Letter to the Editor of European Archives of Otorhinolaryngology

Abstract

We read the interesting Review Article by Slootweg et al. [1] recently published in this Journal. We concur on the importance of an accurate morphology definition of sinonasal cancers (SNC), which is crucial not only for therapeutic decisions but also from the etiologic point of view. In fact, sinonasal carcinomas are strongly associated with occupational exposures, in particular wood and leather dusts and nickel compounds [2]. In Italy since 2008 incidence and etiology of primary epithelial tumors of nasal cavity and paranasal sinuses are surveyed through a nationwide cancer registry. The Lombardy Registry of Sinonasal Cancers was established at the end of 2007 in the most populated (almost 10 million residents at the 2011 census) and industrialized Italian region [3]. It collects all epithelial SNC cases occurring among residents in the region at the time of first diagnosis. The primary sources of information on SNC cases are the departments of pathology, otolaryngology, maxillofacial surgery, and radiotherapy in over 100 hospitals. Histological types are defined according to the World Health Organization (WHO) Classification [4]. Occupational exposure to selected agents is collected through a standardized questionnaire administered to patients or their next of kins by trained interviewers. In the period 2008–2012 we recorded 255 SNC cases with median age at diagnosis of 68 years, 167 (65.5 %) among males, and 88 (34.5 %) among females. Using the European population as standard, the SNC incidence rates (9million) are 6.8 (95 % CI 5.7–8.2) in men and 2.6 (95 % CI 1.9–3.4) in women. The anatomical site mostly affected was the nasal cavity, with 54 cases in males (32.3 %) and 32 (36.4 %) in females, followed by the maxillary sinus, 35 cases (21.0 %) in males and 25 (28.4 %) in females. The ethmoidal sinus was rarely involved in females (7 cases, 8.0 %) while there were 37 cases (22.2 %) in males. The most frequent morphology was squamous cell carcinoma, with a similar distribution across gender, 73 cases (43.7 %) in males and 41 (46.6 %) in females. Conversely, adenocarcinomas were twice as frequent in men (53 cases, 31.7 %) than in women (13 cases, 14.8 %). The majority of adenocarcinomas were intestinal-type adenocarcinomas (ITAC), 37 (22.2 %) in men and 8 (9.1 %) in women. There was a strong association between anatomical site and morphology. Out of 114 squamous cell carcinomas, 52 (45.6 %) originated from the nasal cavity, while among 66 adenocarcinoma cases 27 (40.9 %) were located in the ethmoidal sinus. The higher rates in men and the different distribution of SNC site and morphology between men and women most probably reflect differences in previous exposure to carcinogens. In fact, among the 66 subjects with adenocarcinoma, occupational exposure was recorded for the majority (50, or 75.8 %). Of these, 33 (50 %) had been ever exposed to wood dust and 19 (28.8 %) to leather dust. Conversely, the proportion of subjects ever exposed was about 10 % for squamous cell carcinoma and about 20 % for other morphologies. Although lower, the proportion of subjects with squamous cell carcinoma or other C. Mensi (&) L. Riboldi C. Sieno P. A. Bertazzi D. Consonni Department of Preventive Medicine, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Via San Barnaba 8, 20122 Milan, Italy e-mail: carolina.mensi@unimi.it