Adenocarcinoma of the nose and paranasal sinuses in woodworkers in the state of Victoria, Australia

Occurrence of Sinonasal Intestinal-Type Adenocarcinoma and Non-Intestinal-Type Adenocarcinoma in Two Countries with Different Patterns of Wood Dust Exposure

Sinonasal intestinal-type adenocarcinoma is strongly associated with hardwood dust exposure. Non-intestinal-type adenocarcinoma is a rarer and less well-known subtype considered not to be related with wood dust exposure. We determined the relative numbers of these two tumor types in 56 sinonasal adenocarcinoma patients in France and Finland, relating them with carefully assessed wood dust exposure histories. Diagnostic workup including immunohistochemistry for the intestinal markers CDX2 and CK20 indicated that the proportions of the two tumors differed significantly between France and Finland. In Finnish samples non-intestinal adenocarcinomas were more common than intestinal-type adenocarcinomas (12 non-intestinal vs. nine intestinal), while in the French samples the reverse was true (six non-intestinal vs. 29 intestinal). Such remarkably dissimilar occurrence of these tumors in France and Finland presumably reflects different pathogenetic circumstances in the two countries, and perhaps their different patterns of wood dust exposure. In France the main source of wood dust is from hardwoods. In Finland it is derived from softwoods. This is the first systematic comparison of the occurrence of intestinal-type adenocarcinoma and non-intestinal-type adenocarcinoma in two countries with different wood usage. It appears to be the first systematic study on differences in wood dust exposure between intestinal-type adenocarcinoma and non-intestinal-type adenocarcinoma.

Treatment of Sinonasal Adenocarcinoma: A Population-Based Prospective Cohort Study

Objectives  Sinonasal adenocarcinoma (AC) is a potentially curable disease despite being an aggressive malignancy. Long-term survival can be achieved with early diagnosis and adequate multidisciplinary treatment. Our goal was to evaluate outcomes for patients with AC treated at our institution. Design  In a population-based consecutive prospective cohort, we conducted an analysis of all patients treated for surface epithelial AC between 1995 and 2018. Results  Twenty patients were included, and follow-up was 100%. The mean follow-up time was 89 months for the entire cohort (112 months for patients with no evidence of disease). Intestinal-type AC was found in 65%, whereas nonintestinal-type AC was found in 35% of all cases; 75% had stage T3/4 disease. Tumor grade was intermediate/high in 65%. Eighteen patients underwent treatment with curative intent (craniofacial resection [CFR] in 61%, transfacial approach in 39%, adjuvant radiotherapy in 89%), achieving negative margins in 56% of cases. Overall survival (OS) rates were 90, 68, and 54% after 2, 5, and 10 years of follow-up, respectively, and the corresponding disease-specific survival (DSS) rates were 90, 73, and 58%. Age over 60 years, tumor with a maxillary origin, and microscopic bone invasion were negative prognostic factors. Radical CFR was correlated with better OS and DSS. Conclusion  The high probability of achieving radicality with CFR, the low complication rate, the acceptable toxicity of modern irradiation modalities, and the promising survival rates indicate that this strategy might be considered a safe and an effective option for treating patients with very advanced sinonasal AC.

Intestinal-Type Adenocarcinoma of the Sinonasal Tract: A Clinicopathologic Study of 18 Cases

Background

Intestinal-type adenocarcinoma (ITAC) of the nose and paranasal sinuses is a relatively rare tumor. It commonly affects subjects exposed to wood or leather dust.

Methods

The authors present the clinicopathologic findings of 18 cases of sinonasal ITACs and review the proposed histologic classifications.

Results

All patients, except one, were males; mean age was 60 years (range, 41-79); in 9 cases an occupational exposure to wood or leather dust was found. Common presenting symptoms were epistaxis, nasal obstruction and rhinorrhea. Histologically, tumors were divided into four groups: well-differentiated (G1) ITACs = 3 cases; moderately differentiated (G2) ITACs = 8 cases; poorly differentiated (G3) ITACs = 2 cases; mucinous (M) ITACs = 5 cases. Immunocytochemically, 16/17 cases were positive for carcinoembryonal antigen, 1/17 for somatostatin, and 0/16 cases for gastrin.

Conclusions

Sinonasal ITACs are aggressive tumors, often diagnosed in a relatively advanced stage. Owing the close similarity of the microscopic aspects, a histologic classification of ITACs analogous to that of colonic adenocarcinomas is proposed.

Intestinal-Type Adenocarcinoma of the Nasal Cavity and Paranasal Sinuses. A Clinicopathologic Study of 6 Cases

The clinical and pathologic features of 6 cases of intestinal-type adenocarcinoma of the sinonasal region are presented. These cases were collected in a 17 year period (1972-1988) and account for less than 4% of malignancies of this region in our records for this period. All of the patients were men aged 48 to 82 years (mean, 54 years). Previous exposure to wood dust was reported in 1 case. Radiographic studies, especially computerized tomography, were of critical importance to delineate the extent of tumors. Nasal obstruction was the most common compliant. Duration of symptoms prior to diagnosis is available in 5 cases and ranged from 5 to 36 months (mean 18 months). Surgical treatment was performed in 4 patients (of palliative type in 2) followed by radiotherapy in 3. Histo-pathology revealed tubulo-papillary (5 cases) and mucinous (1 case) patterns. Follow-up is available in all patients (range 0 to 108 months), 50% of whom are still alive. In our series, only 1 patient has survived more than 5 years. Data pooled from the literature reveal that 53% of patients have experienced local recurrences following therapy, and 60% have died of their disease. Of these deaths, 80% occurred within 5 years of diagnosis.

Intestinal-Type Adenocarcinoma: Classification, Immunophenotype, Molecular Features and Differential Diagnosis

Intestinal-type adenocarcinoma is the second most frequent sinonasal adenocarcinoma. High incidence of these tumors is seen among workers with occupational wood dust exposure, particularly of hardwood dusts. Intestinal-type adenocarcinoma has striking histomorphologic and immunophenotypic similarities with colorectal adenocarcinomas, but on the level of molecular pathologic mechanisms these tumors have their own specific features different from gastrointestinal tumors. This article provides an update on current histopathologic classification of intestinal-type adenocarcinomas, their immunophenotypic properties, recent advances in molecular pathologic features and differential diagnostic considerations.

Sinonasal Adenocarcinoma: Update on Classification, Immunophenotype and Molecular Features

Adenocarcinomas of the sinonasal tract may originate from respiratory surface epithelium or the underlying seromucinous glands. These malignancies are divided into salivary-type adenocarcinomas and non-salivary-type adenocarcinomas. The latter are further divided into intestinal-type and nonintestinal-type adenocarcinomas. This review provides an update on tumor classification, differential diagnostic considerations and molecular features, as well as new adenocarcinoma entities in the sinonasal area.

Nasal Cavity and Paranasal Sinuses

The nasal cavity and paranasal sinuses occupy the top of the upper respiratory tract and form pneumatic spaces connected with the atmosphere. They are located immediately beneath the base of the cranium, where crucial vital structures are harbored. From this region, very much exposed to airborne agents, arise some of the more complex and rare benign and malignant lesions seen in humans, whose difficulties in interpretation make this remarkable territory one of the most challenging in the practice of surgical pathology.

Contents of this chapter cover inflammations and infections, polyps and pseudotumors, fungal and midfacial destructive granulomatous lesions, as well as benign, borderline, and malignant neoplasms. Among the neoplasms, emphasis is made on those entities characteristic or even unique for the sinonasal region, such as Schneiderian papillomas, glomangiopericytoma, intestinal- and non-intestinal-type adenocarcinomas, olfactory neuroblastoma, nasal-type NK-/T-cell lymphoma, and teratocarcinosarcoma. Moreover, recently recognized entities involving this territory, i.e., HPV-related non-keratinizing carcinoma, NUT carcinoma, and SMARCB1-deficient basaloid carcinoma, are also discussed in the light of their specific molecular findings. Furthermore, the text is accompanied by numerous classical and recent references, several tables, and 100 illustrations.

Association between Occupational Exposure to Wood Dust and Cancer: A Systematic Review and Meta-Analysis

Objective

To perform a systematic review to analyze the association between occupational exposure to wood dust and cancer.

Methods

A systematic literature search of entries made in the MEDLINE-PubMed database between 1957 and 2013 was conducted to identify studies that had assessed the relationship between occupational exposure to wood dust and different types of cancer. A meta-analysis of selected case-control and cohort studies was subsequently performed.

Results

A total of 114 studies were identified and 70 were selected for review. Of these, 42 studies focused on the relationship between wood dust and nasal cancer (n = 22), lung cancer (n = 11), and other types of cancer (n = 9). Low-to-moderate quality evidence that wood dust acts as a carcinogen was obtained, and a stronger association between wood dust and nasal adenocarcinoma was observed. A lesser association between wood dust exposure and lung cancer was also observed. Several studies suggested that there is a relationship between wood dust and the onset of other cancers, although there was no evidence to establish an association. A meta-analysis that included four case-controls studies showed that workers exposed to wood dust exhibited higher rates of nasal adenocarcinoma than other workers (odds ratio = 10.28; 95% confidence interval: 5.92 and 17.85; P<0,0001), although a large degree of heterogeneity was found.

Conclusions

Low-to-moderate quality evidence supports a causal association between cancer and occupational exposure to wood dust, and this association was stronger for nasal adenocarcinoma than for lung cancer. There was no evidence of an association between wood dust exposure and the other cancers examined.

Adenocarcinoma of the upper aerodigestive tract

Although squamous cell carcinoma is the most frequent malignant diagnosis made with upper aerodigestive tract specimens, a myriad of neoplasms can occur throughout the area. Very uncommonly, one encounters adenocarcinomas that cannot be better classified as salivary gland-type neoplasia. This manuscript reviews these tumors, including sinonasal intestinal-type adenocarcinomas, sinonasal low-grade and high-grade nonintestinal adenocarcinomas and nasopharyngeal papillary adenocarcinomas. Clinical, histologic, and immunohistochemical features and differential diagnoses are discussed.

Nasenhöhle und Nasennebenhöhlen

Die Gesichtsmitte (der Bezirk zwischen Oberlippe und Stirn) entwickelt sich zwischen der 4. und 8. Schwangerschaftswoche. [ 220] Der Stirnfortsatz bildet sich währen der 4. postovulatorischen Woche, aus ihm gehen die oberen und mittleren Anteile des Gesichts hervor. Die Oberkiefer- und Nasenwülste entwickeln sich unterhalb des Stirnfortsatzes. Am Ende der 4. Woche bilden zwei oberflächliche Verdickungen der Nasenwülste die Riechplakoden, die ektodermaler Herkunft sind und aus denen der Epithelbelag der Nasenhöhle und Nasennebenhöhlen hervorgeht. Die Plakoden stülpen sich ein und bilden die Riechgruben, aus denen die vorderen Choanen (Nasenlöcher) und weniger oberflächlich die primitiven hinteren Choanen entstehen. Die medialen Nasen- und Stirnfortsätze bilden das Nasenseptum, die Stirnknochen, Nasenknochen, die Siebbeinzellen- Komplexe und die oberen Schneidezähne. Die lateralen Nasen- und Oberkieferfortsätze vereinigen sich zur Bildung des Philtrum und der Columella. Das knorpelige Nasenskelet bildet sich während der 7. und 8. postovulatorischen Woche tief unterhalb der Nasen- und Stirnbeinknochen aus dem Chondrocranium. Die Nasennebenhöhlen entwickeln sich in der 6. Fetalwoche aus den lateralen Nasenwänden, und ihr Wachstum setzt sich nach der Geburt während des gesamten Kindes- und Jugendalters fort.

[Sinonasal adenocarcinomas: our experience]

INTRODUCTION AND OBJECTIVES

Sinonasal adenocarcinoma is a rare epithelial cancer of the nasal cavities and paranasal sinuses and exposure to sawdust particles is a strong aetiological factor.

MATERIAL AND METHOD

Seventy-nine patients (78 men and 1 woman) operated on between 1986 and 2002 were studied.

RESULTS

In 62 patients (78.5 %) there was a history of exposure to wood dust. The clinical factors presenting statistical significance in the multivariate analysis with prognosis were: the exclusive invasion of the middle concha (as good prognosis), recurrence and invasion of the dura mater (as bad prognosis). The actuarial survival rate was 36 % at 5 years falling to 28 % at 10 years.

CONCLUSIONS

Exposure to wood dust, even over a short period of time, must be considered as a high risk factor for the development of a sinonasal adenocarcinoma. This tumour must be ruled out in all patients suffering any type of sinonasal pathology.

Differential diagnosis and treatment options in paranasal sinus cancers

Paranasal sinus malignancies are challenging to treat. Most patients present with advanced lesions, often with intracranial or intraorbital extension, and have a poor overall prognosis. Given the low incidence and diverse pathologies of paranasal sinus cancers, it is extremely difficult to perform prospective, randomized clinical trials to compare different treatment approaches. Improving the prognosis of these cancers continues to be a difficult task, even in light of advances in surgical techniques,radiation delivery techniques, and new chemotherapeutic agents. Cranio-facial resection techniques developed in the past few decades have cured many patients with skull base invasion, who would have been considered unresectable in the past. Furthermore, improvements in radiation therapy can allow more accurate administration to the desired region, with decreased damage to surrounding structures such as the orbit and brain. Aggressive and oncologically sound surgical resection combined with radiation therapy remains the treatment of choice for most patients.Finally, advances in the diagnosis and staging by use of molecular or DNA markers of tumor behavior may allow for more directed therapy.

Evidence of p53 immunohistochemical overexpression in ethmoidal mucosa of woodworkers

A high risk of neoplastic transformation of nasal and paranasal sinuses mucosa is related to the occupational exposure to wood dust, however no conclusive data have been reported up to now about morphological precursors of these tumors, mechanisms of carcinogenesis and role of p53 gene. Immunohistochemical overexpression of protein p53 (DO7 clone) by epithelial cells of ethmoidal mucosa was investigated on 60 woodworkers occupationally exposed for a minimum of 10 years, on 50 functional and/or esthetic nasal surgery patients (control group) and on 15 cases of intestinal-type adenocarcinoma, 10 of these involving subjects who had a longtime exposure to wood dust. In almost all the woodworkers (92%) the normal ciliated epithelium showed tracts of squamous metaplasia. The mean percentage of p53-positive cells in woodworkers and in controls was 28.6 and 7.97%, respectively, in metaplastic epithelium (P<0.001), 11.7 and 2.08% in ciliated epithelium (P<0.001), 12.46 and 1.03% (P<0.001) in the sero-mucous glands of the nasal stroma. Both in tracts of metaplastic epithelium and in those of ciliated epithelium, positive cells were distributed in basal and suprabasal layers. A high number of p53-positive cells was also observed in the normal ciliated epithelium close to the neoplastic cells, of intestinal-type adenocarcinomas affecting subjects with longtime exposure to wood dust. Moreover, a higher number of p53 positive neoplastic cells was showed by the cases occurring in occupationally exposed patients than by the others. The following conclusions can be drawn: (1) in the ethmoidal mucosa, a region at high risk of carcinogenesis in subjects exposed to wood dust, epithelial cells overexpress p53 protein, and this may be linked to the presence of p53 gene mutations; malignant transformation, as at other head and neck sites, may thus occur through this pathway; (2) the presence of p53 overexpression in sero-mucous glands is in keeping with the histogenesis of some tumors from these structures; (3) since tumors of nose and paranasal sinuses, mainly adenocarcinoma, are recognized as occupational neoplasias, immunohistochemical evaluation of p53, perhaps combined with molecular methods, could be the first step to detect subjects at high risk of carcinogenesis among woodworkers.

Schneiderian papillomas and nonsalivary glandular neoplasms of the head and neck

Schneiderian papillomas and nonsalivary glandular neoplasms of the head and neck continue to be a source of confusion for both the clinician and pathologist. An update on these lesions is provided.

Clinical relevance of the histological classification of sinonasal intestinal-type adenocarcinomas

To verify the prognostic value of the histological typing of intestinal-type adenocarcinoma (ITAC) of the sinonasal tract, 41 such lesions were separately classified by 2 pathologists both according to the World Health Organization (WHO) criteria for the histological typing of large intestine adenocarcinomas (well, moderately, poorly differentiated adenocarcinomas, and mucinous adenocarcinomas) and to the criteria of Kleinsasser and Schroeder (papillary-tubular cylinder cell type, alveolar-goblet cell type, signet-ring cell type, and transitional type). Using the WHO classification, 7 adenocarcinomas (17.1%) were well differentiated, 15 (36.6%) were moderately differentiated, and 6 (14.6%) were poorly differentiated; 13 cases (31.7%) were classified as mucinous adenocarcinoma. Following the Kleinsasser and Schroeder classification, 28 adenocarcinomas were of the papillary-tubular cylinder cell type (PTCC), 6 tumors (14.6%) were of the alveolar-goblet cell type (AGC), 1 (2.4%) was of the signet-ring cell (SRC) type, and 6 (14.6%) were of the transitional (TR) type. The interrater agreement in subtyping for both histological classifications was 92.6% (kappa, 0.89; P < .001). Kaplan-Meier analysis of cases stratified according to WHO classification showed that patients with mucinous and poorly differentiated adenocarcinomas had a significantly shorter disease-free interval and survival rate than patients with well and moderately differentiated adenocarcinomas (P = .02 and P < .001, respectively; log-rank test). Separate evaluation of survival for patients with AGC and TR adenocarcinomas did not show any statistically significant difference (P = .5). Clinical stage was advanced in most cases (92.6% of patients had T3 or T4 carcinomas) and had no prognostic relevance in the current series, as did treatment and occupational exposure. We conclude that the histological typing of ITACs is highly reproducible and appears to be related to the clinical outcome of the tumors. Adenocarcinomas with a prominent (>50%) mucinous component tend to have a similar clinical behavior, irrespective of their cyto-architectural features and the presence of an associated tubulopapillary component. Therefore, the separation into alveolar-goblet, signet-ring, and transitional forms has no prognostic impact.

Work-related symptoms and dose-response relationships for personal exposures and pulmonary function among woodworkers

BACKGROUND

Four sawmills, a wood chipping mill, and five joineries in New South Wales, Australia, were studied for the effects of personal exposure to wood dust, endotoxins. (1-->3)-beta-D-glucans, Gram-negative bacteria, and fungi on lung function among woodworkers.

METHODS

Personal inhalable and respirable dust sampling was carried out. The lung function tests of workers were conducted before and after a workshift.

RESULTS

The mean percentage cross-shift decrease in lung function was markedly high for woodworkers compared with the controls. Dose-response relationships among personal exposures and percentage cross-shift decrease in lung function and percentage predicted lung function were more pronounced among joinery workers compared with sawmill and chip mill workers. Woodworkers had markedly high prevalence of regular cough, phlegm, and chronic bronchitis compared with controls. Significant associations were found between percentage cross-shift decrease in FVC and regular phlegm and blocked nose among sawmill and chip mill workers. Both joinery workers and sawmill and chip mill workers showed significant relationships between percentage predicted lung function (FVC, FEV1, FEV1/FVC, FEF25-75%) and respiratory symptoms.

CONCLUSIONS

Wood dust and biohazards associated with wood dust are potential health hazards and should be controlled.

Anterior craniofacial resection for malignant ethmoid tumors--a series of 91 patients

BACKGROUND

Anterior craniofacial resection is now recognized as the best treatment for ethmoid tumors involving the cribriform plate with or without invasion of anterior cranial fossa.

METHODS

Ninety-one patients underwent an anterior craniofacial resection for ethmoid malignant tumors at the Milan Cancer Institute between 1987 and 1994. The patient population was divided into two sections (30 and 61 patients) based upon some important variants (type of craniotomy, antibiotic treatment, postoperative care).

RESULTS

The mean age was 53.4 years (range, 24 to 78 years). There were 62 men and 29 women. Forty-nine patients had a recurrence after previous treatments (surgery and/or radiotherapy). The subdivision by histology was as follows: 50 cases of adenocarcinoma, 16 cases of epidermoid and undifferentiated carcinoma, 8 cases of esthesioneuroblastoma, 5 cases of adenoid cystic carcinoma, 5 cases of melanoma, and 6 rare tumors. The stages (according to our new staging) were as follows: 37 cases with T2, 27 cases with T3, and 27 cases with T4. The mean follow-up was 47 months. Seven patients died after surgery (6 in the first series). The survival at 3 and 5 years was, respectively, 52% and 47%, and the disease-free survival (DFS) was 30% and 24%, with a statistically significant difference at multivariate analysis in favor of patients without prior treatment (p = .033) or T2 versus T3 and T4 (p<.007).

CONCLUSIONS

An anterior craniofacial resection should be performed in cases of ethmoid tumors reaching or eroding the cribriform plate. A scrupulous intra- and postoperative approach is necessary to avoid severe complications. The patients often survive for a long time with recurrence ongoing. Our new staging identifies the critical extensions of ethmoid tumors.

Carcinogenic response of the nasal cavity to inhaled chemical mixtures

Nasal cancers occur in experimental animals following chronic exposure to a wide range of inhaled chemicals. Although exposure to several of these chemicals is common in industrial as well as domestic environments, epidemiological studies have not provided convincing evidence that exposure to these chemicals individually is associated with nasal cancer in humans. The reverse seems to be true for inhalation of chemical mixtures. The evidence for nasal carcinogenicity of inhaled chemical mixtures in experimental animals is very limited, while there is ample evidence in humans that occupational exposure to certain chemical mixtures is associated with increased risk of nasal cancer. Examples of such (complex) chemical mixtures are wood dust, textile dust, chromium- and nickel-containing materials and leather dust. It is remarkable that these mixtures are aerosols, suggesting that a 'dusty working environment' may increase nasal cancer risk.

Adenocarcinoma of the ethmoid sinus

BACKGROUND

Carcinoma of the paranasal sinuses is rare. The majority of these originate in the maxillary sinus with primary ethmoid carcinomas occurring in up to 20% of cases. Adenocarcinomas comprise up to 50% of the ethmoid malignancy. The relative rarity of tumors originating in this area has led to their inclusion in series that consist mainly of maxillary antral tumors.

METHODS

A retrospective chart review of all patients presenting with primary ethmoid adenocarcinoma at West Virginia University Hospitals between 1988 and 1993 was undertaken. Only patients whose epicenter was believed to be in the ethmoids were included in this analysis. CT scans, MRIs, operative notes, pathology, and final outcome were all analyzed.

RESULTS

Eight patients with primary ethmoid adenocarcinoma were treated during this time span. The male to female ratio was 1:1 with a mean age of 50 years. Symptoms had been present from 3 to 18 months (mean 8 months). All patients underwent craniofacial resection with 5 patients receiving postoperative radiotherapy. Pathologically 4 patients had cribriform plate erosion, 2 had dural involvement, and 1 had extension into the sphenoid sinus. With a mean follow-up of 45 months (9-71 months) 7 patients are disease free and 1 patient has died of disease.

CONCLUSIONS

Obtaining clear margins by craniofacial resection is essential to the management of adenocarcinoma of the ethmoid sinuses. Radiotherapy is reserved for positive margins, cribriform plate penetration, dural invasion, and high-grade lesions that are close to the cribriform plate. Local control was obtained in 87% of our patients.

Carcinogenic effects of wood dust: review and discussion

Occupational exposure to wood dust (alone or chemically treated) is associated with an increased risk of developing adenocarcinoma of the nasal cavity. The specific causative agents, i.e., wood dust alone (natural products), wood dust with additives used in the processing or manufacturing of wood products, and/or physical determinants of wood dust and the associated risk factors, are not known or understood. The strongest association of exposure to wood dust and development of nasal cancer is observed in those occupations where workers are exposed to hard wood dust and chemical additives are not used. The time between first occupational exposure to wood dust and the development of adenocarcinoma of the nasal cavity averages 40 years (range 7-70 years). The epidemiological data available are not sufficient to make a definitive assessment between wood dust exposure and increased risk for cancer other than nasal cancer. The toxicity, mutagenicity, and carcinogenicity of wood dust to laboratory animals or in vitro with animal or microbial cells have not been thoroughly studied. Thus there is no direct experimental evidence on the potential hazards of wood dust. Data are insufficient or lacking on 1) wood dust exposure levels in ambient air and worker's breathing zone, and the deposition in the nasal cavity; 2) hard vs. soft wood dusts; 3) particle size and shape; 4) chemical composition of wood dust and the extent of contamination with chemical additives; and 5) interaction between inhaled wood dust, chronic irritation, and tobacco smoking. These data are required so that one can understand the association between wood dust exposure and nasal cavity tumors, along with demographic differences in cancer rates, and to develop strategies for intervention and reduction of disease causing agents in order to reduce risk to wood industry workers.

Preinvasive stages of adenocarcinoma of the nose after exposure to wood dust

The early stages of adenocarcinoma of the nose due to exposure to beech and oak wood dust show superficial preinvasive growth. The papillary and tubular structures of this "adenocarcinoma in situ" are identical with those of invasive adenocarcinomas. There are no indications that cuboid or squamous metaplasia precedes the development of this type of carcinoma.

Pharyngeal adenocarcinoma with intestinal features

A high grade adenocarcinoma arising primarily in the pharynx of a 67-year-old man is presented. A CT-scan revealed a tumour mass growing in the pharynx, largely affecting parapharyngeal soft tissues. Lymph node metastases were found at clinical presentation. Both morphological and immunohistochemical studies displayed similar features to those of intestinal origin. To our knowledge, no previous examples of such neoplasm have been reported at this site. Its possible histogenetical origin is discussed.

A New Zealand Cancer Registry-based study of cancer in wood workers

Wood workers have been previously reported to be at higher risk for the development of cancers of certain sites, including the nasal cavity, paranasal sinuses, lung, stomach, and lymphatic and hemopoietic tissues. Wood work involves exposure to a variety of potential carcinogens, including wood dust itself, chemicals applied to the wood, and other carcinogenic agents that are associated with wood work. We report a series of case-control studies based on the New Zealand Cancer Registry. These studies involved 19,904 male patients registered with cancer from 1980 to 1984 who were 20 years of age or older at the time of registration. For each cancer site studied, the registrants for all other sites (except lung cancer) formed the control group. The following four cancer sites were found to be associated with wood work: lip, nasopharynx, lung, and liver. There was little evidence of increased risks for other cancer sites. Among wood workers, sawmillers experienced the highest risks for lung cancer (odds ratio, 1.76; 95% confidence interval, 1.23 to 2.52) and liver cancer (odds ratio, 3.55; 95% confidence interval, 1.09 to 0.14). Carpenters showed increased risks for lip cancer (odds ratio, 2.28; 95% confidence interval, 1.23 to 4.14) and lung cancer (odds ratio, 1.27; 95% confidence interval, 1.05 to 1.54). The increased risk of nasopharyngeal cancer was strongest for foresters and loggers (odds ratio, 6.02; 95% confidence interval, 1.01 to 28.41).

Adenocarcinoma of the ethmoid sinuses in High Wycombe 1986

Adenocarcinoma of the ethmoid sinus is a rare cancer in this country but relatively common in High Wycombe because of the concentration of furniture factories in this area. The management of five cases occurring recently in the High Wycombe area is described and changes in management since 1960 discussed.

Cancer epidemiology of woodworking

The literature published between 1965 and 1989 on the cancer epidemiology of woodworking in furniture industries and carpentry shops in 17 countries is reviewed. Included are some unpublished data obtained through personal communication with epidemiologists or collected from doctoral dissertations. Of 5,785 cases with sino-nasal cancers, about 23% were found to be woodworkers. Dusty jobs, especially wood processing using high-speed machines, are mainly associated with the enhanced incidence of nasal adenocarcinomas. The latency periods of the latter tumors ranged from 7 to 69 years in five European countries. A variety of neoplasias of the respiratory, digestive, and urinary tracts as well as the hemopoietic and lymphatic systems, including Hodgkin's disease are reported to be significantly associated with occupational exposure to wood dust. These data suggest that the exposure to some types of wood dust might cause a systemic rather than local neoplastic disorder.

Occupation and squamous cell cancers of the pharynx and sinonasal cavity

Lifetime job histories from a population-based case-control study of squamous cell carcinomas of the oro- and hypopharynx (OHPC), nasopharynx (NPC), and sinonasal cavity (SNC) were systematically examined to generate new hypotheses as well as to test previously noted associations between occupation and the cancers under study. The effects of both duration of employment in a particular job and the timing of the employment in relation to cancer diagnosis were investigated in a stratified analysis that controlled for cigarette smoking, alcohol intake, and other major risk factors. Overall, data on 231 cases and 552 controls were analyzed. Occupations at increased risk of OHPC included "food service" workers in the "retail trade" industry (odds ratio = 1.9; 95% confidence interval = 1.0-3.6), "vehicle mechanics" in the "repair services" industry (OR = 2.5; CI = 0.8-8.3), "industrial mechanics" (OR = 31.0; CI = 3.0-315.1), and "carpenters" in the "construction" industry (OR = 1.5; CI = 0.7-3.4). For NPC, similar patterns of increased risk were found for "food service" workers and "vehicle mechanics." For "carpenters" in the "construction" industry, the relative risk estimate was almost five (OR = 4.8; CI = 1.2-19.4). Increases in SNC risk were noted for "food service" workers, as well as a number of occupations in the "lumber and wood product manufacturing" industry, including "forestry and logging" (OR = 2.0; CI = 0.5-8.2), and "wood working machine operators" (OR = 7.9; CI = 1.6-39.2). In each of these instances, the relative risk estimates increased with increasing duration in the job and when a 15-year induction/latency period was taken into account.

Cancer in the respiratory organs of Swedish farmers

In a cohort of 254,417 male Swedish farmers (4,330,717 person-years) the incidence of cancer of the respiratory organs was compared to a reference cohort of 1,725,845 men (30,131,664 person-years) employed in other economic activities than agriculture or forestry. In the study cohort 1450 cases of cancer in the respiratory organs were found in 1961 to 1979 resulting in an estimated relative risk (RR) of 0.38 (95% confidence interval [CI]: 0.36-0.40). For cancer of trachea, bronchus and lung, the decreased risk was equal for adenocarcinoma and squamous cell carcinoma. No time related trend in RR for any of the histologic subtypes could be seen. However, for squamous cell carcinoma in nose and nasal sinuses RR has increased from 0.42 (95% CI: 0.20-0.80) in 1961 to 1966 to 2.06 (95% CI: 1.22-3.50) in 1974 to 1979.

The epidemiology of malignant neoplasms of the nasal cavities, the paranasal sinuses and the middle ear in Canada

Canadian patterns of morbidity and mortality from malignancies of the nasal cavities, the paranasal sinuses and the middle ear for the periods 1970-1980 and 1970-1984 have been examined. Age-standardized morbidity rates have not changed significantly during 1970-1980 for either males (P = 0.65) or females (P = 0.96). Analysis of age-specific morbidity rates revealed that rates of change for male rates have also remained stable during this period for all age groups studied (P greater than 0.29). For females, rates of change for seven of eight age groups examined also failed to achieve statistical significance (P greater than 0.30). However, rates for females aged 45-54 have shown an increase of 0.35 additional new cases per 1,000,000 population per year. This finding is of borderline significance (P = 0.051). In contrast, age-standardized mortality rates have declined significantly during 1970-1984 by, on average, 0.08 and 0.07 fewer deaths per 1,000,000 population per year in males and females respectively. Analysis of age-specific mortality rates reveals that the declines in mortality are attributable to significant reductions in age-specific rates for males aged 65-74 and 85+ and females aged 0-24, 55-64, and 85+. In these groups rates have declined by as much as 4.1 fewer deaths per 1,000,000 population per year (P less than 0.045).

A case-control study of nasal cancers. An occupational survey

A case-control study on the possible association between nasal cancers (NC) and occupations was undertaken for 107 male patients with nasal or paranasal cancer and 413 patients with other otorhinolaryngological disease (controls) admitted during the past 10 years to the Department of Otorhinolaryngology, Tohoku University Hospital. The controls were matched by sex, age, and time of admission. However, in the occupational groups surveyed, no evidence such as reported in England and other countries was obtained that could confirm the relationship between nasal/paranasal cancers and woodwork (especially furniture making). Although the relative risk of NC for farmers, foresters, carpenters and plasterers was found to be approximately 2, occupational exposure was hardly considered to be a likely cause. Instead, some common factors involved in the life style including dietary customs of people engaged in these occupations seemed to play a role in the increased relative risks.

Nasal cancer in the textile and clothing industries

A case-control study of 160 patients with cancers of the nasal cavity and paranasal sinuses and 290 controls showed an excess risk associated with employment in the textile or clothing industries, with the increase (relative risk [RR] = 2.1) found only among female workers. There was, however, no increasing trend in risk with years of employment or duration since first exposure. Both male and female workers were at an increased risk of adenocarcinoma (RR = 2.5), with further enhancement of risks for those experiencing dusty work conditions. Although aetiological inferences cannot be drawn from this study, the finding of raised risk supports some previous observations and the need for further investigation of the cancer experienced by textile and clothing workers.

Respiratory cancers in furniture workers

In a 19 year follow up study of 8141 furniture workers nasal adenocarcinoma was 63 X 4 times more common than expected. The findings also indicate an excess risk of adenocarcinoma of the maxillary sinus. No increase in risk was found for laryngeal cancer, lung cancer, or sinonasal cancers other than adenocarcinoma.

Sinonasal cancer and exposure to softwood

In order to study the connection between occupation and sinonasal cancer we have reviewed the files and histological sections of 70 patients (24 females and 46 males) treated at the Department of Oto-rhino-laryngology, National Hospital of Norway. Detailed information concerning previous occupations was obtained by telephone interviews according to a standardized questionnaire. This pilot study revealed a strong association between wood dust exposure and sinonasal cancer. Of 12 wood dust exposed men, 11 had been exposed exclusively to softwood. While squamous cell carcinoma was the predominant type of cancer in joiners, carpenters and loggers, non-Hodgkin lymphomas appeared to be associated with employment in saw- and planingmill firms. A nationwide case-control study is under preparation for further substantiation of the health hazards connected with exposure to softwood and other possible occupational factors related to sinonasal cancer.

Health hazards of natural and introduced chemical components of boatbuilding woods

The major components of untreated wood--cellulose, hemicellulose, and lignin--have not been implicated as toxicants, but extractive substances, especially in heartwood, can be toxic. Decay-resistant woods are more likely to contain irritants or sensitizers than nondurable woods. Short-term exposures to certain wood dusts may result in asthma, conjunctivitis, rhinitis, or allergic dermatitis, but long-term effects may include nasal cancer and Hodgkin's disease. Some thermophilic microorganisms found in wood are human pathogens, and septic splinters (chromomycosis) and inhalation of ascomycete spores from stored wood chips have been implicated in human illnesses. Reconstituted wood can contain formaldehyde resins, which pose health risks in enclosed humid areas. Pentachlorophenol (PCP)-treated wood is particularly toxic--short-term exposures to PCP-treating solutions can lead to aplastic anemia and mortality, while diseases such as Hodgkin's disease are associated with long-term exposures. Since much commercial lumber is dipped in PCP, the separation of the chronic effects of wood dust from PCP exposure is difficult. Chromated copper arsenate (CCA)- and ammoniacal copper arsenite (ACA)-treated wood may leach arsenic. CCA-treated wood is potentially safer, since it contains the pentavalent arsenic, which is a common constituent in the environment. ACA contains the trivalent arsenic, which is more toxic.

Adenocarcinoma of the ethmoid sinuses. A review of 28 cases with special reference to wood dust exposure

Adenocarcinoma makes up only a small percent of all nasal and paranasal sinus carcinomas, and is most often found in the ethmoid sinuses. Adenocarcinoma of the ethmoid sinuses is known to be associated with exposure to wood dust. Twenty-eight patients with ethmoid adenocarcinomas were collected, mainly during the last decade from a region with approximately 900,000 inhabitants and with a large amount of furniture industries. There were 4 women and 24 men in the study. Twenty of the men were exposed to dust from hardwood for 20 to 55 years (mean, 40 years) which is in accord with other reports and supports data on the increased risk for workers of developing adenocarcinoma of the ethmoid sinuses when exposed to dust from hardwood. Radiologic diagnosis is necessary to delineate the extent of these tumours, and computerized tomography (CT) especially furnishes important information. Most patients received preoperative radiotherapy followed by surgery, 50% of them survived 5 years, which is in accord with other reports.

Non-mutagenicity of some wood-related compounds in the bacterial/microsome plate incorporation and microsuspension assays

Seven commercially available wood-related compounds have been tested for mutagenicity by the use of the Ames and fluctuation test-systems. All compounds were found to be non-mutagenic. Among these compounds, 2,6-dimethoxy-p-benzoquinone showed a very weak and questionable mutagenic activity against Salmonella typhimurium TA 100. In this connection, probable causes of nasal adenocarcinoma of woodworkers are briefly discussed.

Malignant tumors of the paranasal sinuses: radiologic, clinical, and histopathologic evaluation of 200 cases

Malignant tumors of the paranasal sinuses are often found to be greatly advanced by the time a clinical or radiologic diagnosis is established. Therefore, the overall cure rate is low, even when surgery and radiation therapy are combined. The clinical manifestations and pathologic findings are analyzed in 200 cases to illustrate the wide spectrum of these tumors as to their type, specific location, and the extent to which they can spread within the sinuses and to adjacent anatomic areas. The various radiologic modalities, including conventional x-ray films, angiography, and conventional and computed tomography are presented. Their relative merit in the diagnosis and staging of these tumors is evaluated.

Epidemiological study of nasal and nasopharyngeal cancer and their relation to phenoxy acid or chlorophenol exposure

Soft tissue sarcoma and malignant lymphoma have been related to exposure to chlorinated phenoxy acids or chlorophenols as well as exposure to organic solvents and malignant lymphoma. However, colon cancer studied by the same case-referent design did not show any such associations, which helps to rule out alleged systematical bias of the study approach. Further considerations about exposure routes for phenoxy acids and chlorophenols suggested that nasal and nasopharyngeal cancers should be studied. Forty-four cases with nasal cancer and 27 cases with nasopharyngeal cancer were eligible for study during 1970-1979 together with 541 referents, as utilized also in the aforementioned studies. Exposure to phenoxy acids gave formally a doubled but insignificant risk for the studied cancer types. Exposure to chlorophenols, as present particularly in woodwork, was related to an about sevenfold and significant increase in the risk for both cancer types. In woodworkers without exposure to chlorophenols there was an approximate normal risk, but cabinet makers, even without exposure to chlorophenols, had nearly doubled (but insignificant) risk of nasal cancer.