Sinonasal Tumors Research Articles

La linfogammagrafía in vivo de los tumores del seno nasal identifica el ganglio retrofaríngeo y el nivel I como ganglios centinela predominantes

ObjectiveTo evaluate by in vivo lymphoscintigraphy and SPECT-CT imaging, the lymphatic drainage patterns of para-nasal sinus (PNS) tumours. To confirm or refute the belief of the retropharyngeal lymph node (RPLN) being the significant draining lymph node for such tumours. MethodsProspective cohort study conducted on previously untreated PNS tumours with no clinico-radiological evidence of lymph node metastasis. Lymphoscintigraphy undertaken by nasal endoscopic assisted peritumoral injection of 99mTc sulphur colloid. Injections were classified as anterior or posterior as per a vertical line along the maxillary sinus ostium. ResultsSeventeen patients were included. Lymphoscintigraphy successfully identified 17 sentinel nodes in 15 patients and was unsuccessful (lymphoscintigraphy failure) in 2 patients. Predominant sites of sentinel lymphatic drainage were noted to be the RPLN (n=8; 47%) and level I (n=7; 42%). Occasional drainage was identified at the peri-parotid node (n=1) and at level II (n=1). Contralateral drainage was noted in 2 patients (level I-1 and RPLN-1).Anterior injections drained predominantly to level I (6/8) and RPLN (2/8), while posterior injections drained predominantly to the RPLN (6/7). The relative risk of RPLN being identified as the sentinel node was significantly higher for posteriorly placed injections than for anteriorly placed injections (RR: 3.43; 95% CI: 1.0-11.8; P=.05). ConclusionThe RPLN is noted as a frequent draining node for sino-nasal tumours and merits routine attention in all sino-nasal tumours. The radio-colloid SPECT-CT technique described here offers an excellent in vivo technique to further explore and validate the lymphatic drainage pathways of these tumours.

A Clinical Study of Malignant Sino-Nasal Tumors.

The sino-nasal cavities represent an anatomical region affected by a variety of tumors with clinical, etiological, genetic and pathological features, which are distinct from tumors commonly encountered in the area of head and neck cancers. We have undertaken this study with the aim of assessing clinical profile, various treatment modalities and outcome of patients with malignant sino-nasal tumors. In this prospective study of two years, done in a rural tertiary care hospital of India, 40 patients with malignant neoplastic tumors of nasal cavity, sinuses and nasopharynx were analyzed for their clinic-pathological and radiological profile and surgical management. The age range found was 10-78years. There was a significant male preponderance with 23 (57.5%) male patients. Most common histological type seen in our study was Squamous cell carcinoma amongst 32 (80%) of cases. Maximum number of patients were managed with combination therapy of Surgery and Radiotherapy i.e. in 21 patients (52.5%). Multimodality treatment has been deemed the most efficacious choice of treatment which would improve disease free survival for the patients.

Malignant and Nonmalignant Sinonasal Tumors.

Sinonasal tumors are rare, diverse, complex lesions with overlapping demographic and clinical features. Malignant tumors are more common, with a grave prognosis, and require biopsy for accurate diagnosis. This article briefly reviews the classification of sinonasal tumors and provides imaging examples and imaging characteristics of each clinically important nasal and paranasal mass lesions. Although there are no true pathognomonic imaging features, it is important for the radiologist to have a broad knowledge of the various CT and MR imaging findings that can help narrow the differential diagnosis and aid in early diagnosis and mapping of tumor for treatment planning.

Adamantinoma-like Ewing Sarcoma (ALES) May Harbor FUS Rearrangements : A Potential Diagnostic Pitfall.

Adamantinoma-like Ewing sarcoma (ALES) is a rare malignancy currently considered a variant of Ewing sarcoma with most known cases harboring EWSR1 rearrangements. Herein we present a series of 6 cases of EWSR1 -negative ALES. The tumors arose in the sinonasal tract (n=3), major salivary glands (submandibular gland=1; parotid=1), and anterior mediastinum (n=1) in patients ranging from 25 to 79 years of age. Most tumors were basaloid in appearance, growing in large nests separated by interlobular fibrosis without overt squamous pearls. However, 1 case closely resembled a well-differentiated neuroendocrine tumor with uniformly round nuclei, eosinophilic cytoplasm, and trabecular architecture. All cases were diffusely positive for pan-cytokeratin, p40 or p63, and CD99. A subset of cases showed diffuse reactivity for synaptophysin, including 1 sinonasal tumor which also demonstrated sustentacular S100 protein expression. Molecular testing showed FUS rearrangements in all cases. Gene partners included known ETS family members FEV (n=2) and FLI1 (n=1). Our results expand the molecular diagnostic considerations for ALES to include FUS rearrangements. We also show that ALES may harbor FUS :: FLI1 fusion, which has not been previously reported in the Ewing family of tumors. Furthermore, ALES may show unusual histologic and immunophenotypic features that can overlap with olfactory carcinoma including S100-positive sustentacular cells. ALES should be considered in the diagnostic differential of small round cell tumors and tumors with neuroendocrine differentiation with immunohistochemical workup to include p40 and CD99/NKX2.2.

Histopathologic Diagnosis of Sinonasal Tumors: Challenges and the Importance of Establishing the Correct Diagnosis

Histopathologic Diagnosis of Sinonasal Tumors: Challenges and the Importance of Establishing the Correct Diagnosis

Our Experience with Sinonasal Glomangiopericytoma in North India: A Case Series.

Glomangiopericytoma (GPC) is a rare benign sinonasal tumor originating from Zimmerman's Pericytes surrounding capillaries and accounting for less than 0.05% of all sinonasal tumors. Glomangiopericytoma has low malignant potential (5-10%) and is mostly diagnosed in the 6th or 7th decade of age with slight female preponderance. We presented here a case series of 5 patients with sinonasal GPC. This research was conducted at a tertiary healthcare centre in North India. In our case series, all the patients were evaluated and underwent endoscopic surgical resection. All patients underwent digital subtraction angiography (DSA) and preoperative embolization. The coblation technique used for haemostasis proved very effective and time-saving. All patients exhibited cytoplasmic SMA positivity (a marker of GPC) and CD34 negativity, while one patient exhibited a high Ki-67 index (> 10%), which is a predictor of aggressive tumor behavior. None of the patients showed any recurrence in follow-up. We recommend performing complete endoscopic surgical excision to prevent recurrence. The use of DSA, preoperative embolization, and intraoperative use of the coblation technique provides a cleaner surgical field and reduced operating time.

PET/CT Imaging in Treatment Planning and Surveillance of Sinonasal Neoplasms.

Sinonasal cancers are uncommon malignancies with a generally unfavorable prognosis, often presenting at an advanced stage. Their high rate of recurrence supports close imaging surveillance and the utilization of functional imaging techniques. Whole-body 18F-FDG PET/CT has very high sensitivity for the diagnosis of sinonasal malignancies and can also be used as a "metabolic biopsy" in the characterization of some of the more common subgroups of these tumors, though due to overlap in uptake, histological confirmation is still needed. For certain tumor types, radiotracers, such as 11C-choline, and radiolabeled somatostatin analogs, including 68Ga-DOTATATE/DOTATOC, have proven useful in treatment planning and surveillance. Although serial scans for posttreatment surveillance allow the detection of subclinical lesions, the optimal schedule and efficacy in terms of survival are yet to be determined. Pitfalls of 18F-FDG, such as post-surgical and post-radiotherapy crusting and inflammation, may cause false-positive hypermetabolism in the absence of relapse.

Evaluation of high-risk human papillomavirus in sinonasal papillomas and squamous cell carcinomas.

The sinonasal tract is considered a second hotspot for human papillomavirus (HPV)-related tumors in the head and neck, with HPV being identified in up to 62% of squamous cell carcinomas (SCCs) and 38% of papillomas. There is limited data from geographical regions with low prevalence of high-risk (HR)-HPV on the association of HR-HPV in sinonasal neoplasms and on utility of p16 as a surrogate marker.p16 immunohistochemistry, HR-HPV mRNA ISH and quantitative real-time PCR (qPCR) were performed on a retrospective cohort of sinonasal papillomas and SCCs. KRAS mutation analysis was done in oncocytic papillomas.p16 positivity was present in 22/142 cases (15.5%) including eight inverted papillomas, one oncocytic papilloma (OP), and 13 SCC. Among these, mRNA ISH showed HR-HPV in the OP and two SCC, while another SCC was found to harbour HPV18 by qPCR. Two HPV-associated SCCs had foci of OP. mRNA ISH was negative in all p16 negative cases. p16 immunohistochemistry showed 68% concordance with mRNA ISH, and had sensitivity and negative predictive value of 100%; specificity was 67%, and positive predictive value was 14.3%.Association with HR-HPV in sinonasal papillomas and SCC is rare, and may be seen in cases demonstrating oncocytic morphology. p16 immunohistochemistry has low specificity and positive predictive value in low-prevalence populations; thus, reflex direct HR-HPV testing should be performed in p16 immunopositive cases. This two-step approach is viable in resource-limited settings, as the proportion of p16 positive cases is small.

In-vivo lymphoscintigraphy of sinonasal tumors identifies retropharyngeal node and level I as predominant sentinel nodes

ObjectiveTo evaluate by in- vivo lymphoscintigraphy and SPECT-CT imaging, the lymphatic drainage patterns of para-nasal sinus(PNS) tumors. To confirm or refute the belief of the retropharyngeal lymph node (RPLN) being the significant draining lymph node for such tumors. MethodsProspective cohort study conducted on previously untreated PNS tumors with no clinico-radiological evidence of lymph node metastasis. Lymphoscintigraphy undertaken by nasal endoscopic assisted peritumoral injection of 99mTc Sulfur colloid. Injections were classified as anterior or posterior as per a vertical line along the maxillary sinus ostium. Results17 patients were included. Lymphoscintigraphy successfully identified 17 sentinel nodes in 15 patients and was unsuccessful (lymphoscintigraphy failure) in 2 patients. Predominant sites of sentinel lymphatic drainage were noted to be the RPLN (n = 8; 47%), and Level I (n = 7; 42%). Occasional drainage was identified at the peri-parotid node(n = 1) and at Level II (n = 1). Contralateral drainage was noted in 2 patients (level I-1 and RPLN-1).Anterior injections drained predominantly to Level I (6/8) and RPLN (2/8), while posterior injections drained predominantly to the RPLN ( 6/7). The relative risk of RPLN being identified as the sentinel node was significantly higher for posteriorly placed injections than for anteriorly placed injections (RR- 3.43; 95% CI-1.0-11.8, p = 0.05). ConclusionThe RPLN is noted as a frequent draining node for sino-nasal tumours and merits routine attention in all sino-nasal tumors. The radio-colloid SPECT-CT technique described here offers an excellent in-vivo technique to further explore and validate the lymphatic drainage pathways of these tumours.

Inverted papilloma masquerading as juvenile nasopharyngeal angiofibroma in a young adolescent male

Inverted papilloma is a benign sinonasal epithelial tumour that mainly occurs in the fifth to sixth decades of life, with male predominance. The incidence in the young adolescent population is comparatively lower. The clinical and radiological findings may mimic other benign sinonasal tumours, so the diagnosis can only be confirmed by histopathological examination. Consequently, precise diagnostic and therapeutic planning is recommended to achieve the optimal result. We describe a case of unilateral sinonasal tumour in a young adolescent male who showed clinical and radiological features of juvenile nasopharyngeal angiofibroma, such as widening of the sphenopalatine foramen, extension of the mass posteriorly towards the nasopharynx, and presence of flow voids that suggested highly vascular nature of the mass. However, a postoperative histopathological examination showed a diagnosis of inverted papilloma.

Understanding Glomangiopericytoma: A Case Report of a Rare Sinonasal Tumor

Introduction: Glomangiopericytoma (GPC) is a benign neoplasm of the sinonasal tract that consists of spindle-shaped to ovoid cells with lobular or nodular growth patterns. GPCs are low-malignant tumors due to limited mitotic activity and atypia, making them less aggressive. The etiology of GPC remains unknown but is associated with factors like steroid use, past trauma, pregnancy, and hypertension. GPC is more common in women and is usually diagnosed in the sixth and seventh decades of life. Case Presentation: This article presents a case of a 47-year-old woman with a history of type-2 diabetes and nasal obstruction who was diagnosed with glomangiopericytoma (GPC), a rare sinonasal tumor. Computed tomography revealed a vascular mass, and complete surgical resection was achieved via a trans-nasal approach. The diagnosis was confirmed through positive β-catenin staining and negative S100p and STAT6 with a low Ki67 proliferation index. The patient experienced post-operative pain, anosmia, and ageusia, which were treated successfully. This case highlights the clinicopathologic characteristics, clinical and therapeutic aspects, surgical interventions, and differential diagnosis of GPC, a rare disease with limited reports. Conclusion: Glomangiopericytomas are benign sinonasal tumors often mistaken for other neoplasms. Diagnosis is challenging but possible through excision or biopsy with histopathological examination. Endoscopic surgery with follow-up is the recommended treatment, with recurrence occurring up to 12 years post-surgery. CTNNB1 gene mutations and β-catenin nuclear expression are recent diagnostic markers. GPC has a high survival rate and low metastasis, but patients should be closely monitored. This case report underscores the importance of comprehensive diagnosis and management for these rare tumors.

Detection of salivary gland and sinonasal fusions by a next-generation sequencing based, ligation-dependent, multiplex RT-PCR assay.

The discovery of tumour type-specific gene fusion oncogenes in benign and malignant salivary gland and sinonasal (SGSN) tumours has significantly increased our knowledge about their molecular pathology and classification. We developed a new targeted multiplexed next-generation sequencing (NGS)-based method that utilizes ligation dependent reverse-transcriptase polymerase chain reaction (LD-RT-PCR) to detect oncogenic fusion transcripts involving 116 genes, leading to 96 gene fusions known to be recurrently rearranged in these tumours. In all, 180 SGSN tumours (formalin-fixed, paraffin-embedded samples, 141 specimens and 39 core needle biopsies) from the REFCORpath (French network for rare head and neck cancers) with previously identified fusion genes by fluorescent in situ hybridisation (FISH), RT-PCR, or molecular immunohistochemistry were selected to test its specificity and sensitivity and validate its diagnostic use. Tested tumours encompassed 14 major tumours types, including secretory carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, salivary gland intraductal carcinoma, clear cell carcinoma, pleomorphic adenoma, adamantinoma-like Ewing Sarcoma, EWSR1::COLCA2 sinonasal sarcoma, DEK::AFF2 sinonasal carcinoma, and biphenotypic sinonasal sarcoma. In-frame fusion transcripts were detected in 97.8% of cases (176/180). Gene fusion assay results correlated with conventional techniques (immunohistochemistry [IHC], FISH, and RT-PCR) in 176/180 tumours (97.8%). This targeted multiplexed NGS-based LD-RT-PCR method is a robust, highly sensitive method for the detection of recurrent gene fusions from routine clinical SGSN tumours. It can be easily customized to cover new fusions. These results are promising for implementing an integrated NGS system to rapidlydetect genetic aberrations, facilitating accurate, genomics-based diagnoses, and accelerate time to precision therapies in SGSN tumours.

Single Institution Experience With Sinonasal Glomangiopericytoma: A Case Series.

Introduction: Sinonasal glomangiopericytoma (GPC) is an uncommon neoplasm, accounting for less than 0.5% of all sinonasal tumors. It is characterized as having low malignant potential, with complete surgical excision representing optimal treatment. Presenting symptoms are typically due to mass effect and vascularity of this tumor, often including unilateral nasal obstruction or epistaxis. Accounts of this tumor in the literature remain sparse. Methods: Single institution retrospective review. Results: Six cases of sinonasal GPC were identified from a review of the electronic medical records spanning from 2009 through 2021. Age at diagnosis ranged from 48 to 67 years, with a gender distribution of 5 males and 1 female. Most subjects presented with unilateral sinonasal obstruction of variable duration. Each underwent endoscopic resection of the mass with negative margins, and no adjuvant therapy was pursued. Pathologic specimens demonstrated a vascular patterned tumor with spindled cells surrounding vessels and were positive for smooth muscle actin and negative for cytokeratin. Active post-surgical follow-up ranged from 11 months to 10 years. All patients were without endoscopic evidence of recurrence, and 2 had post-operative imaging which showed no evidence of disease. Conclusions: This review of 6 cases of sinonasal GPC represents the largest known series of this rare pathology in the literature to date. Based on our experience, and in agreement with the available literature, this disease is reliably managed with complete surgical excision. Adjuvant therapy can be avoided in otherwise uncomplicated cases. Although rare, GPC should be considered in the differential diagnosis of all vascular sinonasal tumors.

SINONASAL ADAMANTINOMA-LIKE EWING SARCOMA: A CASE EXPANDING THE MORPHOLOGIC SPECTRUM

Adamantinoma-like Ewing sarcoma (ALES) is an exceedingly rare sinonasal malignancy defined by complex epithelial differentiation and EWSR1-FLI1 gene fusion. A 43-year-old female presented with painful facial swelling and proptosis. Computed tomography showed an exuberant heterogeneous tumor in the right sphenoid sinus that extended into the maxillary sinus, parapharyngeal space, orbit, and anterior cranial fossa. Microscopic analysis revealed sheets of monotonous basaloid cells with regular nuclear membranes and discernible nucleoli. Additionally, large foamy cells, ducts, whorls, and foci of abrupt keratinization were identified. Tumor cells were diffusely positive for AE1/3, p40, and CD99, and negative for NUT. The Ki-67 proliferation index was 40%. EWSR1 rearrangement was detected by FISH, confirming the final diagnosis of sinonasal ALES. Pathologists should consider ALES when evaluating aggressive sinonasal tumors composed of basaloid cells with focal keratinization. Immunopositivity for AE1/3, p40, and CD99, and molecular confirmation of EWSR1 rearrangement are essential for diagnosis. Adamantinoma-like Ewing sarcoma (ALES) is an exceedingly rare sinonasal malignancy defined by complex epithelial differentiation and EWSR1-FLI1 gene fusion. A 43-year-old female presented with painful facial swelling and proptosis. Computed tomography showed an exuberant heterogeneous tumor in the right sphenoid sinus that extended into the maxillary sinus, parapharyngeal space, orbit, and anterior cranial fossa. Microscopic analysis revealed sheets of monotonous basaloid cells with regular nuclear membranes and discernible nucleoli. Additionally, large foamy cells, ducts, whorls, and foci of abrupt keratinization were identified. Tumor cells were diffusely positive for AE1/3, p40, and CD99, and negative for NUT. The Ki-67 proliferation index was 40%. EWSR1 rearrangement was detected by FISH, confirming the final diagnosis of sinonasal ALES. Pathologists should consider ALES when evaluating aggressive sinonasal tumors composed of basaloid cells with focal keratinization. Immunopositivity for AE1/3, p40, and CD99, and molecular confirmation of EWSR1 rearrangement are essential for diagnosis.

Sinonasal neoplasms: Update from the WHO 2022

The pathology of poorly differentiated sinonasal malignancies has undergone adynamic evolution during the last decade, resulting in arefined, mostly genetically or etiologically oriented classification of neoplasms in the historical spectrum of sinonasal undifferentiated carcinoma (NUT carcinoma, SWI-/SNF-deficient carcinomas, and others). Moreover, some new entities have been established, while others could be further delineated and better characterized. Ahighlight of the new classification is the inclusion of SWI/SNF (SMARCB1 or SMARCA4)-deficient carcinomas into aseparate category. In addition, carcinomas with DEK::AFF2 fusions have been included as aprovisional entity in the spectrum of nonkeratinizing squamous cell carcinoma. This review addresses the major changes in the classification of sinonasal tract neoplasms in the new WHO classification.

Acute presentation of locally advanced squamous cell carcinoma of frontal sinus—imaging findings of a rare entity: case report

BackgroundThe squamous cell carcinoma is the most common subtype of malignant sinonasal tumours, predominantly involving the maxillary sinuses and nasal cavities in 70 to 80% of cases, and the frontal sinus is extremely rarely involved, in less than 1% of cases. Early clinical and radiological diagnosis is difficult due to overlap of findings with inflammatory sinonasal disease.Case presentationA 55-year-old Caucasian male patient had presented to the emergency department with three-month history of progressive right frontal swelling, acute frontal pain, recent exacerbation of right eye vision impairment and new lid swelling. There was no recent history of trauma and no neurological deficit on examination. Contrast-enhanced CT head was performed which demonstrated large bony destruction of frontal sinus with partly enhancing necrotic-looking tumour within the sinus. There was further intraorbital and intracranial extension of disease. Subsequent MRI confirmed these findings with better demonstration of intracranial and intraorbital component of the disease. The PET imaging did not reveal any avid disease elsewhere. Histopathology confirmed squamous cell carcinoma.ConclusionsFrontal sinus squamous cell carcinoma is a rare and the least common site within the paranasal sinuses. Early clinical and imaging diagnosis could be challenging; however, the index of suspicion should be high with indeterminate imaging findings. CT and MRI are the complimentary imaging techniques.

A Metagenomic Analysis of the Virome of Inverted Papilloma and Squamous Cell Carcinoma.

Inverted papilloma (IP) is a sinonasal tumor with a well-known potential for malignant transformation. The role of HPV in its pathogenesis has been controversial. The purpose of this study was to determine theviromeassociated with IP, with progression to carcinoma-in-situ, and invasive carcinoma. To determine the HPV-specific types, a metagenomics assay that contains 62,886 probes targeting viral genomes in a microarray format was used. The platform screens DNA and RNA from fixed tissues from 8 control tissue, 16 IP without dysplasia, 5 IP with carcinoma-in-situ, and 13 IP-associated squamous cell carcinoma (IPSCC). Paired with next-generation sequencing, 48 types of HPV with 857 region-specific probes were interrogated against the tumors. The prevalence of HPV16 was 14%, 42%, 70% and 73% in control tissue, IP without dysplasia, IP with CIS, and IPSCC, respectively. The prevalence of HPV18 had a similar progressive increase in prevalence, with 14%, 27%, 67%, and 74%. The assay allowed region-specific analysis which identified the only oncogenic HPV type 18 E6 to be statistically significant when comparing to control tissue. The prevalence of HPV18-E6 was 0% in control tissue, 25% in IP without dysplasia, 60% in IP with CIS, and 77% in IPSCC. There are over 200 HPV types that infect human epithelial cells, of which only a few are known to be high-risk. Our study demonstrated a trend of increasing prevalence of HPV18-E6 that correlated with histologic severity, which is novel and supports a potential role for HPV in the pathogenesis of IP. This article is protected by copyright. All rights reserved.

A multi-institutional retrospective study of 340 cases of sinonasal malignant tumor

ObjectiveSinonasal malignant tumors (SNMT) are relatively rare among head and neck malignant tumors. Most are squamous cell carcinomas, and malignant melanomas, olfactory neuroblastomas, adenoid cystic carcinomas, sarcomas, and others also occur. The most common primary site of nasal sinus squamous cell carcinoma is the maxillary sinus.In recent years, a decrease in incidence of maxillary sinus squamous cell carcinoma (MSSCC) has been reported along with a decrease in the incidence of sinusitis. MSSCC is treated with a combination of surgery, radiation, and chemotherapy. Treatment decisions are made according to the progression of the disease, the patient's general condition, and the patient's own wishes. There are variations in treatment policies among facilities due to the specialty of staff and cooperation with other departments at each facility. We conducted a multi-institutional retrospective study to compare outcomes by treatment strategy. MethodsIn this study, 340 patients with SNMT who were treated at 13 Hospitals (Head and Neck Oncology Group (Kyoto-HNOG) ) during the 12-year period from January 2006 to December 2017 were included. There were 220 patients with squamous cell carcinoma, 32 with malignant melanoma, 21 with olfactory neuroblastoma, and 67 with other malignancies. Of the squamous cell carcinomas, 164 were of maxillary sinus origin. One hundred and forty cases of MSSCC that were treated radically were included in the detailed statistical analysis. ResultsThere were 5 cases of cStage I, 9 cases of cStage II, 36 cases of cStage III, 74 cases of cStage IVa, and 16 cases of cStage IVb. There were 92 cases without clinical lymph node metastasis (cN(-)) and 48 cases with clinical lymph node metastasis(cN(+)).Primary tumors were treated mainly by surgery in 85 cases (Surg) and by radical radiation therapy (with or without chemotherapy) of 6-70 Gy in 55 cases(non-Surg).The 5-year overall/disease-free survival rate (OS/DFS) for MSSCC was 65.1%/51.6%. Old age, renal dysfunction, and clinical T progression were independent risk factors for OS, and renal dysfunction was an independent risk factor for DFS.In cN(-) patients, OS and DFS were significantly better in Surg group than in non-Surg group. In cN(+) patients, there was no significant difference in OS and DFS between Surg and non-Surg groups. ConclusionFor patients with MSSCC without lymph node metastasis, aggressive surgery on the primary tumor contributes to improved prognosis.

A study of benign sino-nasal tumors in rural tertiary care hospital

Background: The sino-nasal unit, although anatomically a very small space, is quite exceptional in the sense that an eclectic mix of neoplastic tumors originate from here. The diverse nature of the neoplastic pathologies and their unique natural histories prompted for this study. Methods: In this prospective study of two years, done in a rural tertiary care hospital of India, 46 patients with benign neoplastic tumors of nasal cavity, sinuses and nasopharynx were analyzed for their clinic-pathological and radiological profile and surgical management. Results: The incidence of benign tumor was predominant in second decade (34.8%) with significant male preponderance (M:F ratio 2.28:1). Unilateral nasal obstruction (100%) and epistaxis (84.8%) were the two most common presenting complaints. Almost half (48%) of the patients presented as late as more than one year after the onset of the symptoms. Nasal cavity was the commonest site of the tumors (50%). The most common benign tumor in present study was capillary hemangioma (41.31%) followed by angiofibroma (26.09%). All tumors were removed by a standard functional endoscopic sinus surgery or combined approach. Except a single case of inverted papilloma, all the other cases showed no recurrence at the end of one year follow up period. Conclusions: It can be concluded from present study that conjoint application of radiology, endoscopy and histopathology is of utmost importance in dealing with benign neoplastic pathology of sino-nasal region. There is significant success in managing benign sino-nasal tumors with functional endoscopic sinus surgery or by combined approach.

Clinical Outcome in Patients with Large Sinonasal Tumors with Intracranial Extension.

Objectives Malignant tumors of the sinonasal cavities with extension to the frontal skull base are rare and challenging pathologies. Combined-approach surgery using a frontobasal craniotomy and endoscopic sinus surgery with reconstruction of the anterior skull base followed by adjuvant radiotherapy is a preferred treatment strategy in selected cases. Morbidity and mortality rates are high in this population. We aim to add our experience to the current literature. Design We performed a retrospective cross-sectional single center study of the long-term clinical outcome in a tertiary university referral hospital in the Netherlands between 2010 and 2021. Descriptive statistics and frequency distributions were performed Participants Patient, tumor, treatment, complications and survival characteristics of eighteen consecutive patients were extracted from the electronic health records. Main Outcome Measures The primary outcome measures are progression free survival, overall survival and complication rate. Results Eighteen consecutive patients were included with a mean age of 61 (SD ± 10) years (range 38-80); ten males and eight females. Gross total resection was achieved in 14 (77%) patients. Eleven (61%) patients underwent local radiotherapy, one (5%) chemotherapy and three (17%) a combination of both. Mean follow-up duration was 49 months (range 3 - 138). Three (17%) patients died in hospital due to post-operative complications. Six (33%) patients died during follow-up due to disease progression. Mean progression-free survival was 47 months (range 0 - 113). Conclusion In conclusion, the overall survival was 50% for this group of patients with large sinonasal tumors. Progressive disease affects survival rate severely. Surgical complications were seen in five (28%) patients. Radiotherapy is associated with high complication rates. Radiation necrosis was a serious complication in two patients and could be treated with high dose steroids.