Biphenotypic sinonasal sarcoma: European multicentre case-series and systematic literature review

Objective

Biphenotypic sinonasal sarcoma (BSNS) is a rare low-grade cancer that was included from the 4th edition of WHO classification of head and neck tumours. The purpose of this study is to analyse clinical behaviour, pattern of recurrences and survival outcomes of this neoplasm.

Methods

Retrospective review of patients affected by BSNS who were treated via an endoscopic-assisted approach in 6 European tertiary-care referral hospitals. Cases of BSNS described in literature since 2012 to date were fully reviewed, according to PRISMA guidelines.

Results

A total of 15 patients were included. Seven patients were treated via an endoscopic endonasal approach, 4 with endoscopic transnasal craniectomy, and 4 via a cranio-endoscopic approach. Adjuvant treatment was delivered in 2 cases. After a mean follow-up of 27.3 months, systemic metastasis was observed in 1 case; the 5-year overall survival and disease-free survival rates were 100% and 80 ± 17.9%, respectively.

Conclusions

BSNS is a locally aggressive tumour with a low recurrence rate and encouraging survival outcomes if properly treated with surgical resection and free margins followed by adjuvant radiotherapy for selected cases. Endoscopic-assisted surgery is safe and effective as an upfront treatment within a multidisciplinary care protocol.

Primary Intracranial Adenoid cystic carcinoma: report of three cases

Objective: Nasal cavity and paranasal sinuses host a variety of malignant tumors with adenoid cystic carcinoma (ACC) being the most frequent cancer of salivary gland origin. The histological origin of such tumors virtually precludes a primarily intracranial localization. The aim of this study is to report cases of primarily intracranial ACC without evidence of other primary lesions at the end of an exhaustive diagnostic workup. Methods: An electronic medical record search complemented by manual searching was conducted to identify prospective and retrospective cases of intracranial ACCs treated in Endoscopic Skull Base Centre Athens (ESA) at the Hygeia Hospital, Athens from 2010 until 2021 with a mean follow-up time of at least 3 years. Patients were included if after complete diagnostic work up there was no evidence of a nasal or paranasal sinus primary lesion and extension of the ACC. All patients were treated with a combination of endoscopic surgery performed by the senior author followed by radiotherapy (RT) and/or chemotherapy. Results: Three unique illustrative cases (ACC involving the clivus, cavernous sinus and pterygopalatine fossa, one orbital ACC with pterygopalatine fossa and cavernous sinus involvement and one involving cavernous sinus, Meckel’s Cave with extension to the foramen rotundum) were identified. All patients underwent subsequently proton or carbon ion beam radiation therapy. Conclusions: Primary intracranial ACCs constitute an extremely rare clinical entity with atypical presentation, challenging diagnostic workup and management. The design of an international web-based database with a detailed report of these tumors would be extremely helpful.

Social Factors in the Development of Chronic Rhinosinusitis: a Systematic Review

PURPOSE OF REVIEW

In an era where prevention is paramount, understanding social factors for chronic rhinosinusitis (CRS) may facilitate preventive interventions that mitigate risk factors associated with the initiation or progression of the disease.

RECENT FINDINGS

Both passive and active smoking are clearly and unequivocally associated with both the incidence and the severity of rhinosinusitis, while there an increasing body of evidence linking social deprivation and low socioeconomic status with rhinosinusitis and its complications. However, overall, only a handful of studies were longitudinal, while the available studies suffer from lack of standardized definitions of rhinosinusitis. In this systematic review, we assessed the available evidence linking CRS with social factors, such as socioeconomic status and class, educational status, family status, living and working location and conditions, and use of toxins or recreational drugs as well as exercise and diet. Thirty studies from 1995 onwards fulfilled our inclusion criteria and were used for this review. Social deprivation and low socioeconomic level seem to be directly associated with rhinosinusitis, as there are pollutants in living or working environment. A clear and direct association between smoking (both active and passive) and rhinosinusitis was also shown. However, the link between rhinosinusitis and education level, and exercise and diet, if any, seems to be more complex.

EEG correlates of cerebral engagement in reading tasks

This study evaluated the utility of electroencephalographic (EEG) measures as indices of regional cerebral engagement activation during reading in neurologically intact adult volunteers. EEG was recorded from 16 scalp locations as participants performed four visual detection tasks designed to tap into increasingly more complex operations regularly involved in reading, namely visual-spatial, orthographic, phonological, and semantic. EEG records were quantified using power spectrum measures in four frequency bands (delta, theta, alpha, beta1, and beta2), in addition to a non-linear estimate of signal complexity (prediction error). Results showed that (1) changes in spectral power between pairs of reading tasks, and (2) regional variations in EEG measures for each task, were restricted to signals recorded over the left hemisphere. These findings are in agreement with knowledge regarding left hemisphere involvement in higher level component processes of reading.

Usefulness of non-linear EEG analysis

Spectral analysis methods are useful for the evaluation of EEG signals. Nevertheless, they refer only to the frequency domain and ignore any potentially interesting phase information. Analytical methods based upon the theory of nonlinear dynamics provides this and additional information. We used both methods to evaluate the EEG signals of volunteers performing two distinct mental arithmetic tasks. We extracted the power spectrum, the coherence and nonlinear parameters (dimension, the first Lyapunov exponent, the Kolmogorov entropy, the mutual dimension and the dimensions based upon spatial embedding of the original data as well as their surrogates). We found that 1) the spatial embedding dimension differed from that of the surrogates, indicating nonlinearity, 2) there were differences between the two arithmetic tasks, and 3) the spectral and nonlinear methods differ in terms of the information they provide. Our results indicate that nonlinear analysis methods can be useful despite the fact that they are still at an early stage of development.