Sinonasal Malignancies Research Articles

Surgical Management Patterns of Sinonasal Malignancy: A Population-Based Study.

Objectives Determining surgical trends and outcomes for sinonasal tumors is challenging given their low incidence and heterogeneous pathology. This study utilized the National Cancer Database (NCDB) to identify trends and outcomes associated with surgical management of sinonasal tumors. Design Retrospective database analysis. Setting National Cancer Database. Participants Patients with sinonasal malignancies identified from the NCDB between 2010 and 2015. Main Outcome Measures The primary outcome was the choice of surgical therapy used for sinonasal tumor resection: endoscopic versus open approach. Each was cohort analyzed with respect to various demographic and clinicopathologic factors. A treatment effect model was used to identify potential differences between surgical approaches. Survival was evaluated using Kaplan-Meier analysis. Results A total of 10,193 patients with sinonasal malignancies were identified in the NCDB database; of these, 2,292 had a documented subsite, histology, and definitive surgical treatment with documented surgical approach and were included in the analysis. About 71.9% of patients had an open approach and 28.1% a purely endoscopic procedures. Tumor histology, treatment facility type, margin status, and length of stay were all variables that were associated with significant differences between the open and endoscopic cohort. Five-year survival rates for the open and endoscopic cohorts were not significantly different (59.6 and 60.8%, respectively). Conclusions Assessment of the NCDB revealed that 28% patients with sinonasal malignancy were selected for endoscopic surgery. These patients had comparable oncologic outcomes to open resection.

Prognostic Value of Upfront Non-Surgical Management and/or Surgical Margin Status for Advanced Sinonasal Malignancies

Prognostic Value of Upfront Non-Surgical Management and/or Surgical Margin Status for Advanced Sinonasal Malignancies

Analyzing the Impact of Primary Tumor PET Metrics and Clinical Features on Outcomes in Locally Advanced Sinonasal Malignancy

Analyzing the Impact of Primary Tumor PET Metrics and Clinical Features on Outcomes in Locally Advanced Sinonasal Malignancy

Environmental and Life-Style Related Risk Factors for Sinonasal and Nasopharyngeal Malignancies among a Prospective Cohort in Jos, Nigeria.

Background Worldwide evidence indicates that environmental and life-style related factors are associated with increased risk for cancers in the head and neck region. We aim to study the association between these risk factors and cancers in the sinonasal and nasopharyngeal regions in our environment. Methods Longitudinal prospective cohort study at the Jos University Teaching Hospital, Jos, Nigeria. Risk exposures were classified based on the International Agency for the Research on Cancer (IARC) classification of suspected carcinogens. Associations between variables were analyzed using logistic regression. Results We studied 44 patients with malignancies in nasopharynx (n= 24; 54.5%) and sinonasal regions (n= 20; 45.5%). Male to female ratio is 1.9:1 and mean age is 45.2 years. Alcohol was the commonest risk factor in males (n= 19; 43.2%) while cooking wood fumes were the commonest in females (n= 14; 31.8%) which was associated with increased risk for malignancies for all sites, showing ten times risk in nasal cancers (OR= 9.67; 95% CI 1.87- 9.88; p= 0.01). Tobacco was associated with elevated risk of malignancies in the nasomaxillary and nasal regions. Other risks were herbicides, pesticides, and chemical fertilizers in farmers. Conclusion The significant risk exposures in females were cooking wood fumes and alcohol, tobacco, and exposure to agricultural chemicals in males. Life-style modification and environmental changes to ensure clean air in Nigeria are essential to reduce risks.

Impact of neoadjuvant radiation on margins for non–squamous cell carcinoma sinonasal malignancies

Treatment of non-squamous cell carcinoma sinonasal malignancies (NSCCSMs) typically involves surgery and radiotherapy (RT), but optimal sequencing remains controversial. Retrospective chart review. Patients with NSCCSM treated with combined surgery and RT between 2000 and 2011 were identified. Margin control, overall survival, disease-free survival, local recurrence-free survival, and regional recurrence-free survival were compared between neoadjuvant and adjuvant RT groups. Eight-four patients were included (23 neoadjuvant and 61 adjuvant RT). A higher proportion of patients receiving neoadjuvant RT achieved negative/close resection margins compared to those receiving adjuvant RT (83% vs. 41%, P = .003). Multivariable analysis also showed that neoadjuvant RT was associated with an 81% decreased odds of positive margins odds ratio: 0.19, 95% confidence interval: 0.05-0.77, P = .02). Neoadjuvant RT may be associated with improved margin status among patients with NSCCSM treated with surgery and RT. Future prospective studies with larger, more homogeneous populations are needed to clarify optimal treatment strategies. 4 Laryngoscope, 128:2796-2803, 2018.

Benign and malignant odontogenic neoplasms of the jaws show a concordant nondiscriminatory p63/p40 positive immunophenotype

Antibody p40, which recognizes exclusively ΔNp63 but not TAp63, has shown diagnostic utility in salivary gland and sinonasal tract malignancies. Although p63 immunophenotypic characterization of odontogenic lesions has been reported, p40 expression has not been previously studied. We aimed to study p40 immunoreactivity in odontogenic tumors (OTs) and odontogenic cysts (OCs) and to investigate possible discriminatory properties of the combined p63/p40 immunoprofile in OTs and OCs. Fourteen ameloblastomas, 7 adenomatoid odontogenic tumors, 6 calcifying epithelial odontogenic tumors, 1 squamous odontogenic tumor, 4 primary intraosseous odontogenic carcinomas, 5 calcifying odontogenic cysts, 4 glandular odontogenic cysts, 3 odontogenic keratocysts, 3 dentigerous cysts, and 1 each radicular and orthokeratinized cysts were stained for p63 (4A4) and p40 (BC28) antibodies. Ameloblastoma, adenomatoid odontogenic tumor, calcifying epithelial odontogenic tumor, squamous odontogenic tumor, and primary intraosseous odontogenic carcinoma demonstrated concordant p63+/p40+ immunophenotype. P40, similar to p63, highlighted almost all lesional cells of OTs and, overall, the full thickness of the epithelial lining of the cystic areas of OCs and ameloblastoma. The keratin layer of OKC and the adluminal ductal and mucous cells of GOC were p63-/p40-. Both ΔNp63 and TAp63 isoforms are present in neoplastic and developmental odontogenic lesions; and p63/p40 immunophenotype is nondiscriminatory pertaining to benign and malignant OTs and OCs.

Prognostic Factors in Paranasal Sinus Squamous Cell Carcinoma and Adenocarcinoma: A SEER Database Analysis.

Background Outcome studies on sinonasal malignancy are limited to retrospective case series, often with inclusion of diverse histology and short follow-up. The objective of this study was to identify key predictive variables that independently impact survival for paranasal sinus squamous cell carcinoma (SCC) and adenocarcinoma (AC) and to compare these variables in the context of these two distinct clinicopathologic entities. Methods: Analysis was conducted using the Surveillance, Epidemiology, and End Results database from 1973 to 2012 to identify key variables that impact survival for SCC and AC. Results A total of 3,714 cases were included. There were 2,895 SCC cases and 819 AC cases. The mean age at diagnosis was 64.1 years. The male to female ratio for SCC and AC was 1.85 and 1.04, respectively. Patients with SCC and AC were most often diagnosed with stage IV disease in 61.8 and 63.4% of cases, respectively. The majority of patients received combined surgery and radiation (52% for SCC and 43.1% for AC). For SCC, increased age ( p < 0.001) and stage ( p < 0.001) were negative predictors, and surgery improved survival ( p < 0.001) on multivariate analysis. For AC, prognostic factors associated with worse survival include increased age ( p < 0.001) and grade ( p < 0.001) on multivariate analysis. Overall survival was significantly higher in AC compared with SCC at 5 years ( p = 0.001). Conclusion SCC and AC of the paranasal sinuses are both aggressive malignancies with poor survival. For both histological subtypes, increased age predicts worse survival and grade also closely links to survival in AC. These data have important potential implications for treatment planning and pretreatment counseling.

SMARCB1 (INI1)–deficient sinonasal carcinoma: a series of 13 cases with assessment of histologic patterns

A significant proportion of sinonasal malignancies comprise poorly differentiated/undifferentiated carcinomas that defy accurate histologic classification and behave aggressively. Recent years have seen a refinement of this spectrum by inclusion of novel entities harboring specific genetic alterations, including SMARCB1 (INI1)-deficient sinonasal carcinoma (SDSC), characterized by inactivating alterations in SMARCB1 gene, as demonstrated by loss of INI1 immunoexpression. Cyclin D1 is a cell-cycle regulatory protein downstream of INI1. Loss of INI1 leads to derepression of cyclin D1 transcription, suggesting its role as a putative therapeutic target. However, cyclin D1 expression has not been assessed in SDSCs. We retrieved all sinonasal carcinomas, including sinonasal undifferentiated carcinoma, undifferentiated carcinoma, poorly differentiated squamous cell carcinoma, and adenocarcinoma. Histopathologic features were reviewed. INI1 immunohistochemistry was performed. Cyclin D1 was performed in cases showing INI1 loss. Loss of INI1 staining was seen in 13 cases (5.8%), including 11 males and 2 females (age range, 11-65 years). Original diagnoses included SDSC (3/13), sinonasal undifferentiated carcinoma (3/13), adenocarcinoma (3/13), poorly differentiated squamous cell carcinoma (2/13), and poorly differentiated carcinoma (2/13). Tumors were predominantly basaloid in 6 cases and plasmacytoid/rhabdoid in 5 cases. We identified 2 cases having oncocytoid cells arranged in a gland-like pattern. Significant cyclin D1 immunoexpression was absent. SDSC is a rare, emerging entity that resembles a poorly differentiated carcinoma. Histomorphologic spectrum of these tumors is evolving. In addition to basaloid and plasmacytoid/rhabdoid cells, oncocytoid/adenocarcinoma-like pattern can also be seen in SDSC and predicts INI1 loss. These histologic patterns can further be subjected to INI1 immunohistochemistry for correct diagnosis.

Survival in sinonasal and middle ear malignancies: a population-based study using the SEER 1973\u20132015 database

BackgroundThe sinuses, nasal cavity, and middle ear represent a rarer location of head and neck malignancy than more common sites such as the larynx and oral cavity. Population-based studies are a useful tool to study the demographic and treatment factors affecting survival in these malignancies.MethodsPopulation-based database search of the Survival, Epidemiology, and End Results (SEER) database from 1973 to 2015 for malignancies involving the nasal cavity, paranasal sinuses, and middle ear. Data were analyzed for demographics, treatment type, stage, primary site and histopathologic type. Kaplan-Meier analysis was used to assess and compare survival.ResultsA total of 13,992 cases of sinonasal or middle ear malignancy were identified and analyzed. The majority of patients were between ages 50 and 80 at the time of diagnosis. Overall 5-, 10-, and 20-year survival was 45.7%, 32.2%, and 16.4%, respectively. Lymph node metastasis was reported in 4.4% of patients, while distant metastasis was present in 1.5% of cases. On univariate analysis surgical vs. nonsurgical treatment, sex, race, age at diagnosis, T stage, N stage, M stage, AJCC overall stage, primary site, tumor grade, and histopathologic subtype significantly affected survival. On multivariate analysis age, race, sex, primary site, overall AJCC stage, surgical vs. nonsurgical treatment, and T, N, and M stage remained significant predictors of overall survival.ConclusionsMalignancies of the nasal cavity, paranasal sinuses, and middle ear account for a minority of overall head and neck cancers. The overall 5-, 10-, and 20-year survival for these malignancies is relatively low. Higher T, N, M, and overall stage and higher tumor grade is associated with lower survival. Patients treated with surgery as part of the treatment regimen had higher overall survival. Demographics and primary site also significantly affect survival. Certain histopathologic subtypes were associated with poorer survival.

Planned Gamma Knife Boost After Chemoradiotherapy for Selected Sinonasal and Nasopharyngeal Cancers

To determine the feasibility of a Gamma Knife boost after intensity-modulated radiation therapy in combination with multimodal therapy in patients with nasopharyngeal carcinoma and sinonasal malignancies with skull base or cavernous sinus involvement. Nine patients were treated with intensity-modulated radiation therapy followed by a Gamma Knife boost. In one case Gamma Knife was given as salvage treatment after resection. Five patients had sinonasal malignancies and 4 had nasopharyngeal carcinoma. The mean radiation therapy dose was 64.3 Gy (range, 54-70 Gy) at 2 Gy per fraction. The median interval from completion of radiation therapy to Gamma Knife boost was 2.2 months (range, 1-4 months). The most common indication for Gamma Knife boost was involvement of the cavernous sinus, which was identified in 7 patients. The median margin Gamma Knife dose delivered was 13 Gy (range, 12-20 Gy), with median prescription isodose of 50%. All patients tolerated the procedure well, with minimal toxicity. Local control rates were achieved in all patients and no acute grade 3-5 toxicity was observed. One patient experienced late grade 4 toxicity, which was potentially attributable to treatment. Distant failure occurred in 3 patients (1 patient with nasopharyngeal carcinoma and 2 patients with sinonasal malignancies). Planned Gamma Knife boost followed intensity-modulated radiation therapy is feasible, safe, and provides excellent local control in patients with sinonasal malignancies and nasopharyngeal carcinoma, particularly in cases with cavernous sinus involvement. Further follow-up will be necessary to determine the long-term effectiveness and complication profile.

Biphenotypic Sinonasal Sarcoma-Case Report and Review of Clinicopathological Features and Diagnostic Modalities.

Background Biphenotypic sinonasal sarcoma is a recently described malignancy showing dual differentiation with both myogenic and neural elements. Due to its histologic similarities to other sinonasal malignancies, it is a diagnostic challenge. Objective The main purpose of this article is to report a case of biphenotypic sinonasal sarcoma and to consolidate data and provide a comprehensive review regarding pathological differences between biphenotypic sarcoma and other sinonasal malignancies and diagnostic modalities used for biphenotypic sarcoma. Material and Methods A systematic review of all cases of biphenotypic sinonasal sarcoma was performed using electronic databases (PubMed and Medline). Data collected included age, gender, symptoms, sub-site of origin, immunophenotyping, metastasis, recurrence, treatment, duration of follow-up, and survival outcomes. Results Ninety-five cases of biphenotypic sarcoma were found with mean age at diagnosis of 52.36 years (range, 24-87 years). Female to male ratio was 2.27:1. Extra-sinonasal extension was present in 28%. Immunophenotyping revealed that S-100 and SMA (smooth muscle actin) were consistently positive, while SOX-10 was consistently negative. PAX3-MAML3 fusion [t (2; 4) (q35; q31.1)] was the most common genetic rearrangement. Surgical excision with or without adjuvant radiotherapy was the most frequent treatment modality used. Recurrence was observed in 32% of cases with follow-up. None of the cases reported metastasis. Three patients had died at the time of publication that included one case with intracranial extension. Conclusion Biphenotypic sarcoma is distinct sinonasal malignancy with unique clinicopathological features. Testing involving a battery of myogenic and neural immunomarkers is essential for diagnostic confirmation and is a clinically useful endeavor when clinical suspicion is high.

Abstract 3420: Discovery of genetic alterations governing sinonasal squamous cell carcinoma tumorigenesis

Abstract Tumors of the sinonasal tract are uncommon, and comprise 5% of all cancers of the head and neck (H&amp;N). Approximately 50-80% of sinonasal malignancies are sinonasal squamous cell carcinoma (SNSCC). Unlike H&amp;N cancers, tobacco smoking does not seem to play a key role in the development of sinonasal tumors and the exact etiology and molecular mutations governing SNSCC tumorigenesis are not well understood. Inverted sinonasal papilloma (ISP) is a locally aggressive, benign epithelial neoplasm arising in the paranasal sinuses which has a high recurrence rate and transforms to SNSCC in 10% to 25% of cases, and therefore represent an intermediate step in SNSCC progression. Due to its uncommon nature, there is still a significant knowledge gap in our understanding of SNSCC pathogenesis and genetic mutations associated with SNSCC progression have not yet been characterized. To this end, we performed whole exome sequencing (WES) and RNA-Seq on 4 ISPs and matched SCCs samples collected from the same patients. For each patient, DNA extracted from matched lymphocytes was used as a DNA sequencing control, whereas matched uninvolved mucosa was used as a tissue specific control for RNA-Seq. 285 and 602 non-synonymous aberrations were identified across the preneoplastic lesions and tumors respectively. Interestingly, genes associated with adverse survival in HNSCC patients (such as EGFR, FAT1 and IGF1R) were mutated in more than 1 dysplastic lesion. PIK3CA was among the most mutated genes in invasive neoplasms. Notably, in three patients we identified mutations that were present in both preneoplastic and invasive neoplasms, which included cancer driver genes actionable in HNSCC and other solid malignancies (such as PIK3CA, TP53, FAT1 and EGFR). RNA-Seq analysis of the same samples revealed a subset of genes whose expression level sequentially increased or decreased from normal tissue, to early lesions to SNSCC. Interestingly, expression of genes associated with survival, migration, invasiveness and inhibition of apoptosis (such as SET, RAD21, NPM1, PTPN11, CLIP1, KIF5B, EGFR, NRAS, KRAS, MET, MYCL and CCND1) consecutively increased along the tumor progression in all three analyzed, whereas expression of tumor suppressors (such as PTCH1, IKZF1, GAS7, FOXP1, NTRK3 and LRP1B) was downregulated. Although our data suggest that preneoplastic ISP lesions may be clonally related to SCC in some cases, validation of these observations in a larger specimens' cohort is warranted to further delineate the mechanisms underlying the SNSCC tumorigenesis. Citation Format: Adrian D. Schubert, Nyall R. London, Justin A. Bishop, Esther C. Broner, David Sidransky, Evgeny Izumchenko. Discovery of genetic alterations governing sinonasal squamous cell carcinoma tumorigenesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3420.

A case of angiosarcoma of the nasal cavity

&lt;p class="abstract"&gt;Angiosarcoma of the nasal cavity is extremely uncommon accounting for less than 0.1% of all sinonasal malignancies. Here we report a case of angiosarcoma of nasal cavity. A 45 year old male patient with c/o right sided nasal bleeding since 20days, on examination showed mass in nasal cavity. Patient underwent septoplasty with right inferior turbinectomy with submucosal diathermy. The histological examination showed features of angiosarcoma epitheloid variation of nasal cavity, diagnosis was confirmed by immunohistological stain with factor CD 31 and cytokeratin.&lt;/p&gt;

Orbital exenteration for sinonasal malignancies: indications, rehabilitation and oncologic outcomes.

Review the recent literature regarding the management of orbital invasion in sinonasal malignant tumors. There is a recent trend in preserving the orbit in cases of minimal invasion of periosteum and limited periorbit involvement, as well as in presence of good response to neoadjuvant chemotherapy, mainly in squamous cell carcinoma and neuroendocrine histologies. The decision about orbital exenteration in cases of sinonasal malignancies is facilitated if the patient already has clear clinical signs of intraconal invasion such as visual loss, restriction of ocular mobility or infiltration of the eyeglobe. However, in borderline situations, confirmation of orbital involvement should be performed intraoperatively. In selected cases with minimal orbital invasion without functional compromise, orbit sparing surgery can be done with acceptable oncological outcomes.

Is there a link between nasal polyposis and increased risk for sinonasal malignancy?

Is there a link between nasal polyposis and increased risk for sinonasal malignancy?

Incidence and Distribution of Nodal Metastases in Sinonasal Malignancy

Cervical lymph node drainage pathways of sinonasal malignancies (SNM) have not yet been well-established in the literature. We present the largest population-based cohort of SNM to investigate the frequency and pattern of cervical node involvement. The Surveillance, Epidemiology, and End Results registry was queried from 2004 to 2014, identifying patients with sinonasal squamous cell carcinoma (SCC), adenocarcinoma, adenoid cystic carcinoma (ACC), sinonasal undifferentiated carcinoma (SNUC), mucosal melanoma, and esthesioneuroblastoma. Cases were assessed by frequency of cervical lymph node level, distant metastasis, and primary subsite. A total of 4,171 SNM cases were identified, 527 of which presented with cervical nodal disease (12.6%). Level II and level I diseases were most commonly identified (36.1 and 29.5%). This finding was consistent despite histology and primary subsite involved. Regional disease was most commonly seen in SNUC (22.4%) and SCC (15.2%), and least commonly in ACC (4.1%). Malignancies of the maxillary sinus demonstrated the highest rate of nodal disease (19.6%), followed by the sphenoid sinus (15.9%). No cases of nodal disease were identified amongst frontal sinus malignancies. The parotid and level I/level II nodes were least involved in cases with distant metastasis (6% and 10%). Conversely, suboccipital/retroauricular and level VII (mediastinal) nodes most frequently presented with distant metastasis (67% and 33%). Although cervical node involvement in SNM is infrequent compared to other head and neck sites, levels II and I were overwhelmingly involved when present. Knowledge of these sinonasal drainage patterns will ultimately help guide the treatment of the neck in select cases.

Extended endoscopic endonasal approach to the ventral skull base lesions

ObjectiveWith the use of multiple endoscopic endonasal surgical corridors, extended endoscopic endonasal approaches (EEEAs) are now being used to treat a wide range of ventral skull base lesions. Our aim was to present our experience with EEEAs to the ventral skull base lesions. Patients and MethodsThe study group consisted of 106 patients (57 men and 49 women) who underwent surgery for skull base lesions using EEEAs from 2010 to 2017. The EEEA was most commonly used for giant pituitary macroadenomas, sinonasal malignancies, cerebrospinal fluid (CSF) leaks, meningiomas, craniopharyngiomas, and fibro-osseous lesions. Four different approaches were used including transtuberculum-transplanum, transethmoidal-transcribriform, transclival, and transmaxillary-transpterygoidal. ResultsThe overall gross total resection (GTR) rate for these diverse pathologies was 75.0% in 88 patients (excluding the operations performed for non-neoplastic pathologies). GTR was achieved in 100%, 77.8%, 75%, 75%, 72.2%, 62.5%, 60% of fibro-osseous lesions, giant/large pitutary adenomas, meningiomas, esthesioneuroblastomas, sinonasal malignancies, craniopharyngiomas, and chordomas, respectively. The overall rate of improvement in visual fields was 86%. The overall rate of CSF leak was 8.4%. Other surgical complications included intracerebral hematoma and tension pneumocephalus. The mortality rate was 0.9%. ConclusionEEEA is a safe, well-tolerated and effective surgical treatment modality in the management of ventral skull base lesions. It should be performed with close interdisciplinary collaboration. Appropriate case selection is mandatory. However, despite improved reconstruction techniques, postoperative CSF leakage still remains a challenge.

Limitations of the endoscopic endonasal transcribriform approach

The endoscopic endonasal transcribriform approach (EETA) has become a useful strategy in the treatment of various anterior skull base pathologies, including meningoencephaloceles, olfactory groove meningiomas, schwannomas, esthesioneuroblastomas, and other sinonasal malignancies. However, not all pathologies are optimally treated through this approach due to tumor size, extent of the lesion, vascular involvement, and the presence of intact olfaction. One must be prepared to use a transcranial approach if the EETA is not favorable. In some patients, a combined approach (transcranial-EETA) may be needed in appropriate cases. Therefore, patient selection is paramount for achieving a successful result with avoidance of complications. For certain tumors, the limitations of the EETA may result in lower rates of gross-total resection, higher rates of cerebrospinal fluid leakage, postoperative impairment of olfaction, and higher complication rates. In this paper, we discuss the limitations of the EETA when considering approach selection to treat anterior skull base lesions.

Can Diffusion Weighted Imaging Aid in Differentiating Benign from Malignant Sinonasal Masses?: A Useful Adjunct

SummaryBackgroundTo evaluate the role of diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) values at 3 Tesla in characterizing sinonasal masses.Material/MethodsAfter ethical clearance, 79 treatment naive patients with head and neck masses underwent magnetic resonance imaging (MRI), including DWI at 3 Tesla using the following b values – 0, 500 and 1000 s/mm2. Thirty-one patients were found to have sinonasal tumours and were subsequently analysed. Image analysis consisted of a morphological evaluation of conventional MR images, qualitative evaluation of DW trace images and quantitative assessment of mean ADC values. Receiver operating characteristic (ROC) curve was drawn to determine a cut-off ADC value for the differentiation between benign and malignant masses.ResultsSinonasal masses showed an overlapping growth pattern on conventional imaging, irrespective of their biological nature. The mean ADC value of benign lesions was 1.948±0.459×10−3 mm2/s, while that of malignant lesions was 1.046±0.711×10−3 mm2/s, and the difference was statistically significant (p=0.004). When a cut-off ADC value of 1.791×10−3 mm2/s was used, sensitivity of 80% and specificity of 83.3% were obtained for characterization of malignant lesions, which was statistically significant. Juvenile nasopharyngeal angiofibroma (JNA) showed distinctly high ADC values, while meningioma was the only benign lesion with restricted diffusion. Atypical entities with unexpected diffusion characteristics included: adenocarcinoma, adenoid cystic carcinoma, meningioma, chondrosarcoma and fibromyxoid sarcoma.ConclusionsDWI in conjunction with conventional imaging can potentially enhance the diagnostic accuracy in characterizing sinonasal masses as benign or malignant. Some specific entities such as JNA and meningioma showed distinctive diffusion characteristics.

Mental Health Disorders Associated with Sinonasal and Skull Base Malignancies: A Large Cohort Study

Mental Health Disorders Associated with Sinonasal and Skull Base Malignancies: A Large Cohort Study