Nasal Tumors Research Articles

Human papilloma virus (HPV) infection as an etiological factor in malignant sinonasal neoplasms and nasopharyngeal carcinomas: A pathologist’s perspective

Human papilloma virus (HPV) infection as an etiological factor in malignant sinonasal neoplasms and nasopharyngeal carcinomas: A pathologist’s perspective - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2019.044, Indian Journal of Pathology and Oncology-Indian J Pathol O

Co-occurrence of Nasal Polyps and Neoplasms of the Canine Nasal Cavity.

Nasal polyps in dogs are space-occupying soft-tissue masses that have been encountered concurrently with intranasal neoplasia in surgical biopsy specimens. The proportion of nasal polyp co-occurrence with primary nasal tumors was examined, and follow-up biopsies on dogs initially diagnosed with nasal polyp were reviewed. Histologic sections from 321 cases of intranasal neoplasia and 50 cases of nasal polyp from 2004 to 2017 were reviewed. Of the 321 cases of intranasal neoplasia, 51 (16%) had concurrent nasal polyps, and most of these (47/51) had intranasal carcinoma. Twenty-five of the 50 dogs with a primary diagnosis of nasal polyp were rebiopsied, and the diagnoses in these subsequent biopsies were nasal polyp in 15, malignant neoplasm in 9, and intranasal nematode in 1. Nasal polyps occurred frequently in conjunction with nasal carcinoma. In dogs with a diagnosis of nasal polyp, repeat biopsy to reveal possible neoplasia is warranted.

A Rare Variant of Middle Turbinate Extending to the Nasal Vestibule Misinterpreted as Nasal Cavity Tumor

A Rare Variant of Middle Turbinate Extending to the Nasal Vestibule Misinterpreted as Nasal Cavity Tumor

Chemotherapy in the management of olfactory neuroblastoma/esthesioneuroblastoma: An analysis of the surveillance, epidemiology, and end results (SEER) 1973-2015 database.

e17573 Background: Olfactory neuroblastoma (ON) is a malignant tumor of nasal cavity arising in sensory neuroectodermal olfactory cells. Chemotherapy (CT) has been proposed as an adjunct to primary local therapy. Here, we investigated the role of CT in primary ON treatment. Methods: SEER was searched for ON (ICD-3 9522). Inclusion criteria were (1) unique cases; (2) primary nasal cavity tumor; (3) staging information; and (4) ability to derive Kadish stage. Abstracted covariates included sex, age, tumor grade, nodal status, year of diagnosis, derived Kadish stage, and treatment (surgery, radiotherapy (RT), CT). Outcomes included disease-specific (DSS) and overall (OS) survival. In SEER, CT and RT are classified as Yes vs No/Unknown. Uni- and multi-variable Cox analyses assessed CT treatment on DSS and OS, controlling for covariates noted above. To account for proportional hazards violations, such variables were either stratified or time-varying. Multiple imputation addressed missing data. A p < 0.05 was designated for statistical significance. Analyses were conducted using Stata ver 12. Results: 797 ON cases were included. In univariable analysis, CT treatment (yes vs no/unknown) was associated with inferior DSS (HR 2.81, 95% CI 2.11 3.74, p < 0.001) and OS (HR 2.03, 95% CI 1.63 2.54, p < 0.001). In multivariable analyses, CT was again associated with inferior DSS (HR 1.74, 95% CI 1.21, 2.51, p = 0.003) and OS (HR 1.71, 95% CI 1.26, 2.32, p = 0.001). Limiting analysis to those with local/regional disease treated with local therapy (surgery and/or radiation), CT remained associated with inferior outcomes [DSS (HR 2.78, 95% CI 1.63, 4.74, p < 0.001) and OS (HR 2.17, 95% CI 1.45, 3.27, p < 0.001)]. Sensitivity analyses ruled out chemotherapy misclassification as an explanation for our results. Conclusions: Our analysis does not support the use of chemotherapy to improve either DSS or OS in primary ON treatment. We controlled for known ON prognostic factors available from SEER. Other prognostic and treatment selection factors could exist for which we did not control. Chemotherapy may also beneficially affect outcomes other than DSS or OS. While concerns have been expressed regarding CT treatment misclassification in SEER, our analyses did not identify such misclassification as an explanation.

Enzootic nasal adenocarcinoma in sheep: An update

Enzootic nasal adenocarcinoma of sheep (ENAS) is a contagious tumor of the ethmoid turbinate mucosa. The disease occurs naturally in all continents except Australia and New Zealand. Similar disease has been described in goats. ENAS is aetiologically associated with enzootic nasal tumor virus 1 (ENTV-1) a type Beta retrovirus and closely related to jaagsiekte sheep retrovirus (JSRV) and enzootic nasal adenocarcinoma virus of goats (ENTV-2). Clinical signs include continuous nasal discharge, respiratory distress, exophtalmus and skull deformations. The tumors have been classified histologically as low grade adenocarcinoma. ENTV-1 can be demonstrated in tumors by immunohistochemistry using several antisera developed against JSRV antigens which cross-react with ENTV-1 ones. ENTV-1 shares a oncogenic mechanisms with JSRV and ENTV-2 and active replication of the virus is required because oncogenic proprieties are associated with env gene products. Information about immune reactions in relation to ENTV-1 is scarce and controversial. Some early studies indicated absence of immune reaction although more recent studies have detected the presence of neutralizing antibodies in sheep with tumors and in contact sheep. However, the sensitivity and specificity of these tests are very low to be used in field studies. Several specific PRC techniques are available to detect viral genome in tissues and tumors. ENTV-1 can be detected in nasal secretion but is rarely found out of the tumor. The utility of PCR tests in control or eradication plans is discussed.

Simultalneous application of prefibricated strut member obturator prosthesis to the maxillary defect after ablative surgery to the nasal sinus malignant tumor --- a 10 years result

Simultalneous application of prefibricated strut member obturator prosthesis to the maxillary defect after ablative surgery to the nasal sinus malignant tumor --- a 10 years result

Clinical Analysis of Benign and Malignant Nasal Septal Tumors

Clinical Analysis of Benign and Malignant Nasal Septal Tumors

Detection of enzootic nasal tumor virus (ENTV) in a sheep flock in southern Brazil.

Enzootic nasal tumor (ENT) is a contagious neoplasm associated with enzootic nasal tumor virus (ENTV), which may induce disease in sheep (ENTV-1) and goats (ENTV-2). This study aimed to describe the occurrence of ENT in two Texel sheep (Ovis aries) from a 75-sheep flock, located in the city of Gravataí, southern Brazil. Animals used to be purchased from different origins, and no specific tests for disease monitoring or quarantine procedure were performed. Affected animals presented respiratory distress, anorexia with severe weight loss, and mucopurulent unilateral nasal discharge. Necropsy was performed in both animals and nasal cavity masses were observed. Histopathological analysis demonstrated an epithelial neoplasm compatible with nasal adenocarcinoma. PCR using a protocol that amplifies a 591bp sequence of 5'LTR-gag region of ENTV1 was performed followed by DNA sequencing. Both samples were positive, and the sequences obtained presented highest identity (97%) with ENTV strain TN28 (GenBank accession number MH899613) detected in a Texel sheep from Scotland. This is the first report of ENTV-1 leading to enzootic nasal tumor in sheep in Latin America, which confirms the presence of the retrovirus in sheep flocks in the Brazilian territory.

Clinicopathological analysis of 187 cases of external nose skin tumors

Objective:To explore the pathological types, distribution and characteristics of external nose skin tumors, in order to improve the diagnosis and treatment of such diseases, and provide reference for the clinical diagnosis and treatment of external nose skin tumors. Method: The gender, age of onset, lesion location, lesion size, pathological type, course of disease and related risk factors of all 187 cases with external nose skin tumors in our hospital from January 2008 to December 2017 were analyzed retrospectively. Result:The sex ratio of patients with external nasal skin benign tumors was 1.10：1.00, and that of patients with external nasal skin malignant tumors was 0.97：1.00. There was no significant difference in the composition of benign and malignant patients(χ²=0.169,P=0.681). The peak age of skin tumors of the external nose is over 60 years old, accounting for 71.1%(133/187). There was a significant difference in the ratio of benign to malignant tumors among different age groups(χ²=31.378,P<0.001). The ratio of malignant tumors increased with age(χ²trend=28.741, P<0.001). The most common benign external nasal skin tumors were alar nasi(28 cases, 22.2%), nasal root(25 cases,19.8%), dorsal nasal(23 cases, 18.3%), tip nasi(22 cases, 17.5%) and paranasal(18 cases,14.3%). Malignant external nasal skin tumors were alar nasi(18 cases,28.5%), dorsal nasal(15 cases,24.6%) and tip nasi(11 cases,18.0%). Epidermal cellderived basal cell carcinoma was the most common malignant tumor(44 cases,72.1%), followed by squamous cell carcinoma(11 cases,18.0%). Conclusion: External nasal skin malignancies have the characteristics of the elderly at the peak age of onset, skin basal cell carcinoma is the most common, for the incidence of basal cell carcinoma constitutes the largest, so that early detection, early diagnosis, early treatment.

Nasal discharge in dogs - are microbiological and histopathological examinations clinically useful?

Retrospective evaluation of the diagnostic value of bacterial culture of nasal mucosal swabs and histopathologic assessment of nasal mucosal biopsies in dogs with nasal discharge. Medical records of dogs with the predominant clinical sign of nasal discharge that were referred to the ENT Unit of the Small Animal Department between January 2015 and December 2016 were reviewed. Data of 85 dogs were evaluated. On the basis of the results of computed tomography (CT), rhinoscopy, bacterial culture of a nasal mucosal swab and histopathologic examination of nasal mucosal biopsies, dogs were assigned to one of six groups of primary nasal diseases: nasal neoplasia (24/85, 28 %), oronasal defect (22/85, 26 %), idiopathic chronic rhinitis (17/85, 20 %), foreign body (8/85, 10 %), sinonasal aspergillosis (7/85, 8 %) and diseases of the planum nasale (7/85, 8 %). In brachycephalic dogs (14/85, 17 %), oronasal defects (8/14, 57 %) were the most frequent cause of nasal discharge. No cases of a primary bacterial infection of the nasal cavity were observed and, therefore, antibiotic treatment had not been successful. Nevertheless, 72 % of the dogs in this study had received prior antibiotic treatment. Secondary bacterial infec tions diagnosed via nasal mucosal swabs were not diagnostic for the underlying primary nasal diseases. Targeted biopsies of tumors obtained under endoscopic visualization may lead to a definitive diagnosis, whereas biopsies of the nasal mucosa and the type of the inflammatory infiltrate were not diagnostic. Nasal discharge in dogs is frequently an indicator of an underlying severe primary nasal disease possibly leading to mortality of the affected dogs. Further diagnostics under anesthesia should be performed early in the diagnostic evaluation. Rhinoscopy as the central diagnostic is supported by CT and biopsy. Bacterial culture of the nasal discharge does not provide a diagnosis for the primary nasal disease process. Without further diagnostics, antibiotic treatment of dogs presenting with nasal discharge is considered as not appropriate and can be harmful in dogs with nasal tumors or sinonasal aspergillosis. When an intranasal malignant neoplasia is suspected, endoscopic-guided biopsies of the nasal mass should be obtained, because blind nasal biopsies are associated with a high rate of false-negative results.

First detection and genotypic analysis of goat enzootic nasal tumor virus 2 in Chongqing, China.

Enzootic nasal adenocarcinoma (ENA) of goats, characterized by transformation of epithelial cells of the ethmoid turbinates, is caused by enzootic nasal tumor virus 2 (ENTV-2). ENTV-2 belongs to the genus Betaretrovirus and has extended its distribution globally with a high prevalence; however, the genetic diversity and genotypic distribution for ENTV-2 have not been analyzed systematically due to the limited availability of sequence data. In this study, an infection by ENTV-2 was detected by RT-PCR in Chongqing in July 2018, and the complete sequence of one strain (CQ1) was determined. Phylogenetic analysis indicated a high degree of genetic heterogeneity among ENTV-2 sequences, with the existence of two main lineages. Lineage 1 and 2 were composed of ENTV-2 from China and the UK, respectively. Although CQ1 was closely related to recent ENTV-2 strains collected in the neighboring provinces of Chongqing (Shaanxi and Sichuan), it formed a separate sublineage of lineage 1 (sublineage 1.3). This report will enhance our understanding of the epidemiology of ENTV-2 in China.

Outcomes and adverse effects associated with stereotactic body radiation therapy in dogs with nasal tumors: 28 cases (2011-2016).

OBJECTIVE To assess outcomes, factors associated with survival time, and radiation-induced toxicoses in dogs treated for nasal tumors with curative-intent stereotactic body radiation therapy (SBRT). DESIGN Retrospective case series. ANIMALS 28 client-owned dogs. PROCEDURES By use of a 6-MV linear accelerator, dogs were treated with SBRT (3 consecutive-day fractions of 9 or 10 Gy or once with 1 fraction of 20 Gy). Data regarding adverse effects, outcomes, and survival times were obtained from the medical records. RESULTS The median survival time to death due to any cause was 388 days. Of the 24 dogs known to be dead, 14 (58%) died or were euthanized because of local disease progression. Acute radiation-induced adverse effects developed in the skin (excluding alopecia) in 26% (6/23) of dogs and in the oral cavity in 30% (7/23) of dogs. Acute ocular adverse effects included discharge in 26% (6/23) of dogs and keratoconjunctivitis sicca in 4% (1/23) of dogs. Among the 22 dogs alive at > 6 months after SBRT, 4 (18%) developed a unilateral cataract; 4 (18%) developed other complications that may have been late-onset radiation toxicoses (excluding leukotrichia and skin hyperpigmentation). CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that dogs treated with SBRT had outcomes comparable to those reported for dogs with nasal carcinomas and sarcomas that undergo conventionally fractionated radiation therapy. Administration of SBRT was associated with a comparatively lower frequency of acute radiation-induced adverse effects. For SBRT and conventionally fractionated radiation therapy, the frequencies of serious late-onset adverse effects appear similar.

Identification of OTX1 and OTX2 As Two Possible Molecular Markers for Sinonasal Carcinomas and Olfactory Neuroblastomas.

OTX homeobox (HB) genes are expressed during embryonic morphogenesis and during the development of olfactory epithelium in adult organisms. Mutations occurring in these genes are often related to tumorigenesis in human. No data are available today regarding the possible correlation between OTX genes and tumors of the nasal cavity. The aim of this work is to understand if OTX1 and OTX2 can be considered as molecular markers in the development of nasal tumors. We selected nasal and sinonasal adenocarcinomas to investigate the expression of OTX1 and OTX2 genes through immunohistochemical and real-time PCR analyses.Both OTX1 and OTX2 were absent in all the samples of sinonasal Intestinal-Type Adenocarcinomas (ITACs). OTX1 mRNA was identified only in Non-Intestinal Type Adenocarcinomas (NITACs) while OTX2 mRNA was expressed only in Olfactory Neuroblastomas (ONs). We have demonstrated that the differential gene expression for both OTX1 and OTX2 genes might be a useful molecular marker to distinguish the different types of sinonasal tumors.

Identification of OTX1 and OTX2 As Two Possible Molecular Markers for Sinonasal Carcinomas and Olfactory Neuroblastomas

OTX homeobox (HB) genes are expressed during embryonic morphogenesis and during the development of olfactory epithelium in adult organisms. Mutations occurring in these genes are often related to tumorigenesis in human. No data are available today regarding the possible correlation between OTX genes and tumors of the nasal cavity. The aim of this work is to understand if OTX1 and OTX2 can be considered as molecular markers in the development of nasal tumors. We selected nasal and sinonasal adenocarcinomas to investigate the expression of OTX1 and OTX2 genes through immunohistochemical and real-time PCR analyses.Both OTX1 and OTX2 were absent in all the samples of sinonasal Intestinal-Type Adenocarcinomas (ITACs). OTX1 mRNA was identified only in Non-Intestinal Type Adenocarcinomas (NITACs) while OTX2 mRNA was expressed only in Olfactory Neuroblastomas (ONs). We have demonstrated that the differential gene expression for both OTX1 and OTX2 genes might be a useful molecular marker to distinguish the different types of sinonasal tumors.

Aspectos tomográficos das neoplasias nasais em cães

A doença nasal crônica é uma enfermidade rotineira na clínica de pequenos animais que possui causas variadas, sendo necessária a realização de exames complementares para o diagnóstico definitivo, principalmente os de imagem. O objetivo desse estudo retrospectivo foi avaliar tomografias computadorizadas da cavidade nasal de cães e descrever as principais alterações neoplásicas encontradas. Dentre os achados, foi observado em 100% dos animais a opacificação da cavidade nasal, seguida da captação de contraste na lesão em 92,3%, osteólise em 84,6%, e em menor frequência (53,8%) a perda de definição ou desvio do septo nasal. Nesses animais o diagnóstico de neoplasia nasal foi sugerido pelo exame tomográfico e confirmado pelos exames citológico e histológico.

EvaGreen-based real-time PCR assay for sensitive detection of enzootic nasal tumor virus 2

Enzootic nasal tumor virus 2 (ENTV-2), the aetiological agent of enzootic nasal adenocarcinoma in goats, is prevalent in China; resulting in substantial economic losses to the goat-breeding industry. Therefore, it is necessary to establish an efficient detection method for the diagnosis and prevention of ENTV-2 infection. More recently, EvaGreen is emerging as a novel alternative fluorescent dye for quantitative real-time PCR because of its low cost, specific amplification and high resolution. In this study, we developed a specific, sensitive, and cost-effective detection method-an EvaGreen-based real-time PCR assay for the detection of ENTV-2. This assay exhibited high specificity and sensitivity and was able to detect ENTV-2 at concentrations as low as 3.0 × 101 copies, which was more sensitive than the conventional PCR method (detection limit, 3.0 × 102 copies). In addition, the reproducibility test indicated that EvaGreen dye in our assay had a good reproducibility. In conclusion, we report that a highly sensitive, specific, and cost-effective EvaGreen-based real-time PCR assay is successful for the rapid detection of ENTV-2.

Acellular dermal matrix contributes to epithelialization in patients with chronic sinusitis.

Nasal endoscopic surgery is widely used for nasal diseases, including sinusitis and tumors. However, scar hyperplasia, nasal irritation, scab, and nasal obstruction delay nasal mucosal recovery, with prolonged cleaning exacerbating the patient's financial burden. Here, we presented a novel approach for the treatment of nasal mucosal defects, termed acellular dermal matrix. A total of 31 patients with bilateral chronic sinusitis (maxillary sinusitis and ethmoid sinusitis) underwent nasal surgery and nasal mucosal repair in September-October 2016. We divided the nasal cavities of each patient into control and acellular dermal matrix groups, randomly selected one side for nasal mucosal repair by surgery. A suitable acellular dermal matrix size was selected according to the defect in each patient. After pruning, the acellular dermal matrix was placed on the wound surface and filled with gelatin sponge. All patients were followed up for 14 weeks to compare nasal mucosal epithelialization between the control and acellular dermal matrix groups. Results：No obvious complications and adverse reactions were observed after nasal surgery. Lund-Kennedy scores in the acellular dermal matrix group were significantly decreased compared with the control group at 8 (0 (0, 1) vs. 2 (2, 4); P<0.05) weeks. Epithelialization time of eight weeks in the acellular dermal matrix groups was significantly decreased than the control group of 14 weeks. Acellular dermal matrix provides a growth framework for the healthy mucosa on the wounded surface and reduces postoperative epithelialization time.

Development of real-time PCR-based methods for the detection of enzootic nasal tumor virus 2 in goats.

Enzootic nasal adenocarcinoma (ENA) is a contagious neoplasm of sheep and goats, associated with the oncogenic retroviruses enzootic nasal tumor virus (ENTV) 1 and 2, respectively. It appears to be common in countries with substantial small ruminant-production. ENA diagnosis in goats is based on autopsy and histopathology, and there is no real-time PCR method available for ENTV-2 detection. Here, a novel one-tube real-time RT-PCR (RT-qPCR) method for the detection and quantification of ENTV-2 in nasal swabs is presented. The method targets the env gene/U3 region. For the design of ENTV-2-specific oligonucleotides, molecular characterization of seven Greek ENTV-2 strains was performed. Phylogenetic analysis revealed three distinct phylogenetic clades of ENTV-2 that correlate with the country of sample collection. Evaluation of the analytical performance of the RT-qPCR revealed an amplification efficiency of 92.8% and a linear range of quantification between 2 × 108 and 2 × 102 RNA transcripts. Analysis of nasal swabs from 23 histopathologically confirmed, naturally occurring ENA cases via RT-qPCR yielded positive results. Moreover, modification of the method for use in a real-time PCR (qPCR) assay enables detection of proviral DNA in tumor specimens. Both methods are highly specific and can be used for the confirmation of ENA-suspected cases. Future applications could include ante-mortem diagnosis, verification of the ENTV-2-free status in animal trade, disease surveillance, and control programs.

Turbinate-septal suture for middle turbinate medialization during endoscopic sinus surgery

Background Lateralization of middle turbinate (MT) and synechia formation are common complications after endoscopic sinus surgery (ESS). These complications can be prevented with one of MT medialization techniques. Aim The aim of this study was to evaluate the effectiveness of MT-septal suturing technique in prevention of lateralization of MT and synechia formation after ESS. Patients and methods A total of 25 patients were selected for this prospective cohort study in the period between January 2017 and January 2018 at the Otorhinolaryngology Department, Tanta University Hospital, complaining of chronic rhinosinusitis refractory to medical treatment. The age of the patients ranged from 16 to 60 years. We selected patients who did not have a history of previous ESS, nasal tumors, or bleeding disorders. A total of 25 patients of the study had undergone MT medialization (suturing technique) after ESS. All the patients were assessed by endoscopic nasal examination (preoperative, 2 weeks, and 3 months postoperatively) and sinonasal outcome test (SNOT-22) questionnaire (preoperatively and 3 months postoperative). Results Two-week postoperative endoscopic nasal examination of 25 patients showed that there was mild adhesion and synechia to lateral nasal wall in two patients in one side (8%) owing to separated sutures. Synechia was divided in outpatient clinic. No synechia was detected on 3-month postoperative endoscopic examination. Conclusion Lateralization MT and synechia formation after ESS complications can be prevented with one of MT medialization techniques. The MT suturing technique is simple, reliable, and effective in prevention of lateralization of MT and synechia formation after ESS.

Metastases to the nose from clear cell renal cell carcinoma

Rationale:Patients with nasal metastases are seldom seen among clear cell renal cell carcinoma (CCRCC). We report a rare case presenting as a solitary nasal cutaneous nodule, and summarize the therapeutic experience of tyrosine kinase inhibitors (TKIs).Patient concerns:A 86-year-old man with a chief complaint of continuous back pain for 3 months and discovery of a cutaneous nodule on the nose for a month visited the oncology department of our hospital. Maxillofacial computed tomography (CT) scans demonstrated a 1.5 × 0.9 cm and ovoid soft tissue density shade at dorsum of the nose. CT of abdomen revealed a 3.5 × 2.7 cm mass in right kidney and presenting an obvious heterogeneous enhancement.Diagnoses:The pathological examination of nasal excision biopsy confirmed the diagnosis of nasal clear cell carcinoma. Immunohistochemical analysis indicated that the nasal metastatic tumor had a renal origin.Interventions:Sunitinib at a dose of 50 mg/day was administered initially, while the serious cutaneous toxicities, especially hand-foot syndrome, occurred to the patient. Subsequently, axitinib at a dose of 5 mg twice daily was accepted as second-line treatment.Outcomes:The nasal mass shrinked significantly after 8-week treatment of axitinib, and the primary tumor has been stable till now.Lessons:Axitinib successfully controlled the nasal cutaneous metastasis with mild adverse reactions, and did not aggravate the cutaneous toxicities resulting from sunitinib. The incidence of cutaneous adverse events were low which had been reported by previous studies; however, it is difficult to say that axitinib is a more effective treatment modality for RCC with nasal metastases, which requires further studies.