[Malignomas of the nasal cavity and the paranasal sinuses: clinical characteristics, therapy and prognosis of different tumor types]

A review of the clinicopathological and radiological features of unilateral nasal mass

Unilateral sinonasal pathology are common presentations but are regarded with caution as neoplastic conditions during their early stages may mimic an inflammatory pathology. The aim of the review was to analyse the varied presentations of patients with unilateral nasal mass and to identify features suggestive of neoplastic pathology. A retrospective review of all cases of unilateral nasal mass/polyp from Jan 09 to Jan 10 presenting at a tertiary care hospital were analysed. The patients were grouped as per their histopathological diagnosis as inflammatory and neoplastic. The demographic data, presenting symptoms, radiological and histopathological findings were compared between the two groups. Out of the 53 patients of unilateral nasal mass, 44 (83.1%) had inflammatory conditions and 9 (16.9%) had neoplastic conditions. Benign nasal polyp and inverted papilloma were the commonest inflammatory and neoplastic condition. Neoplastic conditions were significantly commoner in males (P = 0.0315) and in the age group above 50 years (P = 0.0046). Epistaxis and extranasal symptoms like facial pain, dental and orbital complaints were found to be significantly higher in neoplastic conditions. Neoplastic lesions of nose and paranasal sinus are one of the most challenging conditions that otolaryngologists have to diagnose and treat due to their hidden nature and late presentations. In our review neoplastic conditions were found to be higher in elderly male with epistaxis, extranasal symptoms and presence of extensive soft tissue involvement and bony destruction on CT scan. The clinician should have a high index of suspicion to rule out a neoplastic aetiology in all cases of unilateral nasal mass.

Characterization of initial clinical symptoms and risk factors for sinonasal adenocarcinomas: results of a case-control study

PURPOSE

Sinonasal adenocarcinoma is a rare cancer, frequently associated with occupational exposure to inhalable wood dust. Among the EU member States, Germany was reported to have the highest number of exposed workers. Location and long latency make early diagnosis difficult. This case-control study was aimed at assessing potential risk factors and at characterizing initial clinical symptoms, both serving as matrix to identify persons at increased risk and to improve management of this cancer.

METHODS

Of 58 patients, 31 diagnosed with sinonasal adenocarcinoma (cases) between 1973 and 2007 were identified and underwent standardized interview on clinical data. A total of 85 patients diagnosed over the same period with carcinoma of the oral cavity served as controls.

RESULTS

The ethmoid was confirmed as the predominant site of adenocarcinoma associated with wood dust exposure, whereas the nasal cavity was most commonly affected in patients denying any exposure to wood dust. Cases were significantly engaged in mainly woodworking occupations compared to controls. The main initial clinical symptoms were nasal obstruction 6 months (71%) and epistaxis 4 years (41.9%) prior to diagnosis. Hardwood dust from beech and oak proved to be the most common occupational exposure, with a mean exposure period of 32.3 years and a latency of 43.5 (34-58) years.

CONCLUSIONS

Our investigation confirms the importance of regular screenings for persons exposed to wood dust even years after the end of occupational or private exposure. Banal clinical symptoms such as epistaxis and nasal obstruction might be predictive, requiring early and thorough investigation.

Endoscopic minimal access surgery in nasal and sinus tumours: lessons from initial experience

The role of endoscopic techniques in the treatment of Nose and Para-Nasal Sinus tumours is the subject of wide debate. Technical advances in skills, imaging and instrumentation have resulted in Endoscopic Minimal Access Surgery gaining wide acceptance in the treatment of benign tumours. The place of endoscopes in malignant disease is more controversial. Defining the aims of endoscopic surgery is key to achieving a successful outcome. Experience with these new technologies and strategies should be gathered in a Clinical Network and Multi-Disciplinary Team setting, with planned long-term follow up. We report our initial experience of 33 patients managed with EMAS (27 curative, six debulking/palliative cases). Initial experience of the transition from the benign to malignant arenas supports a continued, cautious, structured evaluation of the endoscopic approach.