Sinonasal Malignancies Research Articles

The neurosurgical management of sinonasal malignancies involving the anterior skull base: a 28-year experience at The MD Anderson Cancer Center.

Sinonasal malignancies that extend to the anterior skull base frequently require neurosurgical intervention. The development of techniques for craniofacial resection revolutionized the management of these neoplasms, but modern and long-term data are lacking, particularly those related to the incorporation of endoscopic techniques and novel adjuvant chemotherapeutics into management schema. The present study was performed to better define the utility of surgical management and to determine factors related to outcome. Patients who underwent surgery between 1993 and 2020 were included in this retrospective cohort study. Only patients with greater than 6 months of clinical and radiological follow-up were included. Outcome measures included progression, survival, and treatment-related complications. Two hundred twenty-five patients were included. The mean clinical follow-up was 6.5 years. The most common histological diagnosis was olfactory neuroblastoma (33%). Overall, metastatic disease and brain invasion were present in 8% and 19% of patients, respectively, at the time of surgery. A lumbar drain was used in 54% of patients. When stratified by decade, higher-stage disease at surgery became more frequent over time (15% of patients had metastatic disease in the 3rd decade of the study period vs 4% in the 1st decade). Despite the inclusion of patients with progressively higher-stage disease, median overall survival (OS) remained stable in each decade at approximately 10 years (p = 0.16). OS was significantly worse in patients with brain invasion (p = 0.006) or metastasis at the time of surgery (p = 0.014). Complications occurred after 28% of operations, but typically resulted in no long-term negative sequelae. Use of a lumbar drain was a significant predictor of complications (p = 0.02). Permanent ophthalmological disabilities were observed after 4% of surgical procedures. One patient died during the perioperative period. Finally, major complications (Clavien-Dindo grade ≥ IIIb) decreased from 27% of patients in the 1st decade to 10% in the 3rd decade (p = 0.007). The surgical management of sinonasal malignancies with anterior skull base involvement is effective and generally safe. Surgical management, however, is only one facet of the overall multimodal management paradigms created to optimize patient outcomes. Survival outcomes have remained stable despite more extensive disease at surgery in patients who have presented in recent decades. The safety of such surgery has improved over time owing to the incorporation of endoscopic surgical techniques and the avoidance of lumbar spinal drainage with open resection.

Pretreatment neutrophil-lymphocyte ratio predicts the long-term survival of patients with sinonasal malignancy.

Pretreatment neutrophil-lymphocyte ratio predicts the long-term survival of patients with sinonasal malignancy.

Human Papillomavirus-Related Carcinomas of the Sinonasal Tract.

The sinonasal tract is home to a uniquely heterogenous collection of malignant tumors. Human papillomavirus (HPV) has been detected in a number of these, but the virus' role as an oncogenic driver or coincidental finding remains unclear. We aim to highlight five sinonasal tumor types and synthesize the prevalence, etiologic role, and known clinicopathologic relevance of HPV in each. The last decade has seen an expansion of investigation into HPV's oncogenic and prognostic significance within sinonasal malignancies. The sinonasal tract poses challenges to HPV detection where p16 lacks value as an accurate surrogate. A growing body of data supports a potentially favorable clinical profile for certain sinonasal HPV-positive lesions. HPV represents a potential biologically and clinically relevant factor for some sinonasal malignancies. Definitive conclusions regarding HPV's role as a potential oncogenic agent require routine testing using validated methodologies, genomic interrogation, and large-scale prospective studies.

Sinonasal Tumors With Neuroepithelial Differentiation (Olfactory Carcinoma): Delineation of Their Pathologic and Clinical Features With Insights into Their Relationship to Olfactory Neuroblastoma and Sinonasal Carcinoma.

Olfactory carcinoma is one of many names applied to sinonasal malignancies with histologic similarity to olfactory neuroblastoma (ONB) but cytokeratin expression or gland formation. It is unclear whether these neuroepithelial tumors represent a unified category and if they are separate from ONB and currently-recognized sinonasal carcinomas. This study aims to explore their clinicopathologic characteristics based on a large collective experience. A total of 53 sinonasal tumors with neuroepithelial differentiation were identified affecting 41 men and 12 women, median age 47 years (range: 12 to 82 y). The vast majority arose in the superior nasal cavity and presented at the high Kadish-Morita stage. Frequent histologic findings included (1) lobulated and solid growth, (2) rosettes and/or neurofibrillary stroma, (3) high-grade cytology, (4) complex, often ciliated glands, (5) nonfocal pancytokeratin expression, (6) neuroendocrine pos+itivity, and (7) variable S100-positive sustentacular cells. Twelve patients with available follow-up (48%) developed progressive disease at a median 8 months (range: 0 to 114 mo to progression), and 7 (28%) died of disease. Despite disparate historical terminology, neuroepithelial differentiation is a recurrent and recognizable histologic pattern that is associated with aggressive behavior in sinonasal tumors. While tumors with this phenotype may originate from olfactory mucosa, well-developed epithelial features warrant separation from conventional ONB and neural elements distinguish them from most sinonasal carcinomas. Although their full histogenesis remains uncertain and some heterogeneity may exist, we propose that this pattern is sufficiently distinctive to merit separate recognition as olfactory carcinoma. Use of consistent nomenclature may facilitate greater recognition of tumors with this phenotype and understanding of their pathogenesis and classification.

Sinonasal inverted papilloma - malignant transformation and non-sinonasal malignancies.

To assess malignant transformation rate, non-sinonasal malignancies, and factors contributing to recurrence in patients treated for sinonasal inverted papilloma (SNIP). Retrospective study. We retrospectively reviewed medical records of all patients treated for SNIP (n=296) between the years 1984-2014 at Helsinki University Hospital. Data from the Finnish Cancer Registry confirmed the number of those patients with sinonasal and non-sinonasal malignancies. Only 2 of 296 (0.7%) patients primarily diagnosed with benign SNIP developed sinonasal cancer in a mean follow-up of 5.8 years. The most common non-sinonasal cancer sites were similar to those reported for the whole Finnish population. None of the patients presented with an HPV-associated non-sinonasal malignancy. The recurrence rate among patients who underwent attachment-oriented surgery was significantly lower compared to those operated on with other approaches (40.2% vs. 56.6%, p=0.006). Dysplasia in SNIP was associated with a higher recurrence rate (p < 0.001). Malignant transformation of SNIP was rare. Patients with SNIP were not prone to HPV-associated non-sinonasal malignancies. Endoscopic resection and attachment-oriented surgery have become predominant approaches in the treatment of SNIP; meanwhile, the total number of SNIP recurrences has decreased. 3 Laryngoscope, 133:506-511, 2023.

Feasibility of lattice radiotherapy using proton and carbon-ion pencil beam for sinonasal malignancy.

BackgroundSinonasal malignancies are a treatment challenge because of their complex anatomy and close proximity to organs at risk (OARs). We aimed to investigate the feasibility of lattice radiotherapy (LRT) using pencil beam scanning (PBS) proton or carbon-ion beams in the treatment of sinonasal malignancies.MethodsA total of 10 patients with nonoperative and bulky sinonasal adenoid cystic carcinomas (ACC) were enrolled. Spherical vertices with a 1 cm diameter and average center-to-center (c-t-c) distance of 3.51 cm were delineated within the gross tumor volumes (GTVs). The prescription doses were 15 Gy[relative biologic effectiveness (RBE)] to the vertices and 3 to 3.5 Gy(RBE) to the periphery, delivered as clinical target volume boosts (CTVboosts) in 1 fraction. Photon, proton, and carbon-ion LRT plans were generated. Peak-to-valley dose ratios (PVDRs) and the doses delivered to the vertices, the CTVboost, and OARs were compared among the 3 plans.ResultsThe mean PVDRmin values for the photon, proton, and carbon-ion LRT plans were 4.78 (range, 4.34 to 5.36), 4.82 (range, 4.15 to 5.37), and 4.69 (range, 4.31 to 5.28), respectively. The mean PVDRmean values for the same plans were 3.42 (range, 3.15 to 3.79), 2.93 (range, 2.19 to 3.74), and 3.58 (range, 3.09 to 4.68), respectively. There were no significant differences between the PVDRmin and PVDRmean values across the 3 LRT plans. Most critical organs were better protected in the proton and carbon-ion LRT plans than in the photon LRT plans. The photon LRT plans showed the highest maximum degree (Dmax) of vertices. Furthermore, these plans did not introduce more doses to the OARs compared to the 1-fraction clinical boost plan.ConclusionsDespite minimal differences in PVDR, proton and carbon-ion LRT plans can better protect OARs than photon LRT plans.

Descriptive analysis of recurrences of nasal intestinal-type adenocarcinomas after radiotherapy.

Despite adjuvant radiotherapy, rates of recurrences of endoscopically operated nasal intestinal-type adenocarcinomas (ITAC) have not been improved in successive series. To better understand how to improve local control, we aimed to investigate the site of local recurrences of ITACs. Retrospective study in a reference center in sinonasal malignancies. For all patients with a local recurrence, radiotherapy plans were retrieved and compared to the delineation of local recurrences. Of 63 patients, 54 underwent adjuvant radiotherapy of which 14 (25.9%) had a local recurrence. Eleven of them had their onset in an optimally irradiated area. Difficulty to dissect the cribriform plate and/or the lateral lamina was reported for 11 patients with local recurrences in the operative reports (p<0.0001). Most of recurrences arose in an optimally irradiated area. A close cooperation between surgeons and radiotherapists is required to define areas at risk and adapt treatment.

Functional Outcomes and Quality of Life in Patients with Sinonasal, Nasopharyngeal, and Anterior Skull Base Tumors.

This article will review functional and QOL outcomes among patients treated predominantly for sinonasal and nasopharyngeal malignancies. Treatment advances and interdisciplinary supportive care help to lessen the functional impairments and the reduction in quality of life (QOL) that were once accepted as inevitable tradeoffs for cure. Recent progress in QOL and Patient-Reported Outcome (PRO) instruments for this population will be covered. Sinonasal and nasopharyngeal tumors affect patients' quality of life, appearance, and critical functions. Tumors arise in proximity of vital structures including the orbit, cranial nerves, carotid artery, brain, cervical spine, and pituitary gland. Surgical morbidity, along with acute and late effects of systemic therapy and radiotherapy on normal tissues in this functionally critical region, may result in wide-ranging symptoms. Patients with skull base tumors report a high symptom burden at presentation, prior to treatment, relative to other malignancies in the head and neck region.

Towards a Molecular Classification of Sinonasal Carcinomas: Clinical Implications and Opportunities.

Simple SummaryIn recent years, there have been several molecular and immunohistochemical additions to the pathologic diagnosis of sinonasal malignancies that could facilitate the identification of clinically relevant groups of sinonasal malignancies. Molecular profiling is progressively integrated in the histopathologic classification of sinonasal carcinomas, and it is likely to influence the management of these tumors in the near future. In this article we review the recent literature on molecular analysis and/or subtyping of sinonasal carcinomas and we discuss the possible clinical implications of a classification of sinonasal tumors based on their molecular features.Sinonasal carcinomas are a heterogeneous group of rare tumors, often with high-grade and/or undifferentiated morphology and aggressive clinical course. In recent years, with increasing molecular testing, unique sinonasal tumor subsets have been identified based on specific genetic alterations, including protein expression, chromosomal translocations, specific gene mutations, or infection by oncogenic viruses. These include, among others, the identification of a subset of sinonasal carcinomas associated with HPV infection, the identification of a subset of squamous cell carcinomas with EGFR alterations, and of rare variants with chromosomal translocations (DEK::AFF2, ETV6::NTRK and others). The group of sinonasal adenocarcinomas remains very heterogeneous at the molecular level, but some recurrent and potentially targetable genetic alterations have been identified. Finally, poorly differentiated and undifferentiated sinonasal carcinomas have undergone a significant refinement of their subtyping, with the identification of several new novel molecular subgroups, such as NUT carcinoma, IDH mutated sinonasal undifferentiated carcinoma and SWI/SNF deficient sinonasal malignancies. Thus, molecular profiling is progressively integrated in the histopathologic classification of sinonasal carcinomas, and it is likely to influence the management of these tumors in the near future. In this review, we summarize the recent developments in the molecular characterization of sinonasal carcinomas and we discuss how these findings are likely to contribute to the classification of this group of rare tumors, with a focus on the potential new opportunities for treatment.

Impact of Routine Surveillance Imaging on Detecting Recurrence in Sinonasal Malignancies

<h3>Purpose/Objective(s)</h3> Surveillance imaging guidelines for sinonasal malignancies are varied and lack scientific data supporting the basis of these recommendations. This study wishes to examine the utility of surveillance imaging in detecting local, regional, and distant failures as well as second primary tumors in patients with sinonasal malignancies treated with surgical resection followed by adjuvant radiation. <h3>Materials/Methods</h3> Using an IRB-approved institutional database of head and neck cancer patients, we performed a retrospective review of 41 patients with sinonasal malignancies treated at a single institution between the years 2005 to 2021. Patient information regarding tumor location, staging, pathology, smoking status, alcohol use, chemotherapy, radiation treatment plan, and data surrounding surveillance imaging including type, frequency, and concern for recurrence were collected. Patients were divided into two groups comparing the frequency and type of imaging ordered: patients with <4 scans/year Group 1 and ≥ 4 scans/year Group 2. We compared the time to recurrence between the two groups using log-rank test and Cox proportional hazard ratio. A p-value of < 0.05 was considered the threshold for significance. <h3>Results</h3> Median follow up was 37.5 months (14.4-68.9 months). Overall 80% (n=32) patients had primary nasal cavity malignancies and 20% (n=8) had paranasal sinus disease. Thirteen (32.5%) patients had a squamous cell carcinoma (32.5%), twelve (30.0%) patients had an esthesioneuroblastoma, 5 (12.5%) patients had an adenocarcinoma and 3 (7.5%) patients had sinonasal undifferentiated carcinomas. The remaining few patients had sarcomatoid squamous cell carcinoma, adenoid cystic carcinoma, large cell neuroendocrine, and small cell neuroendocrine tumors – with a majority of patients having advanced disease (AJCC 7^th edition). In 27.5% (n=11) patients there was a recurrence: 4 had local failures, 4 had regional failures, and 3 had distant failures. The type of imaging (CT vs. PET/CT vs. MRI) ordered had a non-significant association with recurrence (p=0.802). There was no association with the frequency (HR: 1.13, 95% CI: 0.73-1.74) and total number of scans (HR: 1.24 [0.93-1.66]) with time to recurrence. Rate of recurrence-free survival at 2-years was 86% and 80% in patients with <4 scans/year and ≥ 4 scans/year, respectively. <h3>Conclusion</h3> In our study, the recurrence rates were limited for patients with sinonasal malignancies treated with definitive intent. Increasing the total number or frequency of scans in the first year after treatment was not associated with time to recurrence. These findings suggest a judicious approach in using post-treatment surveillance imaging.

Recurrence Patterns and Efficacy of Surveillance Modalities for Sinonasal Malignancies.

There is limited information regarding the recurrence patterns and efficacy of surveillance modalities in patients with sinonasal malignancies. A retrospective study was conducted between the years 2001-2018 at a tertiary care center. Included were all patients with sinonasal malignancies treated in our institution. Data regarding recurrence and survival were analyzed. Eighty-one patients were included. Multimodal treatment was administered to the majority of patients. 24 (35.3%) patients recurred with a median time of 17 months (range, 4-180). Although the majority of recurrences occurred within the first 5 years (83.3%), 4 (16.6%) recurred later on (5-15 years). Recurrences were local in 83.3%, regional in 20.8% and distant in 16.6%. All local recurrences occurred within the radiation treatment field and all patients with distant failure had mucosal melanoma. The majority of recurrences (70.6%) were diagnosed clinically or endoscopically, mainly in patients with SCC during the first 2 years of follow up. MRI or PET-CT were crucial in detecting extra-sinus and distant failures. Salvage surgery was feasible in the majority of patients (58.3%). Overall, 5 years survival (OS) rate was 60.9%. Frequent clinic visits with nasal endoscopy combined with frequent imaging studies should be routinely practiced as part of a long-term surveillance plan. Longer follow up duration should be considered in these patients.

Proceedings of the North American Society of Head and Neck Pathology, Los Angeles, CA, March 20, 2022: SWI/SNF-deficient Sinonasal Neoplasms: An Overview

The pathology of poorly differentiated sinonasal malignancies has been the subject of extensive studies during the last decade, which resulted into significant developments in the definitions and histo-/pathogenetic classification of several entities included in the historical spectrum of “sinonasal undifferentiated carcinomas (SNUC)” and poorly differentiated unclassified carcinomas. In particular, genetic defects leading to inactivation of different protein subunits in the SWI/SNF chromatin remodeling complex have continuously emerged as the major (frequently the only) genetic player driving different types of sinonasal carcinomas. The latter display distinctive demographic, phenotypic and genotypic characteristics. To date, four different SWI/SNF-driven sinonasal tumor types have been recognized: SMARCB1(INI1)-deficient carcinoma (showing frequently non-descript basaloid, and less frequently eosinophilic, oncocytoid or rhabdoid undifferentiated morphology), SMARCB1-deficient adenocarcinomas (showing variable gland formation or yolk sac-like morphology), SMARCA4-deficient carcinoma (lacking any differentiation markers and variably overlapping with large cell neuroendocrine carcinoma and SNUC), and lastly, SMARCA4-deficient sinonasal teratocarcinosarcoma. These different tumor types display highly variable immunophenotypes with SMARCB1-deficient carcinomas showing variable squamous immunophenotype, while their SMARCA4-related counterparts lack such features altogether. While sharing same genetic defect, convincing evidence is still lacking that SMARCA4-deficient carcinoma and SMARCA4-deficient teratocracinosarcoma might belong to the spectrum of same entity. Available molecular studies revealed no additional drivers in these entities, confirming the central role of SWI/SNF deficiency as the sole driver genetic event in these aggressive malignancies. Notably, all studied cases lacked oncogenic IDH2 mutations characteristic of genuine SNUC. Identification and precise classification of these entities and separating them from SNUC, NUT carcinoma and other poorly differentiated neoplasms of epithelial melanocytic, hematolymphoid or mesenchymal origin is mandatory for appropriate prognostication and tailored therapies. Moreover, drugs targeting the SWI/SNF vulnerabilities are emerging in clinical trials.

Exclusively endoscopic surgical resection of esthesioneuroblastoma: A systematic review.

BackgroundHistorically sinonasal malignancies were always addressed via open craniofacial surgery for an oncologic resection. Increasingly esthesioneuroblastomas are excised using an exclusively endoscopic approach, however, the rarity of this disease limits the availability of long‐term and large scale outcomes data.ObjectiveThe primary objective is to evaluate the treatment modalities used and the overall survival of patients with esthesioneuroblastoma managed with exclusively endoscopic surgery.MethodsIn accordance with PRISMA guidelines, PubMed was queried to identify studies describing outcomes associated with endoscopic management of esthesioneuroblastomas.ResultsForty‐four out of 2462 articles met inclusion criteria, totaling 399 patients with esthesioneuroblastoma treated with an exclusively endoscopic approach. Seventy‐two patients (18.0%) received adjuvant chemotherapy and 331 patients (83.0%) received postoperative radiation therapy. The average age was 50.6 years old (range 6–83). Of the 399 patients, 57 (16.6%) were Kadish stage A, 121 (35.2%) were Kadish stage B, 145 (42.2%) were Kadish stage C, and 21 (6.1%) were Kadish stage D. Pooled analysis demonstrated that 66.0% of patients had Hyams histologic Grade Ⅰ or Ⅱ, while 34.0% of patients had Grade Ⅲ or Ⅳ disease. Negative surgical margins were achieved in 86.9% of patients, and recurrence was identified in 10.3% of patients. Of those with 5‐year follow‐up, reported overall survival was 91.1%.ConclusionExclusively endoscopic surgery for esthesioneuroblastoma is performed for a wide range of disease stages and grades, and the majority of these patients are also treated with adjuvant chemotherapy or radiation therapy. Reported overall recurrence rate is 10.3% and 5‐year survival is 91.1%.

Amelanotic Malignant Mucosal Melanoma of the Nasal Cavity: Case Report and Literature Review

Sinonasal malignant melanoma is a rare but aggressive tumor of the head and neck area. It has a poor prognosis. Common symptoms are nasal obstruction, epistaxis, or purulent rhinorrhea. Diagnosis relies on histopathology with immunohistochemistry (IHC) studies. Surgery is the essential treatment, most often supplemented by radiotherapy or immunotherapy. A 63-year-old female patient, with a history of right dacryocystorhinostomy and Parkinson's disease, consulted for symptoms of right nasal obstruction with increasing intensity accompanied by two episodes of mild unilateral epistaxis. Rigid optic examination showed a white-pinkish right obstructive supra-centimetric endonasal tumor. CT revealed an extensive tissue process of the right nasal cavity invading the maxillary sinus, the inferior and middle conchas. A biopsy of the lesion was conducted under local anesthesia. The immunohistochemical study has shown undifferentiated tumor with positive antibody anti PS100 and anti-melan A evoking malignant sinonasal melanoma. The patient underwent two surgeries for maxillectomies as she presented a first local recurrence. She was started on adjuvant radiotherapy. At one year of follow-up, she does not present any local or general signs of disease. Sinonasal melanoma is a particular entity of head and neck mucosal melanomas. The highest incidence is described to be in the seventh and eighth decades of life with no sex difference. IHC profiling of different melanoma subtypes showed the importance of alterations in the KIT gene, this genetic data may constitute a therapeutic target. After surgery, the important local recurrence rates and regional failure justify adjuvant radiotherapy also for resections in free margins. Most authors consider that prophylactic neck dissection is not necessary. Preoperative imaging features (CT scan) are characteristic and helpful for diagnosis. IHC is essential, has a high sensitivity for differentiating achromic melanomas from other neoplasms. Sinonasal achromic melanoma is a very uncommon tumor, invasive, and frequently associated with distant metastasis. Paraclinic examinations are essential for staging and guiding therapeutic management. Immunotherapy is a promising ground of research as it comes to metastatic and advanced disease.

Small round cell tumours of the sinonasal tract: Five years experience at a tertiary cancer institute in India

Sinonasal malignancies (SNM) constitute nearly 3% of Head &amp; Neck cancers. Though rare, they still are one of the most challenging conditions to manage. Immunohistochemical (IHC) evaluation using relevant antibodies has become an indispensable ancillary technique for differentiating these tumours. An early and definitive diagnosis is important for optimally managing these aggressive tumours.This study was done in the department of Head &amp; Neck Surgery in association with department of Oncopathology of a tertiary Cancer Hospital in Northeast-India. Hospital records of all patients who received treatment for a sinonasal malignancy between the years 2013 to 2017 were retrospectively reviewed. Patients reported having a ‘Small round cell tumour’ in their initial histopathological examination (HPE) of biopsied tissue were included in the study. The study included 31 patients of Sinonasal SRCT, nearly 38% of the total 81 patients diagnosed with a sinonasal malignancy during the study period of 5 years. The median age of these patients was 43 +/- 8 years (range 8-82 years). With a gender ratio of 1.6: 1 (M: F), SRCTs was found slightly commoner in males. Epistaxis and nose block (unilateral or bilateral) were the commonest symptoms. Mean symptom duration was approximately 3 months. Establishing a precise diagnosis of Sinonasal SRCT is important not only in determining how aggressive the tumor might be, but is especially critical in deciding treatment modalities and their sequences. Immunohistochemistry plays an important role in proper histopathological diagnosis and further treatment planning.

Outcomes in surgical management of sinonasal malignancy-A single comprehensive cancer center experience.

Sinonasal malignancies are a complex and diverse group of tumors. Over the past five decades, treatment advances have changed the management paradigms for these tumors. Our aim was to analyze the outcomes of patients from a comprehensive cancer center. We retrospectively assessed 400 patients with sinonasal malignancies treated with surgery at our center between 1973 and 2015. Multiple variables were reviewed to assess the influence on 5-year outcomes. The median age was 56 years (IQR 46.8-68). Two hundred and fifty-nine (65%) were males and 141 (35%) were females. Overall survival (OS) and disease-specific survival (DSS) improved in the last analyzed decade. Orbital invasion, advanced pT-classification and pN-classification, and melanoma histology were associated with poorer outcomes. Treatment outcomes for patients with sinonasal malignancy have improved over time. This is likely multifactorial with advances in surgical technique, adjuvant treatment, and patient selection. pT-classification, pN-classification, orbital invasion, and histology are predictive of survival.

Role of Human Papilloma Virus in the Aetiology of Sinonasal Cancers.

Sino nasal carcinogenesis is attributed to numerous factors, namely tobacco, alcohol and snuff as the most common. Human Papilloma virus (HPV) has been associated with aetiopathogenesis of malignancies in the upper aerodigestive tract (UADT). The prevalence of HPV in Sino-nasal malignancy (SNM) which is closely related to UADT in location is not known. Hence, this study aims to explore if there is any such association between HPV and Sino nasal malignancies. This study aims to explore the association between HPV and SNM. A prospective case control study using tumour tissue specimens from 40 Sinonasal carcinoma patients and benign nasal tissue specimens from 50 cancer-free controls were conducted. Histopathological analysis and DNA extraction (DNeasy® Tissue kit) and polymerase chain reaction for detection of HPV was done. Positive samples underwent sequencing to detect the HPV serotype and statistical correlation was performed using SPSS software. All 90 patients were tested for HPV and we found that none of the patients had any association with HPV. Sino-Nasal malignancy in the Indian Sub-continent may not be related to HPV primarily.

Acellular cadaveric dermal matrix grafts for orbital wall reconstruction in patients with sinonasal malignancies

ABSTRACT Purpose To describe the utilization of acellular cadaveric dermal matrix (ACDM) in patients undergoing orbital wall reconstruction after orbital preservation surgery for sinonasal malignancy. Methods Retrospective case series of seven patients with sinonasal malignancy who had orbital reconstruction with ACDM implants from January 2012 to August 2020. Orbital preservation was performed in all patients with tumor extension up to and including periorbital. The main outcome measures were implant exposure, orbital infection, diplopia in primary gaze, enophthalmos, and eyelid malposition. Results Patients ranged 37–78 years old (median: 66 years) and included 4 females and 3 males. The median follow-up time was 9 months (range 6–43 months) from the date of surgery. Squamous cell carcinoma comprised the majority of tumors with all patients needing medial wall reconstruction. Three patients received postoperative radiation therapy. No patients had any implant exposure, orbital infection, enophthalmos, or eyelid malposition. Conclusions ACDM grafts can be used safely in orbital wall reconstruction in patients with sinonasal malignancies.

In-office drainage of a frontoethmoidal mucocele with non-axial proptosis: an alternative to operating-room drainage

Mucocele of the paranasal sinus is a cystic lesion with accumulation of mucus within the sinus walls, which is capable of expansion. The frontal sinus is most commonly involved, whereas ethmoidal, sphenoid, and maxillary mucoceles are rare. The floor of the frontal sinus is shared with the superior orbital wall, which explains orbital displacement in enlarging frontal mucoceles. This article presents a case of a spontaneous right frontoethmoidal mucocele with non-axial proptosis in a 26-year-old male patient who was referred by an ophthalmologist to our ENT (ear, nose, throat) clinic for a biopsy to rule out a sinonasal malignancy. An intranasal endoscopic approach was done to obtain a tissue biopsy in a clinic setting, which turned out to be a both diagnostic and therapeutic procedure with complete resolution of symptoms.

Comparison of clinicopathological and preoperative computed tomography findings of sinonasal masses

Background and objectives: Computerized tomography (CT) scan with contrast can delineate soft tissue pathologies and is now the first choice in diagnosing sinonasal malignancy and inflammatory lesions. The present study compared the diagnostic nasal endoscopy (DNE) and CT scan to diagnose cases presented with sinonasal mass. Materials and methods: This was a descriptive study conducted on patients with sinonasal masses attending at Government TD Medical College, Alappuzha, Kerala from 1/1/2014 to 30/6/2015. Each patient was examined by diagnostic nasal endoscopy and had undergone preoperative CT scan. Histopathological examination of the specimens was carried out and compared with the findings of DNE and CT scan. Results: A total of 72 cases were enrolled in the study. Age group was from 13-85 years with a male to female ratio of 1.3:1. Nasal obstruction was the commonest symptom. Among the 72 cases, 59 belonged to the non-neoplastic group and 13 to the neoplastic group. Sinonasal polyps (65.3%) formed the majority of the non-neoplastic lesions. Vascular lesions (6.9%) were the commonest benign neoplastic mass and malignancy was seen in 6.9% of cases. Diagnosis by DNE and CT scan was same except in 3 cases. Histopathology and radiological scan result correlated well except in 3 cases. Conclusion: Histopathology still remains the gold standard in the diagnosis of sinonasal masses. Clinical, CT scan and histopathology diagnoses were complementary with each other. However, CT scan is indispensible in studying the anatomical variants and providing the route map prior to and during endoscopic sinus surgeries. IMC J Med Sci 2022; 16(1): 008 *Correspondence: Santhi Thankappan Pillai, Department of Otorhinolaryngology, Government TD Medical College, Vandanam, Alappuzha, Kerala 688005, India. Email: sttpillai@gmail.com