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Oto Board Pearls of Wisdom - Section III Diseases, Disorders, and Conditions > 24 Neoplastic - Nose/NP > Flashcards

24 Neoplastic - Nose/NP Flashcards

1
Q

NP CA accounts for what % of all CA dx in Kwangtung province of southern China

A

20%

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2
Q

Incidence of NP CA among native born Chinese vs Caucasians

A

118x higher

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3
Q

Incidence of NP CA among North American born Chinese vs Caucasians

A

7x higher

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4
Q

What EBV product is likely to play a role in malignant transformation of NP epithelium

A

Latent membrane protein (LMP-1)

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5
Q

What environmental factor is most strongly linked to NP CA

A

Frequent consumption of dried salted fish

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6
Q

What is the 5 yr survival of pts with WHO II or III dz

A

70%

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7
Q

5 yr survival of pts with WHO I dz

A

30%

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8
Q

M/c site of origin of NP CA

A

fossa of rosenmuller

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9
Q

Which nodal groups does NP CA spread to

A

Retropharyngeal nodes of Rouviere, jugulodigastric nodes, spinal accessory chain

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10
Q

In the staging system described by Ho, poorer prognosis is associated with cervical mets to which area of the neck

A

Inferior to a plane spanning from CONTRA sternal head of clavicle to IPSI superior margin of trapezius

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11
Q

T/F: The presence of unilateral vs b/l nodal dz in pts with NP CA has no prog significance

A

True

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12
Q

Incidence of skull base erosion on pts w/ NP CA

A

25%

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13
Q

M/c site of distant mets from NP CA

A

bone

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14
Q

Smooth, submucosal NP masses located in the midline are most often what

A

Embryologic remnants (Thornwaldt’s cysts, pharyngeal bursa remnants)

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15
Q

What factors described by Ho and Neel are regarded as important adverse prognostic indicators in pts with NP CA

A
  • Length and symptomatology of dz
  • extension of tumor outside of NP
  • presence of inferior cervical nodes
  • keratinizing histo architecture (WHO I)
  • cranial nerve and skull base extension
  • distant mets
  • low ADCC titers
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16
Q

Extension into which space is a/w worst prog in pts with NP CA

A

Anterior masticator space

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17
Q

What is the primary tx modality for NP CA

A

RT to the NP (66-70 Gy) and neck (60 Gy)

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18
Q

Why is the clinically negative neck treated in NP CA

A

Studies have shown improved local control and dz-free survival for ppx irradiation of the clinically negative neck in pts w/ NP CA

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19
Q

What are the complications from RT over-dosage in the tx of NP CA

A

Osteoradionecrosis, brain necrosis, transverse myelitis (45 Gy), hearing loss, hypopituitarism, hypoT, optic necrosis

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20
Q

What is the role of induction chemo for tx of NP CA

A

No survival advantage has been proven

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21
Q

What is the standard tx protocol for stage III and IV NP CA

A

Concomitant cisplatin and RT followed by adjuvant chemo with cisplatin and 5-FU

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22
Q

How does tx failure usu manifest in NP CA

A

Dz at both primary site and cervical LN

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23
Q

What is m/c site of recurrent/persistent NP CA

A

Lateral wall of NP

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24
Q

What are the tx options for recurrent/persistent NP CA at primary site

A

Reirradiation w/ larger therapeutic dose that initial tx; stereotactic RT; brachytherapy w/ split plate implantation of radioactive gold grains; surgical resection

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25
Q

What is m/c benign sinonasal neoplasm

A

Inverting papilloma

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26
Q

What is m/c malig sinonasal neoplasm

A

SCCa (80%)

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27
Q

What is 2nd m/c malign sinonasal neoplasm

A

Adenocarcinoma

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28
Q

M/c location of sinonasal SCCa

A

Maxillary sinus > nasal cavity > ethmoids

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29
Q

Are elective ND warranted in pts with sinonasal SCCa

A

No, incidence of occult cervical mets is 10%

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30
Q

Percent of sinonasal tumors attributable to occupational exposures

A

44%

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31
Q

Where do these tumors most often originate

A

Lateral nasal wall, adjacent to MT

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32
Q

Which substances are thought to predispose to sinonasal neoplasms

A

Nickel, chromium, isopropyl oils, volatile hydrocarbons, organic fibers from wood, shoe, and textile refineries

33
Q

Which of these is classically a/w SCCa

A

Nickel

34
Q

Which of these are classically a/w adenoCA

A

Hardwood dust and leather tanning substances

35
Q

Which virus is thought to play a role in etiology of sinonasal tumors

A

HPV, 6 and 12

36
Q

T/F: Smoking by itself is not a significant etiologic factor for sinonasal tumors

A

True

37
Q

Which nasal masses should not be biopsied in clinic

A

Masses in kids or adolescents and masses suspicious for angiofibroma

some recommend delaying bx of any nasal mass until after imaging has been obtained

38
Q

What are the 3 subtypes of Schneiderian papillomas

A

Fungiform, inverting, and cylindrical

39
Q

Where do inverting papillomas most commonly arise

A

Lateral nasal wall

40
Q

What factor is most related to the chance of recurrence for IP

A

Method of removal

41
Q

What is incidence of recurrence after resection of IP via lateral rhinotomy/medial maxillectomy

A

13-15%

42
Q

In pts who undergo resection of IP via lateral rhinotomy/medial maxillectomy, what is most imp factor related to risk for recurrence?

A

Mitotic index

43
Q

What is ddx of small cell sinonasal tumor

A
  • Esthesioneuroblastoma
  • Plasmacytoma
  • Melanoma
  • Lymphoma
  • Sarcoma
  • Poorly differentiated SCCa
  • Ewing’s sarcoma
  • Peripheral neuroectodermal tumor (PNET)
  • SNUC
44
Q

What is a SNUC

A

Sinonasal undifferentiated carcinoma – a very aggressive small cell sinonasal tumor

45
Q

What are the poor prognostic factors for SNUC

A

Orbital involvement and neck mets

Tumors in the paranasal sinuses have a worse prog than those arising in the nasal cavity

46
Q

SNUC tumors have Ab’s to what substances

A
  • Cytokeratin
  • Epithelial membrane Ag
  • Neuron-specific enolase
47
Q

What is tx for SNUC

A

Preop CRT followed by surgical resection for those tumors w/o distant mets or extensive intracranial involvement

48
Q

In what age group is olfactory neuroblastoma usu seen

A

Bimodal – 20s and 50s

49
Q

Esthesioneuroblastom involving ethmoids is what Kadish stage

A

B

50
Q

What are the 3 m/c malig bone tumors of the paranasal sinuses

A

Multiple myeloma, osteogenic sarcoma, and chondrosarcoma

51
Q

Pathophysiology of fibrous dysplasia

A

Nl medullary bone is replaced by collagen, fibroblasts, and osteoid

52
Q

Where is fibrous dysplasia most commonly found in H&N

A

maxilla

53
Q

Where is ACC of the H&N most commonly found

A

Palate > major salivary glands > paranasal sinuses

54
Q

Where is melanoma m/c found in nose and paranasal sinuses

A

nasal septum

55
Q

How does nasal melanoma differ from cutaneous melanoma

A

More aggressive with a worse prognosis and an unpredictable course – local recurrence is the m/c cause of failure

56
Q

What is the m/c type of lymphoma of nose and paranasal sinuses

A

Non-hodgkin’s lymphoma

57
Q

What is Ohngren’s line and how is it significant

A

Imaginary line from medial canthus to angle of mandible; tumors below the line have a better prognosis than tumors above the line (w/ palate as an exception)

58
Q

comprises only 3% of schneiderian papillomas

A

cylindrical

59
Q

M/c type of schneiderian papilloma, typically seen on nasal septum

A

Fungiform

60
Q

2-13% of these benign nasal tumors have malig potential

A

IP

61
Q

Has a predilection for mandible and sunray appearance on X-ray

A

osteogenic sarcoma

62
Q

More than 90% will have invaded through at least one wall of the involved sinus at presentation

A

SCCa

63
Q

Benign tumor m/c seen in pts less than 20 yo and has a ground glass appearance on x-ray

A

fibrous dysplasia

64
Q

Benign tumor m/c found in the frontal sinus

A

osteoma

65
Q

Encapsulated benign tumor that arises from surface of nerve fibers

A

neurilemoma

66
Q

unencapsulated tumor that arises from w/in a nerve; 15% become malig

A

neurofibroma

67
Q

2nd m/c malig sinonasal tumor; tend to be located superior to Ohngren’s line

A

AdenoCA

68
Q

Arise from pericytes of Zimmerman and considered neither benign nor malig

A

Hemangiopericytoma

69
Q

Arise from cells of neural crest that differentiate into olfactory sensory cells; Homer Wright rosettes are characteristic

A

Esthesioneuroblastoma

70
Q

May progress to multiple myeloma

A

extramedullary plasmacytoma

71
Q

M/c tumor to met to sinonasal area

A

renal cell

72
Q

Well circumscribed mobile painless lesion m/c found on tongue that has malig potential and histopath shows poygonal cells w/ abundant eosinophils

A

Granular cell tumor

73
Q

Met to the brain more frequently than any other soft-tissue sarcoma

A

Alveolar soft part sarcoma

74
Q

What sinonasal neoplasms remodel rather than erode bone

A

Sarcomas, minor salivary gland carcinomas, hemangiopericytomas, extramedullary plasmacytomas, large cell lymphomas, and olfactory neuroblastomas

75
Q

Primary modality of tx for extramedullary plasmacytomas

A

RT

76
Q

After benign lymphoid hyperplasia, what is m/c benign NP tumor

A

JNA

77
Q

From which site in NP does JNA develop

A

Trifurcation of the palatine bone, horizontal ala of the vomer, and the root of the pterygoid process

78
Q

What is the stage of a JNA eroding the skull base with minimal intracranial extension

A

IIIA

79
Q

Main blood supply to JNA

A

IMAX or ascending pharyngeal artery

Oto Board Pearls of Wisdom - Section III Diseases, Disorders, and Conditions (14 decks)

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