HISTOPATHOLOGICAL STUDIES OF THE CARCINOMA OF THE MAXILLARY SINUS WITH THE LARGE SECTIONS

Abstract

Forty-seven specimens of the maxillary sinus cancer removed en bloc with the normal suround- ing tissues were observed macroscopically and his- tologically by means of large section. The sections were made in mass without sepa- rating organs or tissues of the specimens. 18 cases of those observed were preoperatively irradiated. The specimens were investigated from the points of view of the effect of the preoperative irradiation, invasion of the cell into the bone, the periost, surrounding tissues as such fatty tissues, muscles, etc. and compared with their clinical fin- dings. The results obtained were as follows. 1) 40 squamous cell carcinomas, 3 basal cell and 4 adenocarcinomas were found in the specime- ns. There was no significant relationship between their histological types and prognosis. 2) In the preoperatively non-irradiated cases, higher structural atypism, smaller alveolar struc- ture, irregularity of cellular structure and direct bony destruction by cancer cells had bad influences upon their prognosis. While in preoperatively irradiated cases, the differences in histological fin- dings were not concerned with their prognosis. 3) In many cases cancer had already destroyed the walls of the maxillary sinus, especially the na- sal wall and posterior wall (85% of the cases). 4) In 12 cases there were submaxillar lymph node metastases and in 4 cases laterocervical lymph node metastases. Their prognosis was worse than those without metastases. 5) The cases undergoing sinectomy, polypoto- my, extraction of teeth, incision of the palate be- fore adjust treatments, also had worse prognosis. In such cases histologically severe invasion into the surrounding tissues were observed. 6) Thickning of the periostal layer on the outer side of the sinus wall were observed in ma. ny cases, and those cases had good prognosis. 7) The preoperative irradiation (4000r) resul- ted into degeneration and necrosis of the cancer cell, the increase of the connective tissues thickning of the periostal layer on the outer side of the sinus wall destroyed by cancer and decrease of the can- cer in size. 18 months after the treatment 66.6% of preoperatively irradiated cases was free of recu- rrences. There were marked differences in progno- sis between the irradiated and non-irradiated cases (35.0%).