H&N Evaluation and management of paranasal sinus malignancy

Question 1

Which environmental risk factor is associated with

adenocarcinoma of the ethmoid sinus?

Answer 1

Wood dust (wood workers)

Question 2

Nickel exposure greatly increases which type of

sinonasal cancer?

Answer 2

Squamous cell carcinoma

Question 3

Inverted papilloma is associated with malignant

transformation to what type of cancer?

Answer 3

Squamous cell carcinoma

Question 4

What is the most common sinonasal malignancy?

Answer 4

Squamous cell carcinoma

Question 5

Which histologic type of sinonasal malignancy is

associated with exposure to wood dust?

Answer 5

Intestinal-type adenocarcinoma

Question 6

What is the second most common sinonasal

malignancy?

Answer 6

Adenoid cystic carcinoma

Question 7

What histologic type of sinonasal adenoid cystic
carcinoma is the most common and has the best
prognosis?

Answer 7

Cribriform

Question 8

What rare sinonasal tumor is thought to arise from
the mucoserous glands of the sinonasal cavity and
stains positive with mucicarmine?

Answer 8

Mucoepidermoid carcinoma

Question 9

Mucoepidermoid carcinoma

Answer 9

Lateral nasal wall including turbinates

Question 10

Esthesioneuroblastoma arises from what location?

Answer 10

Olfactory mucosa along the cribriform plate

Question 11

Which sinonasal tumor has the following histo-
pathologic features: S100-positive sustentacular

cells, Homer-Wright rosettes, and Flexner-Winter-
steiner rosettes?

Answer 11

Esthesioneuroblastoma

Question 12

What sinonasal tumors can be considered small,

round blue cell tumors?

Answer 12

Sinonasal undifferentiated carcinoma, small cell carcinoma, esthesioneuroblastoma, poorly differentiated and nonkeratinizing squamous cell carcinoma, neuroendocrine carci-
noma, plasmacytoma, lymphoma, mucosal melanoma,
Ewing sarcoma, rhabdomyosarcoma, synovial sarcoma,
desmoplastic small round blue cell tumor

Question 13

What are common histopathologic features of

sinonasal small cell carcinoma?

Answer 13

Small cells with scant cytoplasm and round hyperchromatic
nuclei with absent or poorly visualized nucleoli. Cells grow
in clusters and commonly display extensive necrosis and
hemorrhage.

Question 14

What is the most common pediatric malignant

sinonasal tumor?

Answer 14

Rhabdomyosarcoma

Question 15

Alveolar type rhabdomyosarcoma is associated

with what chromosomal translocation?

Answer 15

t(2;13)(q35;q14), PAX3-FKHR gene fusion

Question 16

Hemangiopericytomas arise from what cell types?

Answer 16

Extracapillary pericytes (of Zimmerman)

Question 17

What are typical clinical features of sinonasal

hemangiopericytomas?

Answer 17

Soft, slow-growing tumors typically arising in the nasal
cavity that occasionally metastasize. The most common
presentation is nasal obstruction and epistaxis.

Question 18

In what anatomical site are sinonasal angiosarco-

mas most frequently found?

Answer 18

Nasal cavity

Question 19

Which type of tumor is the most common to

metastasize to the nose and paranasal sinuses?

Answer 19

Renal cell carcinoma

Question 20

What is the most common sinonasal lymphoma in

Western populations?

Answer 20

Diffuse large B-cell lymphoma

Question 21

What is the most common sinonasal lymphoma in

Asian populations?

Answer 21

Natural kill (NK)/T-cell lymphoma

Question 22

What is the name of the syndrome in a patient
who has epistaxis, diplopia, decreased visual
acuity, and numbness above the eye?

Answer 22

Orbital apex syndrome

Question 23

What is the name of the constellation of symptoms that includes ophthalmoplegia, periorbital numbness, ptosis, proptosis, and fixed dilated
pupil?

Answer 23

Superior orbital fissure syndrome

Question 24

A patient has unilateral nasal obstruction, eye
proptosis, and decreased sensation of his cheek.
Which cranial nerve is affected?

Answer 24

V2 (infraorbital nerve)

Question 25

Which imaging modalities are most useful in | sinonasal malignancies?

Answer 25

MRI and CT scan

Question 26

How is CT superior to MRI in evaluation of paranasal sinus masses?

Answer 26

Better bone detail. Better evaluation of skull base and | lamina papyracea erosion

Question 27

How is MRI superior to CT in the evaluation of | paranasal sinus masses?

Answer 27

● Better soft tissue detail ● Differentiates tumor from inspissated secretions ● Better evaluation of dural invasion ● Differentiates brain invasion from brain edema ● Better assessment of perineural invasion

Question 28

TNM staging for sinonasal cancer includes what | three primary anatomic sites?

Answer 28

Maxillary sinus, ethmoid sinus, and nasal cavity

Question 29

A squamous cell carcinoma localized to which two | sinonasal sites is automatically stage T4?

Answer 29

Frontal and sphenoid sinuses

Question 30

What is unique about the AJCC staging of head | and neck mucosal melanoma?

Answer 30

All lesions are considered T3 or T4, reflecting the aggressive behavior.

Question 31

What is the Kadish staging system for esthesio- | neuroblastoma?

Answer 31

A tumor limited to the nasal cavity B tumor in nasal cavity but extending into paranasal sinuses C tumor extends beyond paranasal sinuses to involve cribriform, skull base, orbit or intracranial space D tumor with neck or distant metastasis

Question 32

The Hyams grading system of esthesioneuroblastoma has proven to provide significant prognostic information and includes what histologic features?

Answer 32

``` ● Lobular architecture ● Neurofibrillary background ● Rosettes ● Nuclear pleomorphism ● Mitosis ● Necrosis ● Calcification ```

Question 33

Which sinonasal sarcoma has the best prognosis?

Answer 33

Chondrosarcoma

Question 34

Which sinonasal malignancy has the worst prog- | nosis?

Answer 34

Mucosal melanoma

Question 35

Which sinonasal malignancy has the best prog- | nosis?

Answer 35

Minor salivary gland tumors

Question 36

Invasion of which structure by a sinonasal malig- | nancy has the worst prognosis?

Answer 36

Brain; 5-year survival is 26% in the largest series.

Question 37

Which pathologic finding in sinonasal malignancy | has the worst prognosis?

Answer 37

Positive margins are associated with a 24% 5-year survival.

Question 38

What is the treatment of choice for advanced | esthesioneuroblastoma?

Answer 38

Multimodality treatment including surgical resection and | radiation therapy with or without chemotherapy

Question 39

What is the treatment of choice for most sinonasal | undifferentiated carcinomas?

Answer 39

Multimodality treatment including surgical resection and | radiation therapy with or without chemotherapy

Question 40

What is the treatment of choice for sinonasal | diffuse large B-cell lymphoma?

Answer 40

Chemoradiation therapy (R-CHOP and IFRT)

Question 41

What long-term complication can occur after resection of a frontal sinus tumor with osteoplastic flap and frontal sinus obliteration?

Answer 41

Frontal sinus mucocele

Question 42

What is the surgical procedure best used to treat a sinonasal malignancy that has invaded through the cribriform plate?

Answer 42

Anterior craniofacial resection

Question 43

What is the surgical procedure best used to treat a sinonasal tumor limited to the medial wall of the maxillary sinus?

Answer 43

Inferior medial maxillectomy

Question 44

What is a common postoperative complication of | medial maxillectomy?

Answer 44

Epiphora and/or recurrent dacryocystitis from division of | the nasolacrimal duct

Question 45

What locoregional flaps are commonly used to close large anterior skull-base defects after ante- rior craniofacial resection?

Answer 45

Vascularized pericranium and nasoseptal mucosa flaps

Question 46

What free tissue flap is best for reconstruction of large anterior skull base defects after craniofacial resection?

Answer 46

Rectus abdominis

Question 47

What free tissue flaps are best used for reconstruction of total maxillectomy defects?

Answer 47

Osteocutaneous free flaps for bone stock to reconstruct the orbital floor, orbital rim, and/or alveolar ridge