Ethmoid Carcinoma Research Articles

Anterior Craniofacial Resection for Squamous Cell Carcinoma Ethmoid Sinus Involving Anterior Skull Base

Abstract Sinonasal squamous cell carcinoma (SCC) is a rare form of head-and-neck malignancy, with an incidence of 3%, while SCC of the ethmoid sinus is even more infrequent with relatively few cases cited in the literature. Management of anterior skull base tumors is complex due to the anatomic detail of the region and the variety of tumors that occur in this area. Currently, the “gold standard” for surgery is the anterior craniofacial resection. A 61-year-old man with a locally advanced SCC of the ethmoid sinus involving orbit with intracranial extradural extension was surgically treated performing anterior craniofacial resection followed by adjuvant intensity-modulated radiation therapy to the tumor bed. Currently, the “gold standard” for ethmoid carcinoma with intracranial extension is the anterior craniofacial approach. It allows wide exposure of the complex anatomical structures at the base of the skull permitting monobloc tumor resection. A multidisplinary team approach involving an otolaryngologist, neurosurgeon, plastic surgeon, pathologist, and radiologist is required for effective management of these tumors.

Anterior mediastinal masses — A multidisciplinary pathway for safe diagnostic procedures

ObjectiveThe objective of this study was to report our multidisciplinary diagnostic approach for patients with anterior mediastinal masses (AMM). MethodsA retrospective review of patients with AMM at a tertiary pediatric surgical oncology centre (January 2011–December 2016) was performed. We analyzed data on clinical presentation, mode of tissue diagnosis, anesthetic techniques, and complications. ResultsOf the 44 patients admitted with AMM (median age 11 years, 27 males and 17 females), 22 had respiratory symptoms. Imaging revealed tracheobronchial compression in 26 children. Twenty patients had a lymph node biopsy. Ten patients had image-guided core biopsy of the mediastinal mass, and 2 had mediastinoscopic biopsy of a paratracheal lymph node. One patient with likely recurrence of a relapsed metastatic ethmoid carcinoma did not have a biopsy. The diagnosis was made from alternative tissues, such as pleural fluid in 4 and peripheral blood in 7 patients. Twenty-five anesthetics were assessed, as 14 patients required no or only local anesthesia, and 5 had unavailable anesthetic notes. Eighteen of 25 patients were anesthetized maintaining spontaneous breathing, mostly by means of ketamine sedation. There were no major anesthetic complications. ConclusionSafe tissue diagnosis of anterior mediastinal masses can be obtained by a personalized multidisciplinary approach. Use of alternative tissues, local anesthesia, and ketamine sedation help minimize the need for general anesthesia, muscle paralysis, and controlled ventilation. Level of evidenceIV (Case Series with no Comparison Group).

Evaluation of nose and paranasal sinus disease, anatomical variations by computerized tomography

<p class="abstract"><strong>Background:</strong> The anatomy of paranasal sinuses is very complicated. Evaluation of the location, extent of sino nasal diseases and anatomical variations by preoperative radiologic evaluation of the paranasal sinuses is essential in planning surgical intervention. Meticulous radiographic delineation of the small structures in this region, coupled with endoscopic evaluation, provides detailed preoperative information regarding morphology and pathology.</p><p class="abstract"><strong>Methods:</strong> Patients with sinonasal symptoms indicating requirement of CT scan evaluation and aged more than 10 years were included in the study. Each CT scan was interpreted by an otolaryngologist and a radiologist and interpretation was by consensus. The data collected was evaluated and results are reported as rates and proportions. </p><p class="abstract"><strong>Results:</strong> Sinusitis (single or multiple sinus involvement), nasal polyposis, frontal mucocele and ethmoidal carcinoma with destruction of medial wall of maxilla were the pathologies observed in these CT scans with sinusitis [22 (43.1%)] being the most common pathology observed. Deviated nasal septum [21 (41.2%)] was the most common anatomical variation observed. All patients who had concha bullosa [5 (9.8%)] were observed to have sinusitis involving multiple bilateral PNS. Based on Keros’ classification, olfactory fossa depth type I was most commonly observed followed by type II and type III.</p><p><strong>Conclusions:</strong> CT scan is important in patients undergoing endoscopic sinus surgery for sinonasal diseases where it acts as a road map in identifying the presence, extent of disease and any anatomical variations. This pre-operative CT scan evaluation improves planning and helps in significantly reducing morbidity and possible complications during surgery. </p>

Combined Anterior Craniofacial Resection for Locally Advanced Ethmoid Carcinomas

Carcinoma of the ethmoid sinus is very rare, and treatment for locally advanced tumors remains as a formidable challenge to the clinician. We reviewed cases of ethmoid carcinoma in which anterior craniofacial resection had been undertaken and evaluated the safety and validity of the operative methods. We retrospectively reviewed 13 patients with ethmoid carcinoma who underwent combined anterior craniofacial resection. We evaluated the surgical procedures, complications, outcomes, local recurrence, and the survival rate. Coronal incision and anterior craniotomy were performed in all cases. Four out of 13 cases underwent ipsilateral orbital exenteration due to involvement of the orbital contents. There were no potentially fatal complications, except for two cases of epidural abscesses which were successfully cured. Positive surgical margins were observed in 6 patients, and they received postoperative radiotherapy and/or chemotherapy. Local recurrences occurred in 4 cases, and 3 died at 9, 11, and 49 months after the surgery. Distant metastasis was not observed during the observation period. The overall 5-year survival rate was 75.2% (Kaplan-Meier method). These tumors were safely removed without severe complications and postoperative mortality. Combined anterior craniofacial resection is an effective and safe option for treatment of locally advanced ethmoid carcinomas after various preoperative treatments.

Primary small cell neuroendocrine carcinoma of paranasal sinuses.

Small cell neuroendocrine carcinoma of the paranasal sinuses is an extremely rare and aggressive neoplasm. Despite aggressive management, the tumor carries a poor prognosis, with a high risk of local recurrence or distant metastases. The management strategy is based on that for pulmonary small cell cancer and includes platinum-based chemotherapy combined with radiotherapy. We are reporting a case of an 89-year-old female patient diagnosed with small cell carcinoma of right-sided ethmoid and sphenoid sinuses. The tumor was found to have invaded the right orbit and anterior cranial fossa. Metastases to cervical lymph nodes and bone were also found. Due to the extended stage and poor prognosis of the patient, the management plan is palliative chemoradiotherapy.

Vertebroepidural metastasis of an ethmoid adenocarcinoma: A case report

Ethmoid adenocarcinoma is the most frequent ethmoid tumor. To date, only a single case of spinal cord compression resulting from ethmoid adenocarcinoma has been reported. The current case study presents a recent case of vertebroepidural metastasis of an ethmoid adenocarcinoma leading to spinal cord compression. Modern imaging studies, including magnetic resonance imaging (MRI) and 18 fludeoxyglucose positron emission tomography (FDG PET), as well as histological and immunohistochemical analyses, have led to diagnoses of a metastasis of an ethmoid adenocarcinoma, which is a mucinous variant, dedifferentiated when compared to the primary tumor. The present case discusses current diagnostic and treatment protocols of this condition. Since survival rates associated with the primary tumor are improving, the incidence of spinal metastasis of ethmoid carcinomas is likely to increase in the future, therefore requiring appropriate diagnostic and therapeutic management.

Brauer-Buschke-Fischer keratoderma associated with two malignancies

Hereditary punctuate palmoplantar keratoderma is a rare autosomal dominantly inherited condition with variable penetrance. We report a case of a 65-year-old manual laborer who presented with multiple asymptomatic hyperkeratotic lesions on both palms and soles of about 45-year duration, which was diagnosed as Brauer-Buschke-Fischer keratoderma and was associated with squamous cell carcinoma of chest wall and ethmoidal carcinoma. This case is being presented for its rarity and the association of Brauer-Buschke-Fischer keratoderma with two malignancies in a single individual.

Relevance of both individual risk factors and occupational exposure in cancer survival studies

Wood dust is a well-established risk factor for intestinal type sinonasal adenocarcinoma. The 5-year overall survival has varied from 20% to 80% according T1-T4 stages; 5-year survival according to histologic subtype has varied from 20% to 50%. To date, no study has evaluated whether environmental, occupational, and personal risk factors have any impact on both overall and cancer-specific survival. We aimed to determine whether exposure to carcinogenic risk factors besides wood exposure can influence the survival of patients with sinonasal ethmoid carcinoma. Retrospective cohort study of the association of survival data and occupational and personal carcinogenic risk factors. All patients hospitalized for ethmoid adenocarcinoma at the Nantes University Hospital between 1988 and 2004 were included . Data concerning TNM classification, histology, type and quality of tumor resection at the macro- and microscopic level, and occupational and personal exposure to carcinogens were collected. Statistical analysis was conducted using univariate and multivariate linear regression. A total of 98 patients were included with a response rate of 98%. Data showed 86% of patients had been exposed to wood dust. The 5-year survival was 62%. We first identified four factors that independently influenced overall survival: diplopia (P = .0159), spread to the orbit (P = .0113), bilateral involvement (P = .0134), TNM stage (P < .001). When the analysis included all occupational environmental factors (wood dust, solvent, and metals exposure) as well as personal risk factors, the length of exposure to metals (P = .0307) and tobacco exposure (P = .0031) also were found to influence 5-year overall survival. We identified high prevalence of colon cancer (4%) and double cancer (18%). We showed exposure to both environmental (tobacco) and occupational (metal dust) factors could influence survival in the diagnosis of a cancer. Our study suggests that screening for colon cancer should be offered to wood dust workers. A prospective multicentric study should be necessary to confirm our results.

EXPANDED ENDOSCOPIC ENDONASAL APPROACH FOR ANTERIOR CRANIAL BASE AND SUPRASELLAR LESIONS

The traditional boundaries of the transsphenoidal approach can be expanded to include the region from the cribriform plate of the anterior cranial fossa to the foramen magnum in the anteroposterior plane. The introduction of endoscopy to transsphenoidal surgery, with its improved illumination and wider field of view, has added significant further potential for the resection of a variety of cranial base lesions. We review our experience with the expanded endoscopic endonasal approach in a series of 22 patients with anterior cranial base and supradiaphragmatic lesions. From June 2005 to June 2007, the expanded endoscopic endonasal approach was used in 22 patients with the following pathologies: 6 craniopharyngiomas; 4 esthesioneuroblastomas; 3 giant pituitary macroadenomas; 2 suprasellar Rathke's pouch cysts; 2 angiofibromas; and 1 each of suprasellar meningioma, germinoma, ethmoidal carcinoma, adenoid cystic carcinoma, and large suprasellar arachnoid cyst. This study specifically focused on the surgical indications and approaches to these lesions and the surgical results, complications, and limitations associated with this technique. Gross total tumor removal, as assessed by postoperative magnetic resonance imaging, was possible in the majority of patients (73%), with the exception of the craniopharyngioma group, in which only 1 lesion was completely removed. There were no permanent neurological complications except for increased visual disturbance in 1 patient. Other complications included cerebrospinal fluid fistulae in 4 patients (18%) and meningitis in 1 patient (5%). There was no operative mortality. Large lesions, significant lateral extension, encasement of neurovascular structures, and brain invasion in malignant lesions are considered some of the contraindications for this technique. The expanded endoscopic endonasal approach is a promising minimally invasive alternative to open transcranial approaches for selective lesions of the midline anterior cranial base. The avoidance of craniotomy and brain retraction and reduced neurovascular manipulation with less morbidity are potential advantages. Major complications have been few, but there are also limitations with this technique. This approach should be included in the armamentarium of cranial base surgeons and considered as an option in the management of selected patients with these complex pathologies.

Dural metastases responsible for benign vertebral collapses

A 17-year-old male patient was transferred to our centre for an invasive ethmoidal carcinoma extending to both frontal lobes of the brain. Bone scintigraphy with single photon emission tomography (SPECT) showed hyperactivity at the level of the 3 to 5 and 7 to 9 vertebral bodies of the dorsal spine. Standard X-ray suggested benign bone fractures. F-fluorodeoxyglucose (FDG) positron emission tomography (PET) showed no increased uptake of the tracer in any vertebral body but there were highly hypermetabolic lesions posterior to the vertebral body at multiple levels where hyperactivity was present on the bone scan images. Magnetic resonance imaging (MRI) showed multiple metastases in the intradural extramedullary space evoking benign bone fractures, confirming the PET observations (see figure). The most probable phenomenon explaining the association of intradural metastases with benign bone fractures is vascular compression leading to vertebral infarction [1]. Indeed, vertebral infraction may accompany anterior spinal artery syndrome since the arterial supply to the dorsal part of the vertebral body derives from this artery [2]. The present observation reveals an unexpected pathophysiology for the association of bone and dural spinal lesions in advanced cancer. Classically, this association is attributed to primary bone metastasis secondarily invading the extradural space [3]. The present case unveils a possible reversed link between vertebral and dural lesions. This phenomenon is certainly far less frequent than the invasion of the extradural space by cells emanating from a vertebral metastasis. Intradural extramedullary metastasis is indeed a rare situation consequent to tumour cell spread from the blood stream and lymphatics, or from intracranial cancer sites [4], as was probably the case in our patient. Practically, the present case draws attention to the fact that “benign” vertebral collapses may be the stigmata of malignant invasion of the spinal canal in patients with cancer.

Which Role for Radiation Therapy in Ethmoid Cancer? A Retrospective Analysis of 84 Cases from a Single Institution

To define the results of radiotherapy for the treatment of ethmoid carcinoma in a large, retrospective, substantially unselected series from a single institution. A relatively large series of 84 consecutive patients treated at our Institution over a 30-year period (1970-2000) was retrospectively analyzed. Sixteen more patients treated in the same period were affected by a relapse of disease at presentation and were therefore excluded from the analysis. Most of the patients had T3 or T4 disease (76%), and half of them had undifferentiated (G3-G4) tumors. Radical surgery preceded radiotherapy in 60 patients, the remaining had only biopsy or incomplete surgery. Average ICRU dose varied according to the extent of postsurgical residual disease. The 5-year actuarial overall survival of the entire series was 48.6%, 5-year disease-specific survival 58%, and 5-year relapse-free survival 54.6%. Overall, disease-specific and relapse-free survival were significantly better (logrank test) for early stage patients (T1-T2) and for those with low-grade disease; relapse-free and disease-specific survival were also significantly (or almost significantly) better for patients who had radical surgery and for those with less extended postsurgical residue. Patients treated with radiotherapy after biopsy only or grossly incomplete surgery had 5-year relapse-free, disease-specific and overall survival of 22%, 42% and 37%, respectively. Higher cumulative doses (>60 Gy) were related to a not significantly lower recurrence probability in patients with micro- or macroscopic residual disease after surgery (54% vs 62%). Multivariate analysis (Cox model) showed that only T stage and grading were independent prognostic factors for overall and disease-specific survival, whereas the prognostic impact of radical surgery was limited to relapse-free survival. Radical radiation therapy alone is able to cure about 25% of the unfavorably selected cases, after biopsy only or partial surgery. Radical surgery is associated with better relapse-free survival rates, but the contribution of postoperative radiotherapy to the primary treatment of these patients cannot be eliminated.

Radiothérapie conformationnelle : la tomothérapie

Conformal radiation therapy allows the possibility of delivering high doses at the tumor volume whilst limiting the dose to the surrounding tissues and diminishing the secondary effects. With the example of the conformal radiation therapy used at the AZ VUB (3DCRT and tomotherapy), two treatment plans of a left ethmoid carcinoma will be evaluated and discussed in detail. The treatment of ethmoid cancer is technically difficult for both radiation therapy and surgery because of the anatomic constraints and patterns of local spread. A radiation therapy is scheduled to be delivered after surgical resection of the tumor. The treatment plan for the radiation therapy was calculated on a three-dimensional (3D) treatment planning system based on virtual simulation with a beam’s eye view: George Sherouse’s Gratis®. An effort was made to make the plan as conformal and as homogeneous as possible to deliver a dose of 66 Gy in 33 fractions at the tumor bed with a maximum dose of 56 Gy to the right optic nerve and the chiasma. To establish the clinical utility and potential advantages of tomotherapy over 3DCRT for ethmoid carcinoma, the treatment of this patient was also planned with Peacock Plan®. For both treatment plans the isodose distributions and cumulative dose volume histograms (CDVH) were computed. Superimposing the CDVHs yielded similar curves for the target and an obvious improvement for organs at risk such as the chiasma, brainstem and the left eye when applying tomotherapy. These results have also been reflected in the tumor control probabilities (equal for both plans) and the normal tissue complication probabilities (NTCP), yielding significant reductions in NTCP for tomotherapy. The probability of uncomplicated tumor control was 52.7% for tomotherapy against 38.3% for 3DCRT.

Osteoplastic frontal sinusotomy and extradural microsurgical repair of frontobasal cerebrospinal fluid fistulas.

The choice of the surgical approach and operative technique for the management of cerebrospinal fluid (CSF) fistulas of the anterior cranial fossa are still a controversially discussed topic. Although "extracranial" approaches through the paranasal sinuses are becoming increasingly more popular among otolaryngologists and maxillo-facial surgeons, most neurosurgeons traditionally prefer the "intracranial" repair of CSF fistulas by a craniotomy. We present an approach through the frontal sinus for the repair of dural defects behind the posterior wall of the frontal sinus and at the floor of the anterior cranial fossa. The operative procedure comprises the following main steps: 1) exposure of the anterior wall of the frontal sinus by a bicoronal incision; 2) excision of the anterior wall without frontal burr holes; 3) bilateral removal of the posterior wall of the frontal sinus; 4) extradural inspection of the dura behind the frontal sinus and above the cribriform plate, ethmoidal roof, and orbital roof bilaterally; 5) closure of dural tears by direct suture and a periosteal graft; 6) reinsertion of the anterior wall of the frontal sinus and fixation with titanium micro plates. Twenty-five patients operated upon using this technique are described. The aetiology of the frontobasal lesion was traumatic in 23, and an ethmoid carcinoma in two. In all patients, the dural fistulas were successfully repaired during the initial procedure. One patient died from sudden circulatory arrest after an uneventful postoperative course of nine days. Otherwise, there were no postoperative complications. This technique affords atraumatic extradural inspection and repair of dural fistulas bilaterally behind the frontal sinus, and above the cribriform plate and the ethmoidal and orbital roofs with none or minimal brain retraction. It therefore allows early repair of CSF fistulas also in patients with severe brain injury. Although we consider the extradural closure of fistulas the method of choice, this approach also allows for a combined extradural-intradural procedure, thus enabling the surgeon to treat associated intradural pathologies, such as traumatic lesions or tumours of the frontal cranial base.

AgNOR count as a marker in ethmoid carcinoma in bovids.

AgNOR count as a marker in ethmoid carcinoma in bovids.

Adenocarcinoma of the ethmoid sinus.

Carcinoma of the paranasal sinuses is rare. The majority of these originate in the maxillary sinus with primary ethmoid carcinomas occurring in up to 20% of cases. Adenocarcinomas comprise up to 50% of the ethmoid malignancy. The relative rarity of tumors originating in this area has led to their inclusion in series that consist mainly of maxillary antral tumors. A retrospective chart review of all patients presenting with primary ethmoid adenocarcinoma at West Virginia University Hospitals between 1988 and 1993 was undertaken. Only patients whose epicenter was believed to be in the ethmoids were included in this analysis. CT scans, MRIs, operative notes, pathology, and final outcome were all analyzed. Eight patients with primary ethmoid adenocarcinoma were treated during this time span. The male to female ratio was 1:1 with a mean age of 50 years. Symptoms had been present from 3 to 18 months (mean 8 months). All patients underwent craniofacial resection with 5 patients receiving postoperative radiotherapy. Pathologically 4 patients had cribriform plate erosion, 2 had dural involvement, and 1 had extension into the sphenoid sinus. With a mean follow-up of 45 months (9-71 months) 7 patients are disease free and 1 patient has died of disease. Obtaining clear margins by craniofacial resection is essential to the management of adenocarcinoma of the ethmoid sinuses. Radiotherapy is reserved for positive margins, cribriform plate penetration, dural invasion, and high-grade lesions that are close to the cribriform plate. Local control was obtained in 87% of our patients.

Computed perimetry study of optic nerve compression caused by orbital tumors

Seventeen cases of compressive optic neuropathy caused by orbital masses were examined with a 30-degree threshold program of automated perimetry. The orbital pathologies were represented by five cases of Graves' orbitopathy, three optic nerve sheath meningiomas, two hemangiopericytomas, two diffuse pseudotumors, one perineuritis, one case of orbital varices with hemorrhage, one lymphoma, one ethmoidal carcinoma and one suspected angioma. Visual field alterations varied from arcuate, inferior altitudinal and cecocentral scotomas, to temporal hemianopsy, nasal step and diffuse losses. In three cases (one Graves', one acute diffuse pseu-dotumor and one perineuritis), steroid administration was followed by partial or full perimetric recovery; in one case (orbital varices with hemorrhage) the full recovery was spontaneous, while in one case of benign hemangiopericytoma, the surgical removal of the tumor caused a significant improvement of the visual field.In the authors' series, perimetric pattern reflects the...

En Bloc Resection of an Ethmoid Carcinoma Involving the Orbit and Medial Wall of the Cavernous Sinus

En Bloc Resection of an Ethmoid Carcinoma Involving the Orbit and Medial Wall of the Cavernous Sinus

Laterality of sinonasal cancer and its aetiologic implications.

A study of the laterality of cancer arising in the nose and sinuses in Cape Town shows that ethmoid tumours have a pronounced left-sided dominance irrespective of histology or racial group. This supports an exogenous cause for this site. These findings are discussed in the light of results from other clinical and epidemiological research. It seems unlikely that maxillary sinus cancer has the same aetiology as ethmoid carcinoma.

Response of the lymph node to tumour antigen and Bacillus Calmette-Guerin in cattle bearing tumours of the ethmoturbinate region

The immunological response of the Ln subiliacus (externus) in cattle bearing ethmoid carcinoma was studied. The lymph node was stimulated in vivo by I/D administration of tumour antigen and Bacillus Calmette-Guerin and the changes in the lymph node were studied at 3-day intervals up to 15 days. The histological changes in the lymph node were assessed and the functional activity of the activated macrophages in the lymph node impression smears was evaluated using Nitroblue tetrazolium salt reduction test. Similar studies were also undertaken in age-matched healthy nontumour bearing cattle. On stimulation with BCG and tumour antigen there was stimulation of the T cell dependent area. However, the response to the tumour antigen was quicker but shorter in duration compared with that to BCG. The response in healthy animals was proportionately much less. The studies indicated that tumour-bearing animals which were mostly in stage II were immunocompetent.

Craniofacial resection for ethmoid carcinoma in children

The combined craniofacial resection is a well-established method of managing invasive primary malignant nasoethmoidal disease in adults, and serves as an excellent surgical technique for the en bloc eradication of these lesions [6]. The nasoethmoid region is a relatively uncommon site for the development of primary carcinoma. Less than 3% of cancers involving the adult upper aerodigestive system arise in this area [11,13]. Because similar lesions occur in the pediatric population even less frequently, there has been little opportunity to gain the knowledge necessary to develop a standardized treatment of this disease in children. We report the use of a combined therapeutic regimen consisting of cobalt-60 radiotherapy, surgery and chemotherapy, to manage a primary malignant undifferentiated carcinoma of the ethmoid complex in an adolescent. Since the initiation of treatment at the Cincinnati Children's Hospital, the child has remained free of tumor for 24 months. The techniques of craniofacial resection for the removal of certain tumors in the nasoethmoid complex of adults may be easily adapted for use in the pediatric population, and should be included in the surgical armamentarium of the otolaryngologist providing this type of health care for children.