Neoplasms of the Nose and Paranasal Sinuses.pptVIP

Neoplasms of the Nose and Paranasal Sinuses Epidemiology 3% cancer of upper respiratory tract. Males : Females 2 : 1. Industrial fumes and wood dust. Nickel-refining processes. Leather tanning. Mineral oils, chromium and chromium compounds, isopropyl oils, lacquer paint, soldering and welding, radium dial painting. Cigarette smokers. Diagnosis Nasal airway obstruction, epistaxis, headache, facial pain and nasal discharge. Asymptomatic 9 - 12%. Cervical metastases on initial presentation 10%. Distant metastasis on initial presentation 7%. Diagnosis Numbness or hypesthesia of infraorbital V2 or supraorbital V3 nerve. Proptosis, chemosis, extraocular muscle impairment, mass effect in the cheek, gingiva, or gingivobuccal sulcus, loose dentition. History and physical exam Risk factors/cranial nerve deficits Imaging Radiograms Bone erosion, opacification of PNS CT scanning Evaluation of bony boundaries of PNS; not cost-effective MRI Evaluation of soft tissue invasion and perineural spread; differentiate retained secretions from tumor PET Routine evaluation for recurrent disease after primary treatment and distant metastasis; useful for SCC; cost- effectiveness unknown Biopsy Sinus lavage/cytology Fine-needle aspiration Transnasal biopsy Direct or endoscopic. Preferred modality. Pathology - Epithelial Benign Keratotic papilloma Fungiform papilloma Inverted papilloma Cylindrical papilloma Adenoma Malignant Squamous cell carcinoma Transitional cell carcinoma Adenocarcinoma Adenoid cystic carcinoma Melanoma Olfactory neuroblastoma Undifferentiated carcinoma Pathology - Nonepithelial Benign Fibroma Chondroma Osteoma Neurilemmoma Neurofibroma Hemangioma Malignant Soft-tissue sarcoma Rhabdomyosarcoma Leiomyosarcoma Fibrosarcoma Liposarcoma Angiosarcoma Myxosarcoma Hemangiopericytoma Connective tissue sarcoma Chondrosarcoma Osteosarcoma Pathology Lymphoreticular tumors Lymphoma Plasmacytoma Giant cell tumor Metastatic carcinoma Benign Epithel