Category Archives: Sinonasal Tract

Lee J, Thompson L, Garg R, Keschner D, Shibuya T.

International Journal of Otolaryngology and Head & Neck Surgery, Vol. 2 No. 2, 2013, pp. 52-56.

Objectives: Sinonasal schwannomas account for less than 4% of head and neck schwannomas, with the primary treatment modality being surgical excision via external approaches. The aim of this report is to present a rare case of recurrent schwannoma of the ethmoid cavity involving the anterior skull base which was successfully managed with endoscopic resection. Study Design: Case report and review of the literature. Methods: The clinical presentation, radiographic features, histopathologic characteristics, surgical approach, and patient outcome were examined in the context of a literature review. Results: A 43-year-old woman presented with a 9-month history of left facial pain and pressure. She had a prior history of sinonasal schwannoma excision with cerebrospinal fluid (CSF) leak repair via bifrontal craniotomy in 2007. Magnetic resonance imaging (MRI) and nasal endoscopy revealed a left ethmoid mass measuring 2.2 cm × 2.7 cm × 2.4 cm abutting the anterior skull base. The tumor was completely removed using a transnasal endoscopic approach, and the anterior skull base reconstructed with tensor fascia lata graft. Histology of the specimen showed schwannoma, and there has been no evidence of tumor recurrence nor CSF leak after 24 months of follow-up. Conclusion: With continual advances in surgical technique and instrumentation, sinonasal schwannomas have become increasingly more amenable to endoscopic resection even in the case of recurrence and skull base involvement.

PubMed ID: n/a

Article Size: >1 MB

Thompson LD.

Ear Nose Throat J. 2015 Apr-May;94(4-5):146-8.

FIRST PARAGRAPH: The overall clinical presentation of Schneiderian papillomas is quite nonspecific, with nasal obstruction, polyps, headache, epistaxis, and rhinorrhea the most common symptoms.

PubMed ID: 25923270

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Thompson LD.

Ear Nose Throat J. 2014 Oct-Nov;93(10-11):E49-50.

FIRST PARAGRAPH: Mucosal melanoma is a neural-crest–derived neoplasm that originates in melanocytes and demonstrates melanocytic differentiation. Exposure to formalin and ultraviolet light are known etiologic factors; another possible factor is exposure to radiation. Approximately 15 to 20% of all skin melanomas develop on the head and neck, but less than 1% of all melanomas develop in ocular or mucosal sites, including the sinonasal tract.

PubMed ID: 25397394

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Thompson LD.

Ear Nose Throat J. 2013 Jan;92(1):18-22.

FIRST PARAGRAPHS: Wegener granulomatosis presents clinically as ulcerative and crusted lesions with tissue destruction. Wegener granulomatosis (WG) is an idiopathic, nonneoplastic, aseptic, necrotizing disease characterized by vasculitis and destructive properties. In general, affected patients exhibit disease in the sinonasal tract, lungs, and kidney, in some cases metachronously. Patients may present with systemic or localized disease; patients with systemic disease are usually quite sick. Disease progression may be seen when localized disease becomes systemic, but many patients will remain with limited disease.

PubMed ID: 23354886

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Thompson LD.

Ear Nose Throat J. 2012 Jul;91(7):276-8.

FIRST PARAGRAPHS: Radiographic findings are essential to the diagnosis of paranasal sinus mucocele. Usually opacification of the sinus with thinning, erosion, or destruction of the sinus wall are seen. Mucocele of the paranasal sinuses is a distinct clinicopathologic entity in which there is obstruction of the sinus cavity outflow tract, resulting in expansion of the sinus walls. The histologic features are quite nonspecific, requiring clinical, radiologic, and pathologic correlation. Most of these lesions result from increased pressure in the sinus due to sinus outlet obstruction, usually as a consequence of inflammatory or allergic processes. However, tumor, trauma, and previous surgery may play a role.

PubMed ID: 22829031

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Thompson LD.

Ear Nose Throat J. 2012 May;91(5):192, 194.

FIRST PARAGRAPH: Diffuse large B-cell lymphoma accounts for more than 50% of all Waldeyer ring lymphomas, which in turn account for about 15% of all head and neck lymphomas and about 50% of all extranodal head and neck lymphomas.

PubMed ID: 22614552

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Thompson LD.

Ear Nose Throat J. 2012 Mar;91(3):102-4.

FIRST PARAGRAPHS: The cause of lichen planus is not known. Its treatment depends on the specific type–reticular, erosive, or bullous–and usually includes topical or systemic corticosteroids and topical antifungal agents. Patients require lifelong monitoring and/or therapy. Lichen planus (LP) is a chronic, self-limited, inflammatory disorder of unknown etiology that involves mucous membranes, skin, nails, and hair. It is postulated that there is an abnormal T-cell-mediated immune response that results in disruption of the basement membrane. Several drugs are known to be associated with the onset of LP, but the exact mechanism is unknown.

PubMed ID: 22430334

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Thompson LD.

Ear Nose Throat J. 2011 March;90(3):106-107.

FIRST PARAGRAPH: Allergic fungal sinusitis, also known as allergic mucin and eosinophilic fungal rhinosinusitis, is an allergic response in the sinonasal tract mucosa to aerosolized fungal allergens, amplified and perpetuated by eosinophils. The class II genes in the major histocompatibility complex are involved in antigen presentation and immune response (modulation), and an allergic reaction develops to inhaled fungal elements in immunocompetent people. Aspergillus species are the most common agents (widespread in soil, wood, and decomposing plant material), but Alternaria, Bipolaris, Curvularia, Exserohilum, and Phialophora species have also been reported

PubMed ID: 21412738

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Thompson LD.

Ear Nose Throat J. 2010 Jan;89(1):16-8.

FIRST PARAGRAPH: Adenocarcinomas of the sinonasal tract can originate in the respiratory epithelium or the underlying mucoserous glands. Most (60%) arise from the mucoserous glands. These tumors are divided into two categories: salivary-gland-type and nonsalivary-gland-type adenocarcinomas (table). The latter are subdivided into two major categories: intestinal-type adenocarcinomas (ITACs) and nonintestinal-type adenocarcinomas.

PubMed ID: 20155693

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Thompson LDR.

Ear Nose Throat J. 2007 Feb;86(2):79-80.

FIRST PARAGRAPH: Ewing sarcoma (ES) and primitive neuroectodermal tumor (PNET) are closely related, high-grade, round-cell tumors with a neuroectodermal phenotype. These tumors are histologically considered on a morphologic spectrum, and they express similar genetic alterations. ES usually develops in bone and is more undifferentiated, while PNET tends to involve soft tissue and demonstrates more pronounced neuroendocrine features.

PubMed ID: 17385610

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Thompson LD.

Ear Nose Throat J. 2002 Aug;81(8):506.

FIRST PARAGRAPH: Rhinoscleroma (‘hard nose’) is caused by Klebsiella rhinoscleromatis, a gram-negative encapsulated bacterium of low infectivity. The disease is uncommon in the United States; most cases are found in the Middle East (especially Egypt), in parts of Latin America, and in Eastern Europe. The disease process usually involves the nasal cavity and the nasopharynx, but it can also involve the larynx, trachea, bronchi, middle ear, and orbit.

PubMed ID: 12199166

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Thompson LDR.

Head Neck Pathol. 2007 Sep;1(1):81-6.

FIRST PARAGRAPH: The most common type of nasopharyngeal tumor is nasopharyngeal carcinoma. The etiology is multifactorial with race, genetics, environment and Epstein-Barr virus (EBV) all playing a role. While rare in Caucasian populations, it is one of the most frequent nasopharyngeal cancers in Chinese, and has endemic clusters in Alaskan Eskimos, Indians, and Aleuts. Interestingly, as native-born Chinese migrate, the incidence diminishes in successive generations, although still higher than the native population.

PubMed ID: 20614287

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Thompson L.

Ear Nose Throat J. 2005 Jul;84(7):404-5.

FIRST PARAGRAPH: The most common type of nasopharyngeal tumor is a carcinoma. The etiology of nasopharyngeal carcinoma (NPC) is multifactorial; race, genetics, Epstein-Barr virus (EBV) infection, and the environment all play a role. NPC is rare in white populations, but it is one of the most common cancers among Chinese. EBV is almost always present in NPC, indicating that this virus plays an oncogenic role. The viral titer can be used to monitor therapy or possibly as a diagnostic tool in the evaluation of patients who present with a metastasis from an unknown primary. Exposure to environmental carcinogens, especially high levels of volatile nitrosamines (specifically, those in Cantonese-style salted fish), has been implicated in this complicated disorder; carcinogens related to smoking, formaldehyde exposure, and radiation have also been implicated.

PubMed ID: 16813025

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Thompson LD.

Ear Nose Throat J. 2007 Jun;86(6):322, 325

FIRST PARAGRAPH: Sinonasal polyps are caused by a multitude of factors. The most common causes are repeated bouts of sinusitis, allergy, vasomotor rhinitis, infectious rhinosinusitis, and asthma. Less often, they occur in association with diabetes mellitus, cystic fibrosis, and aspirin intolerance. They form as a result of an influx of fluids into the schneiderian mucosal lamina propria. Occasionally, antral (maxillary) polyps expand and prolapse through sinus ostia to present intranasally or in the nasopharynx (antrochoanal polyps). Sinonasal polyps have no predisposition to age or sex. Polyps are uncommon in children, but when they do occur, as many as 30% are associated with cystic fibrosis.

PubMed ID: 17703805

Article Size: <1 MB

Shen T, Shi Q, Velosa CM, Bai S, Thompson LDR, Keen C, Patel A, Simpson R, Wei S, Brandwein-Gensler M. Sinonasal Renal Cell-Like Adenocarcinomas: Robust Carbonic Anhydrase Expression and the Renal-Like Function of Schneiderian Mucosa

Hum Pathol. 2015 Nov;46(11):1598-606.

We report 3 new patients with sinonasal renal cell-like adenocarcinoma (SNRCLA). One case submitted in consultation demonstrated robust carbonic anhydrase IX (CA-IX) expression, leading us to a broader inquiry of CA-IX and carbonic anhydrase II (CA-II) expression in other SNRCLA, Schneiderian tissues, and histologic mimickers. Robust cytoplasmic and membranous CA-IX expression is demonstrated in 6 of 7 SNRCLAs; CA-II expression was demonstrated in 2 of 5 cases. Robust, diffuse CA-II expression is demonstrated throughout sinonasal seromucinous glands in all 10 normal Schneiderian samples. CA-IX is also expressed in all normal sinonasal samples, albeit focally. The closest salivary mimic to SNRCLA is hyalinizing salivary clear cell carcinoma; only focal CA-IX expression was demonstrated in 1 of 2 cases studied. Carbonic anhydrase expression in Schneiderian tissue speaks to its role in regulating the ion concentration of sinonasal secretions and may also explain the origin of this rare tumor.

PubMed ID: 26299508

Article Size: 4.7 MB

 

Orgain CA, Shibuya TY, Thompson LD, Keschner DB, Garg R, Lee JT.

Allergy Rhinol (Providence). 2017 Oct 1;8(3):173-177.

INTRODUCTION: Inverted papillomas (IP) are benign sinonasal neoplasms, which account for 0.5-4% of all nasal tumors. IPs have been known to transform into squamous cell carcinoma in 5-15% of cases. Rarely, transformations to other malignancies have been reported. Here we report a unique case of malignant transformation of an IP into sinonasal undifferentiated carcinoma (SNUC).

METHODS: A case report with a literature review; institutional review board exempted. The clinical presentation, radiographic features, surgical intervention, histopathologic analysis, treatment, and outcome of the case were examined.

RESULTS: A 62-year-old man presented with a 3-month history of nasal airway obstruction, rhinorrhea, and postnasal drip refractory to medical therapy. He had a long history of exposure to fumes, chemicals, dusts, and solvents as a professional painter as well as a 45 pack-year history of smoking and alcohol abuse. The patient was ultimately found to have a left ethmoidal IP with a focus of malignant transformation into SNUC. Endoscopic resection was performed, followed by concurrent chemoradiation and adjuvant chemotherapy. After surgery, he had no evidence of recurrent disease after 9 years of follow-up.

CONCLUSIONS: IP is known to transform into squamous cell carcinoma. Here we report a rare case of malignant transformation into SNUC, a much more uncommon and aggressive lesion. Although traditionally associated with a poorer prognosis, the positive outcome for SNUC observed in this patient may potentially be attributed to early detection and timely therapeutic intervention.

PubMed ID: 29070275

Article Size: 1 MB

 

Penner CR, Thompson LD.

Ear Nose Throat J. 2004 Feb;83(2):92-3.

FIRST PARAGRAPH: Nasal glial heterotopia (nasal glioma) is the term used to describe a mass made up of mature brain tissue that is isolated from the cranial cavity or spinal canal. Most of these rare, benign, congenital tumors are found in the nasal region, particularly at the bridge of the nose and in the nasal cavity. Nasal glial heterotopia is frequently diagnosed in newborns; a few cases have been found in adults.

PubMed ID: 15008441

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Thompson LD.

Ear Nose Throat J. 2017 Dec;96(12):456-457.

FIRST PARAGRAPH: The most common malignancy of the nasopharynx is nasopharyngeal carcinoma. However, nasopharyngeal papillary adenocarcinoma is a rare primary tumor of this location. This tumor shows a remarkable papillary architecture, arising from the surface epithelium and in general showing indolent biologic behavior. There are no known etiologic agents, lacking any Epstein Barr virus or human papillomavirus association.

PubMed ID: 29236265

Article Size: <1 MB

Thompson LDR, Franchi A.

Virchows Arch. 2018 Mar;472(3):315-330.

TheWorld Health Organization recently published the 4th edition of the Classification of Head and Neck Tumors, including several new entities, emerging entities, and significant updates to the classification and characterization of tumor and tumor-like lesions, specifically as it relates to nasal cavity, paranasal sinuses, and skull base in this overview. Of note, three new entities (NUT carcinoma, seromucinous hamartoma, biphenotypic sinonasal sarcoma,) were added to this section, while emerging entities (SMARCB1-deficient carcinoma and HPV-related carcinoma with adenoid cystic-like features) and several tumor-like entities (respiratory epithelial adenomatoid hamartoma, chondromesenchymal hamartoma) were included as provisional diagnoses or discussed in the setting of the differential diagnosis. The sinonasal tract houses a significant diversity of entities, but interestingly, the total number of entities has been significantly reduced by excluding tumor types if they did not occur exclusively or predominantly at this site or if they are discussed in detail elsewhere in the book. Refinements to nomenclature and criteria were provided to sinonasal papilloma, borderline soft tissue tumors, and neuroendocrine neoplasms. Overall, the new WHO classification reflects the state of current understanding for many relatively rare neoplasms, with this article highlighting the most significant changes.

PubMed ID: 28444451

Article Size: 6 MB

Liu JJ, Thompson LD, Janisiewicz AM, Shibuya TY, Keschner DB, Garg R, Lee JT.

Allergy Rhinol (Providence). 2017 Mar 1;8(1):32-36. doi: 10.2500/ar.2017.8.0190

BACKGROUND: Head and neck ossifying fibroma (OF) is a rare, benign, locally aggressive, fibro-osseous tumor. The mandible is the most common site of involvement, followed by the maxilla, and, less frequently, the sinonasal cavities, orbit, skull base, and calvarium. In this study, we aimed to expand our understanding of this entity by presenting a case series of OF that involved the maxilla and sinonasal tract.

METHODS: A multicenter retrospective review was performed on all the patients with a diagnosis of OF from 2004 to 2013. Data were collected with respect to age, sex, clinical presentation, treatment, and outcome.

RESULTS: A total of 13 patients were identified. The mean age was 37 years, with a female predominance (69%). The maxillary sinus was most frequently involved site (46%). Eighty-five percent underwent open surgical resection. After a mean follow-up time of 47.3 months, three patients (23%) developed recurrent disease; all of whom were treated with an open approach.

CONCLUSION: Of the maxilla and sinonasal tract is an uncommon clinicopathologic entity. Although a timely diagnosis may obviate the need for external approaches, open surgical resection is often still necessary for management of extensive lesions. Close follow-up and additional surgery may also be required to treat recurrent disease.

PubMed ID: 28381325

Article Size: <1 MB

 

Thompson LD.

Ear Nose Throat J. 2004 Dec;83(12):807.

FIRST PARAGRAPH: A glomangiopericytoma (sinonasal-type hemangio-pericytoma) is a tumor believed to derive from perivascular modified smooth-muscle cells. Its origin is similar to that of a glomus tumor (not to be confused with glomus jugulare, which is a different neoplasm) but distinctly different from soft-tissue hemangiopericytoma. There is a very slight female preponderance, and the tumor’s peak incidence occurs during the seventh decade of life. Most affected patients experience nasal obstruction and epistaxis along with a wide array of other nonspecific findings that are generally present for less than 1 year. Glomangiopericytomas have a predilection for the nasal cavity and paranasal sinuses, where they grow as polypoid masses. Their average size is approximately 3 cm, and they are often mistaken clinically for inflammatory polyps.

PubMed ID: 15724732

Article Size: <1 MB

College of American Pathologists (CAP)

Protocol applies to all invasive carcinomas of the nasal cavity and paranasal sinuses. Mucosal malignant melanoma is included. Lymphomas, neuroectodermal neoplasms, and sarcomas are not included.

Based on AJCC/UICC TNM, 7th edition
Protocol web posting date: October 2009
Protocol effective date: January 2010

Article Size: 1 MB

Kuan EC, Wang EW, Adappa ND, Beswick DM, London NR Jr, Su SY, Wang MB, Abuzeid WM, Alexiev B, Alt JA, Antognoni P, Alonso-Basanta M, Batra PS, Bhayani M, Bell D, Bernal-Sprekelsen M, Betz CS, Blay JY, Bleier BS, Bonilla-Velez J, Callejas C, Carrau RL, Casiano RR, Castelnuovo P, Chandra RK, Chatzinakis V, Chen SB, Chiu AG, Choby G, Chowdhury NI, Citardi MJ, Cohen MA, Dagan R, Dalfino G, Dallan I, Dassi CS, de Almeida J, Tos APD, DelGaudio JM, Ebert CS, El-Sayed IH, Eloy JA, Evans JJ, Fang CH, Farrell NF, Ferrari M, Fischbein N, Folbe A, Fokkens WJ, Fox MG, Lund VJ, Gallia GL, Gardner PA, Geltzeiler M, Georgalas C, Getz AE, Govindaraj S, Gray ST, Grayson JW, Gross BA, Grube JG, Guo R, Ha PK, Halderman AA, Hanna EY, Harvey RJ, Hernandez SC, Holtzman AL, Hopkins C, Huang Z, Huang Z, Humphreys IM, Hwang PH, Iloreta AM, Ishii M, Ivan ME, Jafari A, Kennedy DW, Khan M, Kimple AJ, Kingdom TT, Knisely A, Kuo YJ, Lal D, Lamarre ED, Lan MY, Le H, Lechner M, Lee NY, Lee JK, Lee VH, Levine CG, Lin JC, Lin DT, Lobo BC, Locke T, Luong AU, Magliocca KR, Markovic SN, Matnjani G, McKean EL, Meço C, Mendenhall WM, Michel L, Na’ara S, Nicolai P, Nuss DW, Nyquist GG, Oakley GM, Omura K, Orlandi RR, Otori N, Papagiannopoulos P, Patel ZM, Pfister DG, Phan J, Psaltis AJ, Rabinowitz MR, Ramanathan Jr M, Rimmer R, Rosen MR, Sanusi O, Sargi ZB, Schafhausen P, Schlosser RJ, Sedaghat AR, Senior BA, Shrivastava R, Sindwani R, Smith TL, Smith KA, Snyderman CH, Solares CA, Sreenath SB, Stamm A, Stölzel K, Sumer B, Surda P, Tajudeen BA, Thompson LDR, Thorp BD , Tong CCL , Tsang RK , Turner JH , Turri-Zanoni M, Udager AM, van Zele T, VanKoevering K, Welch KC, Wise SK , Witterick IJ, Won TB, Wong SN, Woodworth BA, Wormald PJ, Yao WC, Yeh CF, Zhou B, Palmer JN

Int Forum Allergy Rhinol. 2024 Feb;14(2):149-608. doi: 10.1002/alr.23262.

BACKGROUND: Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represents a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field.

METHODS: Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represents a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field.

RESULTS: The ICNST document consists of 4 major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention.

CONCLUSIONS: As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.

PubMed ID: 37658764

Article Size: 4.33 MB