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Korsström C, Lilja M, Hammarstedt-Nordenvall L, Mäkitie A, Haapaniemi A. Endoscopic management of sinonasal tumours in the Nordic university hospitals: a survey. Eur Arch Otorhinolaryngol 2024; 281:785-794. [PMID: 37733092 PMCID: PMC10796644 DOI: 10.1007/s00405-023-08229-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE The Nordic countries (27 M) all have comparable, publicly funded healthcare systems, and the management of sinonasal tumours is centralised to the 21 university hospitals. We sought to assess and compare the treatment practice of sinonasal tumours across the Nordic countries. METHODS A web-based questionnaire was sent to all university hospital departments of otorhinolaryngology-head and neck surgery in the Nordic countries. RESULTS Answers were obtained from all 21 Nordic university hospitals. The endoscopic approach was widely utilised by all, with most (62%) centres reporting 3-4 surgeons performing endoscopic sinonasal tumour surgery. Finland reported the lowest rates of centralisation among university hospitals despite having the highest number of 0.1-1 M catchment population hospitals. Most centres (88%) opted for the endoscopic approach in a patient case warranting medial maxillectomy. In a case of a Kadish C esthesioneuroblastoma, most (52%) of the centres preferred an endoscopic approach. Most centres (62%) reported favouring the endoscopic approach in a case describing a juvenile angiofibroma. Regarding a case describing a sinonasal undifferentiated carcinoma, consensus was tied (38% vs. 38%) between endoscopic resection followed by postoperative (chemo)radiotherapy (RT/CRT) and induction chemotherapy followed by RT/CRT or surgery followed by RT/CRT. CONCLUSION Endoscopic approach was widely utilised in the Nordic countries. The case-based replies showed differences in treatment practice, both internationally and nationally. The rate of centralisation among university hospitals remains relatively low, despite the rarity of these tumours.
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Affiliation(s)
- Carl Korsström
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland.
| | - Markus Lilja
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland
| | - Lalle Hammarstedt-Nordenvall
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Head-, Neck-, Lung- and Skin Cancer, Theme Cancer, Karolinska University Hospital, 17164, Stockholm, Sweden
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Aaro Haapaniemi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland
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Agaimy A, Franchi A. [Special mesenchymal neoplasms of the head and neck: Update from the 2022 WHO]. Pathologie (Heidelb) 2023:10.1007/s00292-023-01203-7. [PMID: 37286852 DOI: 10.1007/s00292-023-01203-7] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 06/09/2023]
Abstract
Similar to the approach adopted in the classification of tumors in other organs, a new feature of the current Word Health Organization (WHO) classification of the head and neck tumors is the exclusion of soft tissue tumors from single organs and their inclusion in a separate chapter devoted to them. This applies to tumors that are principally ubiquitous but show a predilection for the head and neck sites. The only exception to this rule represents those entities that are almost restricted to a specific head and neck site/organ (such as nasopharyngeal angiofibroma, sinonasal glomangiopericytoma, and biphenotypic sinonasal sarcoma), which remain in their respective organ chapters. Included among soft tissue tumors are some old but still underrecognized entities, such as phosphaturic mesenchymal tumors, and newly defined entities, such as GLI1-altered tumors. The aim of including these entities is to enhance recognition of these uncommon but likely under-recognized entities to better characterize them in the future. This review summarizes the main features of these rare entities and discusses their differential diagnoses.
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Affiliation(s)
- Abbas Agaimy
- Pathologisches Institut, Universitätsklinikum Erlangen, Krankenhausstr. 8-10, 91054, Erlangen, Deutschland.
| | - Alessandro Franchi
- Abteilung für translationale Forschung und neue Technologien in Medizin und Chirurgie, Universität Pisa, Pisa, Italien
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Hasnaoui M, Chebil A, Masmoudi M, Bellalah A, Zakhama A, Mighri K. Olfactory cleft mass as the first presentation of asymptomatic metastatic renal cell carcinoma: A case report and review of the literature. Int J Surg Case Rep 2023; 104:107943. [PMID: 36857800 DOI: 10.1016/j.ijscr.2023.107943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/12/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Renal cell carcinoma metastasis in the sinonasal cavities is rare. They account for less than 1 % of all metastases of these renal cancers. CASE PRESENTATION We report the case of a patient with an unremarkable pathological history, who consulted for recurrent right epistaxis. Nasal endoscopy revealed a reddish mass located medial to the right middle turbinate. Computed tomography and magnetic resonance imaging showed a lesion located at the level of the olfactory cleft. The patient had a complete removal of the mass and the anatomopathological examination concluded to a metastasis of a clear cell carcinoma of renal origin. Taking into account these results, a thoraco-abdomino-pelvic CT scan was performed and it discovered a left renal tumor. CLINICAL DISCUSSION The most frequent functional sign of Renal cell carcinoma metastases is epistaxis. This is explained by the rich vascularity of these metastases. The imaging data are not specific and do not allow differentiation between primary tumor and metastasis. The definitive diagnosis can be confirmed only by histologic examination. CONCLUSION Faced with any hypervascularized tumor of the nasal cavity, the ENT physician must evoke a metastasis of a renal cancer, even in the absence of history and symptoms evoking this cancer.
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Thompson LDR, Bishop JA. Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Nasal Cavity, Paranasal Sinuses and Skull Base. Head Neck Pathol 2022; 16:1-18. [PMID: 35312976 PMCID: PMC9018924 DOI: 10.1007/s12105-021-01406-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 11/09/2021] [Accepted: 12/17/2021] [Indexed: 12/31/2022]
Abstract
The World Health Organization Classification of Head and Neck Tumours recently published the 5th edition. There are new entities, emerging entities, and significant updates to the taxonomy and characterization of tumor and tumor-like lesions, specifically in this article as it relates to nasal cavity, paranasal sinuses and skull base. Importantly, the number of diagnostic entries has been reduced by creating category-specific chapters for soft tissue, hematolymphoid, melanocytic, neuroectodermal, and metastatic tumors. Bone and salivary gland tumors are also not separately reported in the sinonasal tract, but included in the jaw and salivary gland sections, respectively. Repetition of characteristic entities in each anatomic site was also reduced, instead highlighting only the unique features in each anatomic site. Two new entities (SWI/SNF complex-deficient sinonasal carcinomas and HPV-related multiphenotypic sinonasal carcinoma) will be highlighted in this review, with a discussion of several emerging entities. There is a short description of updated information for all 24 diagnostic entities included in this edition to allow the reader a snapshot of current state of knowledge, but to encourage more investigation and further broaden understanding of these diverse and rare entities.
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Affiliation(s)
- Lester D. R. Thompson
- Head and Neck Pathology Consultations, 22543 Ventura Boulevard, Ste 220 PMB1034, Woodland Hills, CA 91364 USA
| | - Justin A. Bishop
- University of Texas Southwestern Medical Center, Clements University Hospital, UH04.250, 6201 Harry Hines Blvd., Dallas, TX 75390 USA
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Meerwein CM, Brada MD, Soyka MB, Holzmann D, Rupp NJ. Reappraisal of Grading in Intestinal-Type Sinonasal Adenocarcinoma: Tumor Budding as an Independent Prognostic Parameter. Head Neck Pathol 2022; 16:670-678. [PMID: 35015192 PMCID: PMC9424375 DOI: 10.1007/s12105-022-01410-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/31/2021] [Indexed: 12/01/2022]
Abstract
Since sinonasal intestinal-type adenocarcinomas (ITAC) show resemblance to colorectal adenocarcinomas, we aimed to investigate novel prognostic factors of outcome, with particular focus on the role of tumor budding (TB). Retrospective clinico-pathological single-institution study on consecutive ITAC patients between 1996 and 2020. Histopathological parameters including conventional subtypes and TB features (low, intermediate, high) were evaluated with the aid of pancytokeratin (AE1/AE3) immunohistochemical staining. Parameters were correlated to clinical data and outcome. A total of 31 ITAC patients were included. Overall, 19/31 patients (61.3%) presented with stage III/IV disease. Presence of lymph node or distant metastases was rare (1/31 patient, 3.2%). Treatment protocols consisted of tumor resection in 30/31 patients (96.8%) and primary radiochemotherapy in 1/31 patient (3.2%). Adjuvant radiation therapy was conducted in 20/30 surgically treated patients (66.7%). The 3- and 5-year overall survival (OS) was 83.9% and 78.3% and the 3- and 5-years disease-specific survival (DSS) 83.7% % and 78.5%, respectively. The presence of intermediate/high TB (defined as ≥ 5 buds) was associated with both, worse DSS (log rank p = 0.03) and OS (log rank p = 0.006). No patient with low TB revealed progressive disease or died of the disease. No association between TB and tumor stage or conventional tumor subtype was found. Tumor budding seems to be an independent prognostic factor of worse outcome in ITAC.
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Affiliation(s)
- Christian M. Meerwein
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital of Zurich and University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - Muriel D. Brada
- Department of Molecular Pathology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland
| | - Michael B. Soyka
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital of Zurich and University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital of Zurich and University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - Niels J. Rupp
- Department of Molecular Pathology, University Hospital of Zurich and University of Zurich, Zurich, Switzerland ,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Vonk J, Voskuil FJ, de Wit JG, Heeman WT, Nagengast WB, van Dam GM, Feijen RA, Korsten-Meijer A, van der Vegt B, Witjes M. Fluorescence grid analysis for the evaluation of piecemeal surgery in sinonasal inverted papilloma: a proof-of-concept study. Eur J Nucl Med Mol Imaging 2021. [PMID: 34738141 DOI: 10.1007/s00259-021-05567-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/17/2021] [Indexed: 12/14/2022]
Abstract
Purpose Local recurrence occurs in ~ 19% of sinonasal inverted papilloma (SNIP) surgeries and is strongly associated with incomplete resection. During surgery, it is technically challenging to visualize and resect all SNIP tissue in this anatomically complex area. Proteins that are overexpressed in SNIP, such as vascular endothelial growth factor (VEGF), may serve as a target for fluorescence molecular imaging to guide surgical removal of SNIP. A proof-of-concept study was performed to investigate if the VEGF-targeted near-infrared fluorescent tracer bevacizumab-800CW specifically localizes in SNIP and whether it could be used as a clinical tool to guide SNIP surgery. Methods In five patients diagnosed with SNIP, 10 mg of bevacizumab-800CW was intravenously administered 3 days prior to surgery. Fluorescence molecular imaging was performed in vivo during surgery and ex vivo during the processing of the surgical specimen. Fluorescence signals were correlated with final histopathology and VEGF-A immunohistochemistry. We introduced a fluorescence grid analysis to assess the fluorescence signal in individual tissue fragments, due to the nature of the surgical procedure (i.e., piecemeal resection) allowing the detection of small SNIP residues and location of the tracer ex vivo. Results In all patients, fluorescence signal was detected in vivo during endoscopic SNIP surgery. Using ex vivo fluorescence grid analysis, we were able to correlate bevacizumab-800CW fluorescence of individual tissue fragments with final histopathology. Fluorescence grid analysis showed substantial variability in mean fluorescence intensity (FImean), with SNIP tissue showing a median FImean of 77.54 (IQR 50.47–112.30) compared to 35.99 (IQR 21.48–57.81) in uninvolved tissue (p < 0.0001), although the diagnostic ability was limited with an area under the curve of 0.78. Conclusions A fluorescence grid analysis could serve as a valid method to evaluate fluorescence molecular imaging in piecemeal surgeries. As such, although substantial differences were observed in fluorescence intensities, VEGF-A may not be the ideal target for SNIP surgery. Trial registration NCT03925285. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05567-x.
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Jiang S, Fan R, Zhang H, Jiang W, Xie Z. Outcomes of endoscopic and open resection of sinonasal malignancies: a systematic review and meta-analysis. Braz J Otorhinolaryngol 2021; 88 Suppl 5:S19-S31. [PMID: 34348855 PMCID: PMC9800954 DOI: 10.1016/j.bjorl.2021.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To compare the efficacy of endoscopic and open resection of sinonasal malignancies. METHODS The search was performed using PubMed (1950-2020), Embase (1974-2020), the Cochrane library, and the website clinicaltrials.gov. The hazard ratio, HR, 95% confidence interval, CI, of the rates of overall survival and disease-free survival and the demographic characteristics of the included studies were extracted and analyzed. Pooled analysis was conducted with the studies' individual patient data, using log-rank test, Kaplan-Meier survival, and Cox regression analysis. RESULTS Of 1939 articles retrieved, 23 articles were included. Overall, 1373 cases were incorporated into the final analysis, 653 (47.56%) of which underwent the surgery through an endoscopic approach, whereas 720 (52.44%) cases utilized the open approach. The overall survival was comparable between endoscopic and open resection (HR = 0.84 [95% CI: 0.65-1.07], p = 0.16; random effects analysis). Pooled analysis with Cox regression revealed signifcant differences in overall survival (HR = 0.568 [95%CI:0.380-0.849], p = 0.006) and disease-free survival (HR = 0.628 [95%CI:0.424-0.929], p = 0.02) between endoscopic and open approaches. CONCLUSION The aggregated evidence suggests the survival outcome of endoscopic resection is comparable or greater than that of open resection of sinonasal malignancies.
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Zhai CW, Yuan CC, Wang SY. [ETV6-rearranged low-grade sinonasal non-intestinal-type adenocarcinoma: a clinicopathological analysis]. Zhonghua Bing Li Xue Za Zhi 2021; 50:55-59. [PMID: 33396988 DOI: 10.3760/cma.j.cn112151-20200417-00322] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinicopathologic features, immunophenotype, molecular genetic changes of ETV6-rearranged low-grade sinonasal non-intestinal-type adenocarcinoma (ETV6-RLGSNAC). Methods: Primary sinonasal epithelial malignant tumors were collected from January 2015 to January 2020 in the Department of Pathology, Eye, Ear, Nose and Throat Hospital affiliated to Fudan University. Through morphological observation, immunohistochemical detection and fluorescence in situ hybridization (FISH), ETV6-RLGSNAC was screened out for clinicopathological feature analysis, and relevant literatures were reviewed. Results: There were 550 cases of primary sinonasal epithelial malignant tumors, among which 82 cases were adenocarcinoma. There were 29 cases of low-grade non-intestinal adenocarcinoma, only 3 cases of ETV6-RLGSNAC were screened out. Of the 3 patients, 2 cases were male and 1 case was female, with a mean age of 54 years (range 37-64 years). The main clinical manifestations were nasal stenosis, nasal obstruction and epistaxis. A neoplasm with smooth surfaces was observed under nasal endoscopy. Imaging showed an expansive mass in the sinonasal area. Gross examination showed gray-yellow cut surface with firm texture and a maximum diameter of 2-3 cm. Microscopically, tumors were non-encapsulated and well-circumscribed with expansive growth pattern. The tumor cells were small and mild, cylindrical and cuboidal, and arranged in regular glandular and trabecular patterns. The cytoplasm was eosinophilic and the nuclei were basally located with inconspicuous nucleoli. By immunohistochemistry (IHC), CK7, SOX-10, DOG1 and vimentin were positive and S-100 expressed in small clusters of cells in all cases. GCDFP-15, CD56, CK20, mammaglobin, TTF-1, NR4A3 were all negative. The Ki-67 value-added index of all cases was low (<5%). ETV6 gene rearrangement was confirmed in all the cases by FISH, and two cases had NTRK3 gene rearrangement. All three patients underwent radical resection after diagnosis, and one also had adjuvant radiotherapy. All three patients were available with a follow-up time of 12-25 months, and all were recurrence free. Conclusions: ETV6-RLGSNAC is a rare low-grade and newly named non-intestinal adenocarcinoma. The histomorphology is similar to other low-grade nasal sinonasal adenocarcinomas and some salivary gland tumors. IHC and FISH are useful for the diagnosis and differential diagnosis.
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Affiliation(s)
- C W Zhai
- Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - C C Yuan
- Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - S Y Wang
- Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
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Paehler vor der Holte A, Fangk I, Glombitza S, Wilkens L, Welkoborsky HJ. Impact of human papillomaviruses (HPV) on recurrence rate and malignant progression of sinonasal papillomas. Cancer Med 2021; 10:634-641. [PMID: 33350606 PMCID: PMC7877357 DOI: 10.1002/cam4.3642] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 12/20/2022] Open
Abstract
Sinonasal papillomas are characterized by their potential for frequent recurrences and malignant progression. Currently, the role of human papillomavirus (HPV) infection in sinonasal papillomas is unclear. A study was conducted to elucidate the impact of HPV infection on recurrence and malignant progression of sinonasal papillomas. One hundred and seven patients with 151 tumors could be examined. One hundred and one patients suffered from benign papilloma, mostly inverted papillomas (IP); six patients suffered from carcinomas in situ and squamous cell carcinomas (SCC) ex-IP. Recurrent IP were more often HPV-positive than non-recurrent tumors (38.8% vs. 60%-65%). Low-risk (LR) HPV infection (especially HPV 6) increased the risk of tumor recurrences (p = 0.0385 and p = 0.0556, respectively). IP and oncocytic papillomas (both lesions are known for their malignant potential) were more often high-risk (HR) HPV-positive (15.5% and 16.7%) than fungiform papilloma (which usually does not progress to carcinoma). CIS and SCC ex-IP displayed higher HPV rates than benign IP (83.3% vs. 38.8%), especially higher rates of HR-HPV (66.7% vs. 23.8%, p = 0.0415). Data from this study endorse the hypothesis that recurrence of sinonasal papillomas is promoted by LR-HPV infection and that malignant progression of IP is promoted by HR-HPV infection.
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Affiliation(s)
| | - Inger Fangk
- Department of Otorhinolaryngology, Head and Neck SurgeryNordstadt ClinicAcademic HospitalHanoverGermany
| | - Sabine Glombitza
- Department of Pathology and Molecular PathologyNordstadt ClinicAcademic HospitalHanoverGermany
| | - Ludwig Wilkens
- Department of Pathology and Molecular PathologyNordstadt ClinicAcademic HospitalHanoverGermany
| | - Hans J. Welkoborsky
- Department of Otorhinolaryngology, Head and Neck SurgeryNordstadt ClinicAcademic HospitalHanoverGermany
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Wu N, Wang X, Cheng K, Wei X, Zhang RS, Lu ZF, Rao Q. [Clinicopathological and molecular features of biphenotypic sinonasal sarcoma]. Zhonghua Bing Li Xue Za Zhi 2020; 49:1261-1266. [PMID: 33287510 DOI: 10.3760/cma.j.cn112151-20200313-00200] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To study the clinicopathologic features, immunophenotype, molecular genetics and differential diagnosis of biphenotypic sinonasal sarcoma (BSNS), and to evaluate the role of PAX3 and PAX8 immunohistochemical (IHC) antibodies in the diagnosis of BSNS. Methods: Nasal sinus spindle cell tumors surgically treated at the Jinling Hospital from 2000 to 2019 were collected, including three cases of BSNS, 10 cases of acinar rhabdomyosarcoma, eight cases of schwannoma, five cases of hemangiopericytoma, three cases of fibrosarcoma, and one case of triton tumor. The cases were evaluated by histology, IHC by EnVision for PAX3 and PAX 8 (including PAX8 murine monoclonal antibody, clone number OTI6H8, hereinafter referred to as PAX8-OTI6H8 antibody; PAX8 rabbit monoclonal antibody, clone number EP298, hereinafter referred to as PAX8-EP298 antibody) molecular genetic tests. Results: All three BSNS patients were elderly women with clinical manifestations of nasal congestion and bleeding. Imaging showed a soft tissue density shadow of the nasal cavity and sinuses with bone destruction. The boundaries of tumors which were covered with ciliated columnar epithelium were unclear, and mucosal invasion and squamous metaplasia could be seen. Tumor cells were spindle-shaped, arranged in a bundle-like, braided arrangement, with little cellular atypia and occasional atypical mitotic figures. The tumoral interstitial vessels were mostly thin-walled, some showing staghorn-like changes. There was focal striated muscle differentiation in two cases, and bone invasion was seen in two cases. IHC staining showed that all three cases of BSNS expressed PAX3 and PAX8-OTI6H8, but not PAX8-EP298. All eight cases of schwannoma, five cases of hemangiopericytoma, and one case of triton tumor did not express PAX3, PAX8-OTI6H8 or PAX8-EP298. Eight of the ten cases of alveolar rhabdomyosarcoma expressed PAX3 and PAX8-OTI6H8, but not PAX8-EP298. Three cases of fibrosarcoma showed weak PAX3 and PAX8-OTI6H8 expression, but there was no PAX8-EP298 expression. FISH detection showed that PAX3 break apart in the tumor cells from all three patients (four specimens). Conclusions: BSNS is a distinct sinonasal low grade malignancy with dual differentiation which could be readily confused with a variety of spindle cell tumors encountered in the sinonasal cavity. The molecular genetics of PAX3 gene break is the gold standard for diagnosis of this tumor. IHC marker monoclonal PAX3 is 100% expressed in BSNS, while the specificity is limited. PAX8-OTI6H8 is also expressed in BSNS due to the cross reaction with PAX3 antibody, while PAX8-EP298 is all negative for these tumors.
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Affiliation(s)
- N Wu
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - X Wang
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - K Cheng
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - X Wei
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - R S Zhang
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Z F Lu
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Q Rao
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
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Yuan CC, Zhai CW, Wang SY. [Sinonasal renal cell-like adenocarcinoma: a clinicopathological analysis of five cases]. Zhonghua Bing Li Xue Za Zhi 2020; 49:1147-1151. [PMID: 33152820 DOI: 10.3760/cma.j.cn112151-20200206-00070] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinicopathological features, immunophenotype, differential diagnosis and prognosis of sinonasal renal cell-like adenocarcinoma. Methods: Retrospective analysis was performed on the cases of sinonasal carcinoma from August 2014 to December 2018 at Eye, Ear, Nose and Throat Hospital, Fudan University. Renal cell-like adenocarcinoma was screened for clinicopathologic feature analysis, and relevant literatures were reviewed. Results: There were 460 cases of sinonasal carcinoma, among which 70 cases (15.2%) were adenocarcinoma, with five (1.1%) being renal cell-like adenocarcinomas. Four patients were male and one was female, with a mean age of 46.5 years (range 29-52 years). The main clinical manifestations were nasal obstruction and epistasis. A red polypoid mass was found under nasal endoscopy. Imaging showed nasal cavity and ethmoid sinus mass with invasion into surrounding structures and bone destruction. Microscopically, the tumor cells were arranged in nests, alveoli and microcapsules with abundant intervening capillaries, accompanied by hemorrhage. The cytoplasm of the cells was clear with low nuclear grade, and the nucleoli were inconspicuous. In some areas, the tumor invaded bone tissue. Immunohistochemical markers CKpan, CK7, CAⅨ, S-100 and vimentin were positive, with low Ki-67 proliferation index. RCC, CD10, PAX8, p63, SMA, HHF35, Calponin, CD117, TTF-1 and neuroendocrine markers Syn and CHG were all negative. EWSR1 and ETV6 gene rearrangements were not detected by FISH. All five patients underwent surgical resection after initial diagnosis. One patient underwent surgical resection after second recurrence and adjuvant radiotherapy, one patient received postoperative radiotherapy, one patient underwent surgical resection after recurrence, one patient had no recurrence and one patient received radiotherapy after recurrence. All five patients had no distant metastasis and survived without tumor up to December 2019. Conclusions: Primary sinonasal renal cell-like adenocarcinoma is a special subtype of low-grade non intestinal adenocarcinoma, with low incidence and inert biologic behavior. At present, most of the literatures are case reports. Before a diagnosis is made, other primary and metastatic clear cell tumors need to be excluded. Immunohistochemistry is helpful for diagnosis and differential diagnosis. Surgical resection is the mainstay of treatment, and may be supplemented by radiotherapy.
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Affiliation(s)
- C C Yuan
- Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - C W Zhai
- Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
| | - S Y Wang
- Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
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Abstract
Until the 1990s, radical sinus surgery was considered a standard procedure for maxillary sinus diseases, but it is no longer favored due to the high morbidity. Today, functional endoscopic sinus surgery (FESS) is considered the gold standard in sinus surgery. Modifications of surgical approaches also allow access to regions of the maxillary sinus that were previously difficult to reach. Depending on anatomy and pathology, different methods for widening the maxillary ostium can be selected. In type I sinusotomy, the natural ostium is widened dorsally by a maximum of 1 cm. Sinusotomy type II involves widening the natural ostium up to a maximum diameter of 2 cm. In sinusotomy type III, the natural ostium is widened dorsally to the posterior wall of the maxillary sinus and caudally to the base of the inferior turbinate. Beside the prelacrimal approach, more invasive approaches are the medial maxillectomy, in which the dorsal part of the inferior turbinate and the adjacent medial wall of the maxillary sinus is resected, as well as its modifications "mega antrostomy" and "extended maxillary antrostomy." Correct selection of the size of the maxillary sinus window is prerequisite for successful treatment and long-term postoperative success. Isolated purulent maxillary sinusitis can usually be treated by a type I sinusotomy. Sinusotomy type II addresses nasal polyps with involvement of the mucosa of the ostium, recurrent stenosis after previous surgery, chronic maxillary sinusitis due to cystic fibrosis, and purulent maxillary sinusitis with involvement of other adjacent sinuses. Sinusotomy type III is required for choanal polyps with attachment to the floor of the maxillary sinus, for extensive polyposis and fungal sinusitis, and for inverted papilloma. Particularly for (recurrent) disease and extensive interventions in the maxillary sinus, medial maxillectomy or a modification thereof may be required.
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Affiliation(s)
- F Sommer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland.
| | - T Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - J Lindemann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - J Hahn
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland
| | - M-N Theodoraki
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89075, Ulm, Deutschland
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Yang K, Ellenbogen Y, Algird AR, Sommer DD, Reddy K. Visual Outcomes After Endoscopic Endonasal Resection of Orbital Lesions. World Neurosurg 2020; 139:e501-e507. [PMID: 32311560 DOI: 10.1016/j.wneu.2020.04.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The endoscopic endonasal approach (EEA) has been increasing in popularity as an alternative to traditional transcranial and transorbital approaches in the treatment of orbital pathological entities. The purpose of the present study was to examine the outcomes of patients who had undergone EEA resection of orbital lesions at our center. METHODS We performed a retrospective medical record review of patients who had undergone the EEA for resection of orbital lesions and orbital apex decompression from January 1, 2006 to December 1, 2019. For all the patients, the demographic data, presenting symptoms, symptom duration, imaging data, operative details, and postoperative outcomes were collected and reviewed. RESULTS Nine patients underwent endoscopic endonasal resection of orbital lesions and orbital apex decompression at our center, including 6 male patients and 3 female patients. The mean age was 49.4 years, and the mean follow-up period was 3.8 years (range, 1-13.5 years). The orbital pathological lesions that were treated included nasopharyngeal carcinoma, hemangioma, fibrous dysplasia, IgG4 pseudotumor, inverted papilloma, angioleiomyoma, adenocarcinoma, and neuroendocrine paraganglioma metastasis. All the patients presented with exophthalmos of the affected orbit. Of the 9 patients, 5 presented with decreased visual acuity on examination. Postoperatively, 1 of these 5 patients had improved to baseline visual acuity, 3 had stable vision, and 1 had brief improvement before experiencing progressive visual decline 1 month postoperatively. Two patients presented with diplopia, and both improved postoperatively. Three patients experienced new, transient, and self-limiting postoperative diplopia. CONCLUSIONS For patients with orbital lesions causing compressive optic neuropathy, the endoscopic endonasal approach can be used as an alternative strategy in appropriately selected patients.
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Affiliation(s)
- Kaiyun Yang
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Yosef Ellenbogen
- Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Almunder R Algird
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
| | - Doron D Sommer
- Division of Otolaryngology and Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kesava Reddy
- Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
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Tang SJ, Zhai CW, Yuan CC, Zhang JH, Wang SY. [SMARCB1 (INI1)-deficient sinonasal carcinoma: a clinicopathological analysis of six cases]. Zhonghua Bing Li Xue Za Zhi 2020; 49:47-51. [PMID: 31914534 DOI: 10.3760/cma.j.issn.0529-5807.2020.01.009] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To study the clinicopathological features, diagnostic features and differential diagnoses of SMARCB1 (INI1)-deficient sinonasal carcinoma (SDSC). Methods: Six cases of SDSC diagnosed at Eye, Ear, Nose and Throat Hospital, Fudan University from 2016 to 2018 were retrieved; the clinical features, histomorphology, immunophenotype, radiology and outcome were analyzed with review of literature. Results: There were five men and one woman with age range of 37 years to 75 years (mean 56 years). One case was in stage T2, and 5 cases were in stage T4. Computer tomography and magnetic resonance imaging showed a mass occupying the sinonasal cavity with bone destruction in all six patients. Microscopically, the tumors had infiltrative margins. Four tumors were composed mostly of basaloid cells, which possessed high nuclear/cytoplasmic ratio,scant cytoplasm,and minimalnuclear pleomorphism; and the cells were arranged in sheets or nests in a desmoplastic stroma. Two tumors were composed of rhabdoid cells, which possessed abundant, eosinophilic cytoplasm and eccentric nuclei, often growing in a nests or sheets pattern. Immunohistochemical staining showed that 6/6 cases had complete loss of INI1, diffusely and strongly positive for CKpan, and were negative for S-100 and EBER ISH; 4/6 cases were focally positive for p63; 1/5 was focally positive for Syn and p16. The Ki-67 index was 30% to 70%. The follow-up period ranged 1-26 months, with one patient died of extensive metastases, one had local recurrence, and two had lymph node metastases; one was alive without disease, and one was lost to follow-up. Conclusions: SMARCB1 (INI1)-deficient sinonasal carcinoma is mostly aggressive, with rapid progression and poor prognosis. Histomorphological spectrum predominantly consists of basaloid type and rhabdoid type. The complete loss of nuclear expression of INI1 can help to distinguish this tumor from its many mimickers.
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Affiliation(s)
- S J Tang
- Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
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Chen QH, Wang XY, Zhang B, Hao H, Wu JX, Tong YJ, Feng QQ, Fang JG, Chen XH, Yan F, Zhang SR, Xian JF. [Quantitative dynamic contrast enhancement MR imaging parameters in the prediction and evaluation of the treatment response of malignant sinonasal tumors to chemotherapy:a preliminary result]. Zhonghua Yi Xue Za Zhi 2019; 99:1773-7. [PMID: 31207685 DOI: 10.3760/cma.j.issn.0376-2491.2019.23.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the value of quantitative dynamic contrast enhancement MR imaging (DCE-MRI) parameters in the prediction and evaluation of the response to neoadjuvant chemotherapy in patients with malignant sinonasal tumors by comparing the parameter values before and after chemotherapy. Methods: DCE-MRI was performed in 14 patients (6 male cases, 8 female cases, 16-83 years) with malignant sinonasal tumors before chemotherapy in Beijing Tongren Hospital from January 2012 to December 2013 in which DCE-MRI was performed in 8 patients on the 7th, 21st and 42nd days after chemotherapy. The values of quantitative parameter including K(trans), K(ep), and V(e) of the tumor were assessed and the change rate of these quantitative parameter values after chemotherapy was calculated. Results: Response to chemotherapy of the tumor was found in 11 patients with malignant sinonasal tumors,whereas no response to chemotherapy of the tumor was confirmed in 3 patients. K(trans) ((0.75±0.28)/min) and K(ep) ((3.23±1.48)/min) values of the tumor before chemotherapy in patients with response to chemotherapy were significantly bigger than those ((0.43±0.41)/min, (1.34±0.42)/min) in patients with no response to chemotherapy (all P<0.01).There was no significant difference in V(e) values between two groups (P=0.165). Compared with K(trans) values of the tumor before chemotherapy,the change rate of K(trans) values decreased more than 40% on the 7th,21st and 42nd days after chemotherapy in the patients with treatment response,whereas the change rate did not decrease significantly in the patients without treatment response. Conclusion: The bigger K(trans) and K(ep) values of the tumor before chemotherapy,the better the treatment response of the tumor to chemotherapy.
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Abstract
Invasion of the orbit by tumors of the paranasal sinus represents an advanced state of disease. Prognosis has hardly improved in recent decades, despite multimodal therapeutic approaches. Complete resection of the tumor still remains the most promising therapy. Orbital exenteration implies a dramatic event for the patient's psyche and quality of life. If the eye that would have to be exenterated is the only one remaining with sufficient vision, exenteration should be abandoned in consensus with the patient. Aesthetic improvements following exenteration can be achieved by surgical and prosthetic techniques. The method of prosthesis fixation needs to be determined with respect to the patients' individual expectations and manual abilities. The main aspects of functional rehabilitation are good local cleanability and sufficient nasal breathing without encrusted mucus, which can be achieved by restoring the natural laminar airflow. Tumors of the paranasal sinus with orbital invasion represent a diagnostic and therapeutic challenge. The information regarding prognosis, therapeutic approaches, post-therapeutic quality of life, and rehabilitation options should be thoroughly discussed by patients and therapists prior to treatment.
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Han F, Liu HQ, Wang SY. [Expression of CD117, MITF and NAT10 and their prognostic values in sinonasal mucosal melanoma]. Zhonghua Bing Li Xue Za Zhi 2019; 47:931-935. [PMID: 30522174 DOI: 10.3760/cma.j.issn.0529-5807.2018.12.007] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the correlation between the expression of CD117, MITF, NAT10 and clinical parameters in sinonasal mucosal melanoma (SNMM). Methods: Formalin-fixed paraffin-embedded tumor specimens of 80 cases of SNMM at the Eye, Ear, Nose and Throat Hospital, Fudan University, from December 1999 to November 2013 were analyzed for CD117, MITF and NAT10 expression by immunohistochemistry. Results: There were 40 men and 40 women. The median age was 61 years, age 26 to 85 years. There was no correlation of the expression of CD117, MITF and NAT10 with the patients' age, gender, tumor site, stage, therapy method and brain metastases (P>0.05). The expression of MITF and NAT10 was associated with lymph node metastasis and the tumors were more likely to metastasize when MITF and NAT10 were positive. However, expression of CD117 had no correlation with lymph node metastasis. Log-rank test revealed that the expression of CD117 was correlated with both three-year and five survival rate (P=0.012, P=0.023; respectively) and patients with tumor having low expression of CD117 had the worse outcome. COX test revealed that low CD117 expression, advanced age and lymph node metastasis were independent risk factors (P<0.05). No significant association was found between the expression of CD117, MITF and NAT10 with disease free survival (P>0.05). Conclusions: Patients with SNMM expressing low level of CD117 have decreased survival rate. Tumors with high level of MITF and NAT10 expression are more likely to metastasize. The expression level of CD117 can be used as an important indicator for the patient survival, and the expression of MITF and NAT10 can be used as a predictor of tumor metastasis.
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Affiliation(s)
- F Han
- Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China
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18
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Abstract
OBJECTIVES/HYPOTHESIS Sinonasal cancers are rare but have a poor prognosis. Most previous studies of these cancers have focused on 5-year disease-free survival, but recurrences are also known to occur after this period. We examined the post-5-year recurrence patterns in sinonasal cancer patients by histologic type to determine the indicators for extended and close follow-up requirements. STUDY DESIGN Retrospective chart review. METHODS A cohort of 241 sinonasal cancer patients was included. Demographic data, cancer site and stage, pathology and treatment results, and follow-up and survival data were collected. RESULTS Of the 241 patients, a complete remission occurred in 163 (72.4%) patients, but 83 (50.9%) of these cases developed recurrence, which occurred beyond the 5-year follow-up period in 19 cases (11.7%). The most common post-5-year recurrences were adenoid cystic carcinoma (six patients, 33.3%), followed by melanoma (three patients, 21.4%), poorly differentiated carcinoma (two patients, 18.2%), squamous cell carcinoma (six patients, 6.7%), and olfactory neuroblastoma (no patients, 0%). Post-5-year local recurrence was highest in adenoid cystic carcinoma (six patients, 33.3%), followed by melanoma (three patients, 21.4%), poorly differentiated carcinoma (two patients, 18.2%), and squamous cell carcinoma (five patients, 5.5%). Post-5-year regional recurrence occurred in one squamous carcinoma patient (1.1%), and distant metastasis was seen in one adenoid cystic carcinoma patient (5.5%). CONCLUSIONS Sinonasal cancer shows an 11.7% recurrence rate after a 5-year disease-free period. As this recurrence pattern varies by tumor pathology, a specific follow-up plan is needed for each cancer type. LEVEL OF EVIDENCE 3 Laryngoscope, 129:2451-2457, 2019.
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Affiliation(s)
- Shin Ae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Soon Chun Hyang University Hospital, Soon Chun Hyang University, Seoul, South Korea
| | - Yoo-Sam Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bong Jae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Zhao M, Weng L, Zhao DH, Ma J, Ru GQ, He XL, Wang Z, Wang J. [Clinicopathologic and molecular genetic characterizations of biphenotypic sinonasal sarcoma]. Zhonghua Bing Li Xue Za Zhi 2018; 46:841-846. [PMID: 29224278 DOI: 10.3760/cma.j.issn.0529-5807.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinicopathologic characteristics, immunophenotypes, molecular genetics, and diagnostic and differential diagnostic features of biphenotypic sinonasal sarcoma (BSNS). Methods: Three cases of BSNS were retrieved, the histomorphology, immunophenotype and molecular genetics were analyzed with review of literature. Results: There were 2 male and 1 female patient aged 45, 29 and 40 years, respectively.Computed tomography and magnetic resonance imaging examinations showed a large polypoid mass occupying the sinonasal cavity in all 3 patients. Microscopically, these tumors were un-circumscribed and composed of cellular spindle-shaped cells arranged in long and interlaced fascicles. A hemangiopericytoma-like growth pattern was frequently identified. The overlying hyperplastic respiratory epithelium invaginated down into the tumor forming a cystic (2 cases), glandular (1 case) structures and inverted in a papilloma-like (1 case)pattern, and foci of eosinophilic metaplasia were also noted in 2 of the three cases. The tumor nuclei were bland-appearing, mitoses were scarce and necrosis was absent. Immunohistochemically, the tumor cells showed co-expression of neural and myogenic markers in all the 3 cases, including that 3/3 showed diffuse and strong positivity of S-100 protein, 3/3 positivity of smooth muscle actin (1 diffuse and 2 focal), 1/2 diffuse positivity of calponin, 1/3 focal positivity of desmin, and 1/1 focal positivity of MyoD1.In addition, 1 detected for β-catenin showed focal nuclear positivity. None of the 3 showed positivity to cytokeratin, CD34 or SOX10 in the tumor cells.Ki-67 showed an index <5%, 10% and <2%, respectively. Fluorescence in situ hybridization analysis showed rearrangements of PAX3 gene in all 3 cases. In case 3, reverse transcription polymerase chain reaction, followed by Sanger sequencing, demonstrated an in-frame fusion between PAX3 and FOXO1.Follow-up information (range 3-15 months)showed no evidence of local recurrence or distant metastasis in three cases. Conclusions: BSNS is a newly described entity which can be readily confused with a variety of benign and malignant spindle cell tumors encountered in the sinonasal cavity; immunohistochemistry co-expression of neural and myogenic markers and PAX3 gene rearrangement can help distinguish this tumor from its many mimickers.
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Affiliation(s)
- M Zhao
- Department of Pathology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China
| | - LaoI Weng
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Safadi A, Yafit D, Abu-Ghanem S, Ungar OJ, Wengier A, Abergel A, Fliss DM, Koren I. The clinical behavior of sinonasal inverted papilloma with cellular dysplasia: case series and review of the literature. Eur Arch Otorhinolaryngol 2017; 274:3375-82. [PMID: 28597339 DOI: 10.1007/s00405-017-4629-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/31/2017] [Indexed: 12/18/2022]
Abstract
The prognosis and recurrence rate of inverted papilloma (IP) with concomitant cellular dysplasia are not well-delineated. Demographic, clinical and imaging data of all patients who were surgically treated for sinonasal inverted papilloma (SNIP) in our center between 1996 and 2013 were reviewed. Data regarding the coexistence of dysplastic changes or malignancy within the resected tissues were also retrieved. After the exclusion of malignant cases and patients who were lost for follow-up, 92 patients were included in the study. Five patients had coexisting cellular dysplasia (4.7%), four of them had severe dysplasia and one had mild-to-moderate dysplasia. All four cases with severe dysplasia recurred, three were primarily treated endoscopically and one by external approach. Only the case with mild to moderate dysplasia which had been treated by subcranial approach did not recur. Patients with dysplasia had significantly higher recurrence rate than patients without dysplasia (80 vs. 14%, p = 0.019). This significant relation between histology and recurrence remained even after adjustment to tumor extent. The adjusted odd ratio of dysplasia (dysplasia vs. no dysplasia) is 9.7, p = 0.043. SNIP with dysplasia should be treated aggressively and followed closely. The histopathologic investigation of SNIP specimens should always note the presence of dysplasia and its severity. Further investigation on the clinical behavior of SNIP with dysplasia is needed. Multicenter studies are warranted due to the rarity of dysplastic SNIP.
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Kim BS, Pak K, Yi KI, Kim IJ, Roh HJ, Cho KS. Prognostic value of tumoral heterogeneity and volumetric parameters as measured by F18-FDG PET/CT in sinonasal cancer. Eur Arch Otorhinolaryngol 2016; 274:1437-1443. [PMID: 27747383 DOI: 10.1007/s00405-016-4346-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 10/11/2016] [Indexed: 02/03/2023]
Abstract
The objective of this study was to investigate the value of parameters assessed with F18-FDG PET/CT in predicting recurrence-free survival (RFS) and disease-specific survival (DSS) in patients with cancer of nasal cavity and paranasal sinus. Thirty-eight patients with cancer of nasal cavity (n = 14) and paranasal sinus (n = 24) who underwent PET/CT prior to curative treatment were enrolled. A volume of interest was placed on PET/CT images covering the entire tumor volume, and the maximum SUV (SUVmax), the mean SUV (SUVmean), and volumetric parameters of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured using thresholds of 40 % of SUVmax. The heterogeneity factor (HF) defined as the derivative of volume-threshold function from 40 to 80 % of SUV thresholds. RFS and DSS were defined as the time from the diagnosis to recurrence and death. Median values of SUVmax, SUVmean, MTV, TLG, and HF were 14.81, 9.16, 25.84, 150.74, and -0.496. SUVmax was higher in patients with advanced stage and nodal metastasis. High MTV and low HF group showed shorter RFS. Cox proportional hazards regression analysis revealed low HF was the only significant predictive factor on RFS. Furthermore, high TLG was associated with shorter DSS. High TLG was potent predictor of DSS by Cox proportional hazards regression analysis. In conclusion, the tumoral heterogeneity and volumetric parameters as measured by F18-FDG PET/CT could be significant prognostic surrogate markers in patients with sinonasal cancer.
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Affiliation(s)
- Bum Soo Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Keun-Ik Yi
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-gu, Busan, 602-739, Republic of Korea
| | - In Joo Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Hwan-Jung Roh
- Department of Otorhinolaryngology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kyu-Sup Cho
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-gu, Busan, 602-739, Republic of Korea.
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Ghazizadeh M, Alavi Amlashi H, Mehrparvar G. Radioresistant Extramedullary Plasmacytoma of the Maxillary Sinus: A Case Report and review article. Iran J Otorhinolaryngol 2015; 27:313-8. [PMID: 26788481 PMCID: PMC4710885] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Plasmacytoma is a monoclonal proliferation of plasma cells. It can be an isolated lesion, for which the term extramedullary plasmacytoma is used, or a representation of multiple myeloma.The upper respiratory tract is the most common site for an extramedullary plasmacytoma. Sinonasal plasmacytomas cause different symptoms depending on the sites of origins and the areas of involvement. The treatment of choice for extramedullary plasmacytoma is local radiotherapy. Although it is generally accepted that plasmacytomas are radiosensitive, there are reports of cases that do not respond to radiotherapy. CASE REPORT A case of a 24-year-old male diagnosed with radioresistant extramedullary plasmacytoma of the maxillary sinus, who responded to surgical treatment, is reported. CONCLUSION It is reasonable to consider an interdisciplinary approach in the management of extramedullary plasmacytoma. Considering early surgical intervention in cases encompassing risk factors of radiotherapy resistance is especially recommended before debilitating complications emerge.
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Affiliation(s)
- Matin Ghazizadeh
- Department of Otorhinolaryngology, Head and Neck Surgery, Taleghani Hospital,Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hesamodin Alavi Amlashi
- Department of Otorhinolaryngology, Head and Neck Surgery, Taleghani Hospital,Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Golfam Mehrparvar
- Department of Otorhinolaryngology, Head and Neck Surgery, Taleghani Hospital,Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding Author: Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran. Tel: +989123499607, Fax: +982122432570, E-mail:
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Espitalier F, Michel G, Mourrain-Langlois E, Lebouvier T, Bord E, Ferron C, Malard O. Leptomeningeal carcinomatosis from ethmoid sinus adenocarcinoma. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 131:49-51. [PMID: 23273418 DOI: 10.1016/j.anorl.2012.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/06/2012] [Accepted: 07/09/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Adenocarcinoma of the ethmoid is an aggressive tumor, with potential extension to surrounding structures. Leptomeningeal extension is a rarely reported entity. CASE REPORT A carpenter, aged 55, developed multifocal cranial nerve-related symptoms 1 week after resection of adenocarcinoma of the ethmoid, evolving towards deteriorated general health status and death 10 weeks later. Brain MRI showed diffuse contrast enhancement of the cranial nerves, and repeated cerebrospinal fluid (CSF) examination found increased protein concentration associated with decreased glucose concentration, without malignant cells. The diagnosis of carcinomatous meningitis was based on the association of clinical, CSF and brain MRI data. DISCUSSION/CONCLUSION Leptomeningeal dissemination of adenocarcinoma of the ethmoid is rare; diagnosis is guided by clinical signs. MRI reveals neurological spread, but the presence of malignant cells in the CSF is sufficient for diagnosis. Due to poor prognosis, the only currently available treatments are palliative.
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Affiliation(s)
- F Espitalier
- Service d'ORL et Chirurgie Cervico-Faciale, CHU de Nantes, Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - G Michel
- Service d'ORL et Chirurgie Cervico-Faciale, CHU de Nantes, Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - E Mourrain-Langlois
- Service de Radiologie, CHU de Nantes, Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - T Lebouvier
- Service de Neurologie, Hôpital Nord-Laënnec, CHU de Nantes, boulevard Jacques-Monod-Saint-Herblain, 44093 Nantes cedex 01, France
| | - E Bord
- Service de Neurotraumatologie, CHU de Nantes, Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - C Ferron
- Service d'ORL et Chirurgie Cervico-Faciale, CHU de Nantes, Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - O Malard
- Service d'ORL et Chirurgie Cervico-Faciale, CHU de Nantes, Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
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Pai PS, Moiyadi A, Nair D. Endoscopic v/s conventional approach to sino-nasal tumours - What's the debate? Indian J Surg Oncol 2010; 1:194-9. [PMID: 22930634 DOI: 10.1007/s13193-010-0032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 02/23/2010] [Indexed: 10/18/2022] Open
Abstract
In the past two decades nasal endoscopy has advanced technologically to offer us magnified vision and better illumination along with better instrumentation. Surgery has traditionally been via the transfacial approaches such as lateral rhinotomy or the Weber Fergueson incision. For disease extension into the skull base traditional approach is a transfrontal craniotomy via either the bicoronal incision or the subcranial Raveh's approach. A combined access via the cranium from above and the transfacial access from below aids in encompassing the tumour all around. Transnasal access is a natural trajectory which leads us directly onto the tumour. The endoscope alone or with the microscope has been utilised to improve the magnification and illumination to aid in tumour removal. Minimal access to the Sinonasal and anterior skull base tumours is proven to be possible and feasible. We now have an additional armamentarium to our existing approaches in management of these tumours. We have to be judicious and see which approach can remove the disease completely maintaining the quality of life of the patient.
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Bae KB, Kwon JH, Kim YH, Jung TY, Cho JH. Juvenile Paget's disease with paranasal sinus aplasia. Clin Exp Otorhinolaryngol 2008; 1:224-6. [PMID: 19434273 DOI: 10.3342/ceo.2008.1.4.224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 09/09/2008] [Indexed: 11/08/2022] Open
Abstract
Juvenile Paget's disease (JPD) is a rare skeletal disorder that's characterized by bone demineralization and elevated levels of serum alkaline phosphatase. JPD involves the paranasal sinuses in extremely rare cases. We report here on a 25-month-old Asian male who was diagnosed of JPD associated with aplasia of the paranasal sinuses, but not the ethmoid sinuses. The patient was successfully treated by surgery and we undertook no medical intervention. This appears to be the first reported case of JPD associated with bilateral paranasal sinus aplasia.
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