosis, treatment and prognostic factors]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2011; 46:402-407. [PMID: 21781563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To study the clinical characters, the outcomes of treatments and the factors affecting long-term treatment results of adenoid cystic carcinoma (ACC) of the maxillary sinus. METHODS The clinical data of 80 patients with ACC of the maxillary sinus treated initially were analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Prognosis factors were analyzed by Log-rank test and Cox regression. RESULTS The 5-, 10- and 15-year cumulative overall survival rates were 65.2%, 37.1%, 26.3% respectively and 5-, 10-, and 15-year disease-free survival rates 50.7%, 30.7% and 24.5% respectively. The 5-, 10- and 15-year cumulative local control rates were 68.5%, 47.3% and 47.3% respectively and the cumulative distant metastasis rate were 32.8%, 48.8% and 48.8% respectively. Prognostic factors affecting survival included T stage, pathologic grade and the modes of treatment (P < 0.05). Patients with combined therapy composed of surgery and radiation had a better local control, compared with surgery or radiation alone (χ(2) = 18.33, P < 0.01), and surgery combined with postoperative radiation was prior to preoperative radiation combined with surgery (χ(2) = 6.64, P < 0.05). Patients treated with surgery combined with preoperative radiation, either with doses of ≥ 60 Gy or with negative margins, had a better local control, compared with doses < 60 Gy and with positive margins (χ(2) = 5.06, P < 0.05). The most of patients (62.8%) died of local recurrence. CONCLUSIONS The most of failure was due to recurrence. Combined therapy composed of surgery and radiation improves the local control and survival in patients with ACC of the maxillary sinus, compared with surgery or radiation alone. Surgery combined with postoperative radiation provides the best overall survival and local control and should be the first choice of treatments.
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Affiliation(s)
- Wen-sheng Liu
- Department of Head and Neck Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100021, China.
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32
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Wu TH, Huang JS, Wang HM, Wang CH, Yeh KY. Long-term survivors of adult rhabdomyosarcoma of maxillary sinus following multimodal therapy: case reports and literature reviews. Chang Gung Med J 2010; 33:466-471. [PMID: 20804675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Rhabdomyosarcoma of the maxillary sinus is uncommon in adults. The clinical course and appropriate treatment strategy for the disease remains to be elucidated. This article describes two adult patients with rhabdomyosarcoma of the maxillary sinus who achieved long-term survival after undergoing multimodal therapy. We also reviewed the literature regarding 23 patients who were 15 years of age or older and had rhabdomyosarcoma of the maxillary sinus and were treated between 1950 and 2000. Results of our analysis suggest that multimodal therapy may become the mainstay treatment for adult rhabdomyosarcoma of the maxillary sinus. We believe that adequate surgical procedures, planned radiotherapy, aggressive chemotherapeutic agents and the best supportive care for complications may improve the prognosis of patients with this disease.
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Affiliation(s)
- Tsung-Han Wu
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Zhang ZX, Li ZJ, Xu ZG, Tang PZ, Zhang ZM, An CM. [Clinical analysis of 60 cases with maxillary squamous cell carcinoma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2010; 45:560-564. [PMID: 21055053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To study the clinical characters, treatment modalities and prognosis of patients with maxillary squamous cell carcinoma. METHODS The clinical data of 60 patients with maxillary squamous cell carcinoma treatment between January 1994 and December 2004 were analyzed retrospectively. The patients were treated with three therapy modalities including radiotherapy alone (22 cases), radiotherapy and surgery (R + S, 29 cases) and concurrent chemo-radio-therapy adjuvant surgery (CCR + S, 9 cases). RESULTS The five year survival rate were 18.2%, 51.7% and 33.3% for patients in the radiotherapy alone group, the R + S group and the CCR + S group, respectively. Patients receiving R + S combined modality therapy had a significantly higher five year survival rate than the patients who were treated radiotherapy alone (χ(2) = 15.62, P < 0.01). The five year survival rate (51.7%) of patients in R + S group was significantly higher than that (33.3%) of patients in CCR + S group (χ(2) = 4.28, P < 0.05), and also higher than that (18.2%) of patients in radiotherapy group (χ(2) = 9.49, P < 0.01). CONCLUSIONS The combined therapy of radiation and surgery was a good choice of treatment for the patients with maxillary sinus squamous cell carcinoma. The role of concurrent chemo-radiotherapy adjuvant surgery in the treatment of maxillary sinus squamous cell carcinoma needs further to research.
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Affiliation(s)
- Zai-xing Zhang
- Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
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Farah-Klibi F, El Amine O, Rameh S, Resi H, Châabane H, Touati S, Frikha H, Raies H, Mezlini A, Maalej M, Adouani A, Baltagi Ben Jilani S, Zermani R. [Primary Ewing's sarcoma of the maxillary sinus: report of a new case, successfully treated by radiotherapy and systemic chemotherapy]. Tunis Med 2009; 87:716-717. [PMID: 20187366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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35
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Chew YK, Noorizan Y, Khir A, Brito-Mutunayagam S. Leiomyosarcoma of the maxillary sinus. Med J Malaysia 2009; 64:174-175. [PMID: 20058584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Leiomyosarcoma is a malignant smooth-muscle tumour that has a predilection for the gastrointestinal and female genital tract. It is locally fast-spreading and highly aggressive, and the prognosis is poor. We report a rare case of leiomyosarcoma of the maxilla in a patient who sought treatment for maxillary swelling, nasal obstruction with no epistaxis, orbital involvement or cervical lymph node metastasis. The patient underwent subtotal maxillectomy followed by radiotherapy. At present, he is symptom free with no recurrence and under regular follow up.
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Affiliation(s)
- Y K Chew
- Department of ENT, Hospital Pakar Sultanah Fatimah, 84000 Muar, Johor, Malaysia.
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36
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Bai Y, Yan L, Chen Y, Song L, Zhao R. [Clinical analysis of 43 cases with carcinomas in maxillary sinus by sequent combination therapy]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2008; 22:1073-1076. [PMID: 19253532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To investigate the clinical effects and life quality of 43 cases with carcinomas in maxillary sinus by sequent combination therapy. METHOD All the patients were subjected sequent and combination therapy, which included inductive chemotherapy through superficial temporal artery, operation and radical radiation therapy, and of these, 18 patients were added consolidation chemotherapy after combination therapy. Three year survival rate, 5- year survival rate and life quality were observed in a 5 years follow up. RESULT All patients completed this therapy, the overall 5-year survival rates were 46.5% (20/43) and 3-year were 65.1% (28/43). None were undertaken orbital exenteration and 12 patients recovered their ability of work and manual labour. CONCLUSION The sequent combination therapy is an effective method to enhance the prospective efficacy of treating the carcinoma of maxillary sinus and can raise the local controlling rate. The induced chemotherapy through the temporal artery superficial has many advantages, such as high density of topical remedy, obvious tumor regression after only a cycle chemotherapy, not delaying the surgery opportunity and so on. The consolidation chemotherapy after this combined therapy can reduce the risks of distant metastasis further.
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Affiliation(s)
- Yanxia Bai
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an 710061, China
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37
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Su YR, Wu GH, Zeng ZY, Guo ZM, Chen WK, Wei MW, Chen YF. [Treatment of advanced maxillary sinus squamous carcinoma: an analysis of 92 cases]. Ai Zheng 2008; 27:535-538. [PMID: 18479606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND & OBJECTIVE There is no satisfactory treatment for advanced maxillary sinus squamous carcinoma. The treatment strategy is controversial. This study aimed to explore a rational treatment for advanced maxillary sinus squamous carcinoma. METHODS Clinical data of 92 patients with stage T3-T4 maxillary sinus squamous cell carcinoma, treated in Cancer Center of Sun Yat-sen University from Jan.1978 to Dec.2001, were reviewed. Of the 92 patients, 21 received radiotherapy alone, 8 received surgery alone, 63 received multimodality therapy (51 received surgery combined with radiotherapy, and 12 received chemoradiotherapy). RESULTS The 3-and 5-year survival rates were significantly lower in radiotherapy group and surgery group than in multimodality therapy group (19.0% and 25.0% vs. 46.0%, P<0.05; 9.5% and 12.5% vs. 33.3%, P<0.05). In multimodality therapy group, the 3-and 5-year survival rates were 33.3% and 23.8% for the patients who received radiotherapy followed by surgery, 52.9% and 47.1% for the patients who received surgery follow by radiotherapy, 53.8% and 30.8% for the patients who received pre-and postoperative radiotherapy, and 50.0% and 33.3% for the patients who received chemoradiotherapy. There were no significant differences in survival rate between these four subgroups (P>0.05). CONCLUSIONS The efficacy of multimodality therapy is better than that of single therapy strategy for advanced maxillary sinus squamous carcinoma. The best treatment pattern for advanced maxillary sinus squamous carcinoma needs further research.
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Affiliation(s)
- Yao-Rong Su
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, People's Republic of China
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38
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Kawabata M, Yoshifuku K, Sagara Y, Kurono Y. Ewing's sarcoma/primitive neuroectodermal tumour occurring in the maxillary sinus. Rhinology 2008; 46:75-78. [PMID: 18444498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 12-year-old boy complained of swelling of the left cheek. Fiberscopic examination revealed the presence of a soft reddish mass in the middle meatus of the left nostril. CT scan showed a large mass completely filling the left maxillary sinus. The lesion originated from the maxillary sinus and extended to the middle nasal meatus; bone destruction and invasion of the subcutaneous tissue of the cheek were noted. T2-weighted MRI images revealed a heterogeneous signal in the left maxillary sinus. Under general anaesthesia, biopsies were obtained through an intraoral incision. On pathology, atypical cells containing irregular nuclei with scanty cytoplasm were noted. The tumour cells were strongly positive for CD99 and reacted weakly with NSE however the cells were negative for synaptophysin, LCA and cytokeratin on immunohistochemical examination. Based on these findings, the tumour was diagnosed as a Ewing's sarcoma/primitive neuroectodermal tumour. The patient was treated with radiotherapy and combination chemotherapy; subsequently, the tumour's size decreased markedly. After 20 months of follow-up, the patient showed no evidence of local tumour growth or metastasis.
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Affiliation(s)
- Masaki Kawabata
- Department of Otolaryngology Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Japan.
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39
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Morris CL, Mukundan S, Heimann A, Cummings TJ, Chesnutt DA. Stage IV primitive-appearing sinus and orbital rhabdomyosarcoma presenting in a 68-year-old female previously treated for breast cancer. Orbit 2008; 27:73-77. [PMID: 18307153 DOI: 10.1080/01676830601177489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 68-year-old female who had undergone treatment several years previously for breast cancer presented with diplopia and unilateral proptosis and exposure keratopathy related to biopsy-proven rhabdomyosarcoma of the sinus and orbit. Further evaluation revealed multiple metastatic lesions felt to have originated from the primary sinus and orbital tumor. Histopathologic examination showed primitive-appearing rhabdomyosarcoma with some features suggestive of the alveolar subtype. Orbital or sinus rhabdomyosarcoma is seen almost exclusively in the pediatric population, but may very rarely occur in adults. There are several genetic mutations that appear to play a role in both rhabdomyosarcoma and certain breast tumors. There is also increasing evidence that even low doses of radiation may contribute to the future development of cancer, particularly in susceptible individuals. In our patient with atypical demographics for rhabdomyosarcoma, the previous neoplasm and treatment thereof may have predisposed to the development of this rare tumor.
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Affiliation(s)
- Carrie L Morris
- Department of Ophthalmology, Duke University Eye Center, Duke University Medical Center, Durham, NC, USA
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40
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Liu TR, Chen FJ, Yang AK, Li QL, Guo ZM, Zhang Q, Zeng ZY. [Clinical study of 36 cases with adenoid cystic carcinoma of the maxillary sinus]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2008; 43:37-40. [PMID: 18357710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To study the clinical characters, management and the prognosis of patients with adenoid cystic carcinoma of the maxillary sinus. METHODS The clinical data were analyzed retrospectively for 36 patients with adenoid cystic carcinoma of the maxillary sinus to evaluate the treatment results of different modalities. The contribution of every factors influencing on survival were also analyzed. Survival analysis was performed by life table method, comparison among/between groups was performed using log-rank test, and multivariate analysis was carried out using Cox proportional hazard model. RESULTS The 5-year survival rate was 58.33% in all patients, while they were only 75.0% and 42.9% in stage III and stage IV lesions respectively. The 5-year survival rate of 66.7% was obtained in patients who received surgery combined with radiotherapy,71.4% and 12.5% respectively in those treated by surgery and by radiotherapy alone. Multivariate analysis indicated that stage, treatment modality, and the tumour residues in the primary treatment were the predict factors for the prognosis. CONCLUSIONS Advanced adenoid cystic carcinoma should be treated by combined surgery and radiotherapy. Stage, treatment approach and short-term therapeutic response are the most important factors affecting the prognosis of the patients with adenoid cystic carcinoma of the maxillary sinus.
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Affiliation(s)
- Tian-run Liu
- Department of Head and Neck, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China.
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41
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Abstract
Malignant fibrous histiocytoma is the most common soft tissue sarcoma in adults. The common sites of involvement are the retroperitoneal space and limbs. The occurrence of this tumor in the head and neck is rare. Recent studies have shown that the occurrence of malignant fibrous histiocytoma in the head and neck can follow radiotherapy for the treatment of other tumors. We, herein, report a case of malignant fibrous histiocytoma, which developed 17 years after radiotherapy of a carcinoma in the maxillary sinus.
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Affiliation(s)
- Donya Sadri
- Department of Oral Pathology, Islamic Azad University of Dentistry, Tehran, Iran
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42
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Hölzl M, Stölzel K, Schrom T, Scherer H, Lammert I. [Is orbital exenteration indicated for extensive primary mucosal melanomas of the sinunasal system?]. Laryngorhinootologie 2007; 86:346-51. [PMID: 17226435 DOI: 10.1055/s-2006-944983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Primary mucosal melanomas are most frequently localized in the sinunasal system. Orbital involvement must be excluded in the mostly advanced tumor stage. The aim of our study was to find possible indications for orbital exenteration in the T3-4 sinunasal tumor stage. We evaluated 14 treatment courses at our department from 1988 to 2004. The analysis disclosed orbital involvement in 43 % of the patients. The one patient submitted to orbital exenteration had a survival of only 28 months, which was not relevantly longer than in the other 9 patients with a T3-4 tumor stage (median survival of 27 months) or to the two patients with purely palliative treatment (survival of 10 and 21 months). We conclude that, due to the high generalized metastasis rate, radical surgical procedures can only prolong survival in individual cases of advanced-stage sinunasal tumors. Orbital decompression should be considered with reference to the quality of life.
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Affiliation(s)
- M Hölzl
- Hals-Nasen-Ohrenklinik und Poliklinik Charité, Campus Mitte, Berlin.
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43
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Pomar Blanco P, San Román Carbajo J, Bouso Montero M, Martín Villares C, Fernández Pello M, Tapia Risueño M. [Sinonasal mucosal melanoma]. An Otorrinolaringol Ibero Am 2007; 34:349-58. [PMID: 17844954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Mucosal melanomas of the nasal cavity and paranasal sinuses are rare and agresive neoplasms and carries a bad prognosis. The diagnosis may require confirmatory immunohistochemical stains (S-100 protein, HMB-45, vimentin and cytokeratine). The clinical records of 6 patients with the diagnosis of sinonasal melanomas between 1991 and 2005 were retrospectively reviewed. The mean age was 70 years (range 51 to 83 years), there were 2 men and 4 women. Surgery was performed in four patients, adjuvant radiation therapy was used in one patient after local recurrence and chemotherapy in three patients. Three of four patients (75%) had a recurrence after previous treatment (surgery). The actuarial disease-free survival for this group of 6 is 33.3% (2 of 6). Mucosal melanoma of the head and neck remains a difficult disease to treat, with high locoregional recurrence rates and poor prognosis.
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Affiliation(s)
- P Pomar Blanco
- Servicio de ORL, Hospital de eL Bierzo, Ponferrada, León.
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Khademi B, Owji SM, Khosh KJ, Mohammadianpanah M, Gandomi B. Description of a neural sheath tumor of the trigeminal nerve: immunohistochemical and electron microscopy study. SAO PAULO MED J 2006; 124:333-5. [PMID: 17322954 DOI: 10.1590/s1516-31802006000600006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 10/17/2006] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Malignant neural sheath tumors of the trigeminal nerve affecting the nasal cavity and the paranasal sinuses are extremely rare. With conventional optical microscopy, their identification is difficult, and it is necessary to confirm them by means of electron microscopy and immunohistochemical techniques. CASE REPORT The patient was a 41-year-old woman with a ten-month progressive history of pain followed by painful edema in the left facial region, and with symptoms of bleeding, secretion and nasal obstruction. Studies with imaging methods suggested the presence of an expansive process in the left nasal and paranasal cavities. In the biopsy, the histopathological findings from optical microscopy were suggestive of a tumor of neural origin in the trigeminal nerve. Immunohistochemical and electron microscopy studies confirmed that it was a malignant tumor of the neural sheath of the trigeminal nerve. We describe the clinical, radiological, and histological features of this tumor and review the literature.
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Affiliation(s)
- Bijan Khademi
- Department of Otolaryngology-Head and Neck Surgery, Khalili Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
PURPOSE To report a case of sarcomatoid carcinoma and orbital apex syndrome in a previously healthy adult. METHODS A previously healthy 45-year-old man presented with exophthalmos of the left eye and a mass visible through his left nostril. A biopsy was performed and immunohistochemistry was used to confirm the diagnosis of the tumor. The patient was treated with chemotherapy and radiotherapy. RESULTS After treatment, we observed a substantial reduction in the size of the mass, but side effects of treatment developed. The visual acuity of the left eye was no light perception. Eight months later, the patient presented with bone and liver metastases, and he died 4 months later. CONCLUSIONS Sarcomatoid carcinoma is an aggressive tumor that can produce compressive symptoms with very poor visual and survival prognoses. A cranio-orbital computed tomography scan should be performed when patients present with symptoms of conjunctivitis and orbital apex syndrome.
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Affiliation(s)
- L M Sadaba
- Department of Ophthalmology, University Clinic of Navarra, University of Navarra, Avda/Pio XII 36, 31008 Pamplona (Navarre), Spain.
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Khan MH, Haque S, Yagi K, Takinami S, Khan SH, Ohmori K, Nishioka T. Pattern of local relapse of maxillary sinus carcinoma. Mymensingh Med J 2006; 15:188-91. [PMID: 16878103 DOI: 10.3329/mmj.v15i2.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Maxillary sinus carcinoma (MSC) is a rare disease with a variety of treatment options. The present study was undertaken to review the outcome of patients with treated MSC in order to clarify the factors related to local recurrence by analyzing CT findings. The study group comprised of 47 cases, 40 males and 7 females with a median age of 61 years (range, 40- 84 years) treated between 1988 to 1996 at the department of radiotherapy. CT was taken with a slice thickness of 5 mm and contrast material was routinely used. The mean follow-up period for the group was 45.0 months (range, 3-125 months). The treatment policy was either preoperative radiotherapy of 40Gy/16fr followed by maxillectomy or radical radiotherapy of 65Gy/26fr with partial maxillectomy during the course of radiotherapy. By using CT-simulation, wedge pair techniques were used in most patients with Cobalt or 6MV X-ray machines as treatment sources. Tumor extension was categorized into the following anatomical sites: orbital contents, other paranasal sinuses, posterior wall of the maxillary sinus, pterygoid plate/muscle, nasopharynx, infra-temporal fossa, base of the skull, anterior wall of the maxillary sinus, subcutaneous tissue, cheek mucosa, hard palate and alveolar bone. Local control was computed by using the Kaplan-Meier method and p value was measured by using Chi-squared test. The 5-year overall local control rates for all patients were 56%. The local recurrence was found in 19 of 47 patients (40.4%). Tumors extending to pterygoid plates (n=13) and pterygoid muscles (n=10) showed higher rate of local recurrences as compared to those without extensions (9/13 [69%] vs 10/34 [29%], p<0.02 and 7/10 [70%] vs 12/37 [32%], p<0.05, respectively). Extensions to nasopharynx (6/9, 66%) and base of skull (4/6, 66%) also showed higher rates of recurrence; however, those were not statistically significant. More than 80% of the relapse became manifest within 12 months of diagnosis and isolated local failure was the most common pattern. This analysis indicates that tumor extension to pterygoid plate/muscles, results in higher rates of recurrences. This may due to the difficult surgical accessibility of the tumor. During radiotherapy planning, special emphasis should be given to this sites of tumor extension to avoid possible local recurrence.
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Affiliation(s)
- M H Khan
- Dept. of Dentistry, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorder, BIRDEM Hospital, Dhaka, Bangladesh.
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Head and Neck Cancers Panel Members, National Comprehensive Cancer Network. [A guide to diagnosis and treatment of head and neck malignancy]. Zhonghua Kou Qiang Yi Xue Za Zhi 2006; 41:453-5. [PMID: 17074176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Choi YS, Han GS, Choi JS, Jang TY. Two cases of malignant melanoma in turbinate and maxillary sinus. Eur Arch Otorhinolaryngol 2006; 263:996-1000. [PMID: 16819660 DOI: 10.1007/s00405-006-0103-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2005] [Accepted: 06/01/2006] [Indexed: 10/24/2022]
Abstract
Malignant melanomas develop from malignant transformation of melanocytes that are present in the skin and mucosal linings throughout the body. The overall rate of mucosal melanoma is rare and malignant melanomas developing from turbinates or maxillary sinuses are extremely rare. Symptoms of nasal melanoma are generally nonspecific, and patients often fail to seek prompt medical attention. Diagnosis can be confirmed by the immunochemical profile of staining with anti-S100 and HMB-45 antibodies, even in the case of melanin-free pigment melanoma. The present study reports two cases of primary malignant melanoma in the turbinate and maxillary sinus.
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Affiliation(s)
- Yoon-Seok Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Inha University, Jung-Gu, Incheon 400-711, South Korea
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Abstract
BACKGROUND Plasma cell granulomas are rare and heterogeneous tumor-like lesions of mixed inflammatory cell infiltrates of unknown etiology. Although they have the potential to occur in sites throughout the body, their occurrence in the paranasal sinuses and nasal cavity is uncommon and often associated with unique clinical characteristics and natural history. METHODS We present a case of an aggressive plasma cell granuloma of the maxillary sinus and a review of the literature (28 cases). RESULTS The patient was treated with definitive radiotherapy (45 Gy in 25 fractions) and experienced a local recurrence 2 years later. The lesion initially responded to corticosteroids and then progressed. Resection was performed and was followed by another recurrence. The patient was treated with radiosurgery and is disease free 8 years after initial treatment. CONCLUSIONS Review of the literature indicates that the optimal first line of treatment is high-dose corticosteroids. Surgery is indicated if the lesion fails to respond. Radiotherapy is indicated if complete resection is not feasible.
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Affiliation(s)
- Heather E Newlin
- Department of Radiation Oncology, University of Florida College of Medicine, University of Florida Health Science Center, P. O. Box 100385, Gainesville, FL 32610-0385, USA
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Abstract
OBJECTIVE To report the clinical features of 9 patients with both abducens nerve palsy and postganglionic Horner syndrome. PATIENTS AND METHODS Nine patients with this symptom combination were examined by our Neuro-ophthalmology Clinic in Nihon University Itabashi Hospital between 1978 and 2004. Patient ages ranged from 28 to 63 years (average 47.2+/-8.7 years). Six patients were males and 3 were females. Primary diseases, accompanying symptoms and prognoses were surveyed. RESULTS In primary diseases, neoplasm in the cavernous sinus was observed in 2 patients, sphenoidal sinus cyst in 2, intra-cavernous carotid aneurysm in 2, epipharynx carcinoma in 1, chordoma in the base of the skull in 1, and meningioma in the middle cranial fossa in 1. Five patients with extra-cavernous sinus lesions; sphenoidal sinus cyst, epipharynx carcinoma, chordoma and meningioma, complained of severe headache. However, in patients without severe headache, intra-cavernous sinus lesions such as carotid aneurysm and metastatic carcinoma were detected. After therapy, abducens nerve palsy improved in 5 patients, however, Horner syndrome persisted in all patients. CONCLUSION We emphasize that this symptom combination is an important sign of lesions in the posterior portion of the cavernous sinus or in its vicinity. Moreover, the presence or absence of severe headache depends on whether the lesion is in the intra-cavernous or extra-cavernous sinus.
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Affiliation(s)
- Hiromasa Tsuda
- Division of Neurology, Department of Medicine, Nihon University, School of Medicine, Tokyo
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