耳鼻喉科Otolaryngology topic one: Paranasal sinuses and epithelial tumors

Paranasal sinuses and epithelial tumors

<Pics from Wikipedia, just for study>

1. Four sinuses: 

-- Frontal 

-- Ethmoid

-- Sphenoid (near optic nerve and  CN3, 4, 5-1, 5-2, 6 , internal carotid artery)

-- Maxillary (Max. in size, most common tumor site among paranasal sinuses)

2. Tumor position and symptoms
--Inside nasal cavity (compared to paranasal sinuses)
            ->more symptoms at early stage( ex. epistaxis, nasal congestion)

3. Tumors at paranasal sinuses

-- Occupy only 3 % of head and neck malig.; 
                       1% of all cancers; 
                       diagnosed on elder people(60 y/o) 
                       and chemical/wood dust-exposed workers, 
                       smokers

-- Metastasis to:  retropharygeal LN(right:No. 4), jugulodigastric LN(left:No. 9); both rare

4.  Symptoms of paranasal sinus tumors
-- early : nasal congestions, epistaxis, facial pain
-- late:  epiphora
            facial edema
            trimus, maloccusion
            hearing loss
            neck mass
            proptosis
            cranial nerve deficits( CNII, III, IV, V1, V2, VI)

5. Evaluation tools
-- MRI: nerves, soft tissues
-- CT: bones (thinner at first, thicker in later stages)
-- sinus lavage, FNA, transnasal biopsy: cell type, malig.?

6. Benign epithelial tumors
-- 3P1A (exophytic, inverted, columnar papilloma; adenoma)

Inverted papilloma: 
                              <epi.>       0.2~0.6/100000 incidence; 50 y/o↑ white male; HPV 6, 11 related
                              <location>unilateral, multicentric at lateral wall
                              <macro>   rough, vascularization↑
                                     <micro>   local invasion with intact basal membrane
                               <treat>   high recurrence rate(10~30%), malig. change (5~20%)
                                             suggest En bloc surgery via endoscope and F/U


7. Malig. epithelial tumors

SCC: 
                              <epi.>       50-90% of malig. sinonasal tumor, 50~69y/o
                              <location> Maxillary sinus
                              <prog.>    disease-free survival <50%

Adenocarcinoma: 
                              <epi.>       2nd common malig. sinonasal tumor, hard-wood dust highly related
                              <location> Ethmoid sinus
                              <prog.>     1/3 meta in high grade

Adenoid cystic carcinoma: 
                              <location> Maxillary sinus
                              <prog.>     Perineural spread  (50~76% recurrence)


Mucosal melanoma: 
                              <epi.>       5th to 8th decade
                              <location> Nasal cavity
                              <macro>    grey~black
                              <prog.>     Early vascular and lymphatic invasion; median survival 15 months, five year survival 23%

Neuroendocrine=olfactory neuroblastoma
Esthesioneuroblastoma (ENB)

                              <epi.>       most common NET; bimodal (10~20, 50~60y/o)frequency
                              <micro>    locally aggressive
                             <prog.>      local recurrence >10 y/o later, better prog.
                             <stage>      Kadish/UCLA

 Sinonasal neuroendocrine carcinoma (rare & rarely functional) 

                              <epi.>       more in 50 y/o males
                              <location> unknown origin
                             <prog.>      5 year survival 74~100%
                             <treat>      curative: surgery

 Sinonasal undifferentiated carcinoma (SNUC)

                              <micro>     highly aggressive, local
                             <prog.>      1 year
                             <treat>      OP+RT+CHEMO

 Sinonasal small cell (undifferentiated) carcinoma 

                              <micro>     dis. mets↑