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ENT H&N > H&N Evaluation and management of paranasal sinus malignancy > Flashcards

H&N Evaluation and management of paranasal sinus malignancy Flashcards

1
Q

Which environmental risk factor is associated with

adenocarcinoma of the ethmoid sinus?

A

Wood dust (wood workers)

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2
Q

Nickel exposure greatly increases which type of

sinonasal cancer?

A

Squamous cell carcinoma

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3
Q

Inverted papilloma is associated with malignant

transformation to what type of cancer?

A

Squamous cell carcinoma

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4
Q

What is the most common sinonasal malignancy?

A

Squamous cell carcinoma

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5
Q

Which histologic type of sinonasal malignancy is

associated with exposure to wood dust?

A

Intestinal-type adenocarcinoma

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6
Q

What is the second most common sinonasal

malignancy?

A

Adenoid cystic carcinoma

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7
Q

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

A

Cribriform

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8
Q

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

A

Mucoepidermoid carcinoma

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9
Q

Mucoepidermoid carcinoma

A

Lateral nasal wall including turbinates

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10
Q

Esthesioneuroblastoma arises from what location?

A

Olfactory mucosa along the cribriform plate

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11
Q

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

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

A

Esthesioneuroblastoma

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12
Q

What sinonasal tumors can be considered small,

round blue cell tumors?

A

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

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13
Q

What are common histopathologic features of

sinonasal small cell carcinoma?

A

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.

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14
Q

What is the most common pediatric malignant

sinonasal tumor?

A

Rhabdomyosarcoma

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15
Q

Alveolar type rhabdomyosarcoma is associated

with what chromosomal translocation?

A

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

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16
Q

Hemangiopericytomas arise from what cell types?

A

Extracapillary pericytes (of Zimmerman)

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17
Q

What are typical clinical features of sinonasal

hemangiopericytomas?

A

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

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18
Q

In what anatomical site are sinonasal angiosarco-

mas most frequently found?

A

Nasal cavity

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19
Q

Which type of tumor is the most common to

metastasize to the nose and paranasal sinuses?

A

Renal cell carcinoma

20
Q

What is the most common sinonasal lymphoma in

Western populations?

A

Diffuse large B-cell lymphoma

21
Q

What is the most common sinonasal lymphoma in

Asian populations?

A

Natural kill (NK)/T-cell lymphoma

22
Q

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

A

Orbital apex syndrome

23
Q

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

A

Superior orbital fissure syndrome

24
Q

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

A

V2 (infraorbital nerve)

25
Q

Which imaging modalities are most useful in

sinonasal malignancies?

A

MRI and CT scan

26
Q

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

A

Better bone detail. Better evaluation of skull base and

lamina papyracea erosion

27
Q

How is MRI superior to CT in the evaluation of

paranasal sinus masses?

A

● 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

28
Q

TNM staging for sinonasal cancer includes what

three primary anatomic sites?

A

Maxillary sinus, ethmoid sinus, and nasal cavity

29
Q

A squamous cell carcinoma localized to which two

sinonasal sites is automatically stage T4?

A

Frontal and sphenoid sinuses

30
Q

What is unique about the AJCC staging of head

and neck mucosal melanoma?

A

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

31
Q

What is the Kadish staging system for esthesio-

neuroblastoma?

A

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

32
Q

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

A 
● Lobular architecture
● Neurofibrillary background
● Rosettes
● Nuclear pleomorphism
● Mitosis
● Necrosis
● Calcification
33
Q

Which sinonasal sarcoma has the best prognosis?

A

Chondrosarcoma

34
Q

Which sinonasal malignancy has the worst prog-

nosis?

A

Mucosal melanoma

35
Q

Which sinonasal malignancy has the best prog-

nosis?

A

Minor salivary gland tumors

36
Q

Invasion of which structure by a sinonasal malig-

nancy has the worst prognosis?

A

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

37
Q

Which pathologic finding in sinonasal malignancy

has the worst prognosis?

A

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

38
Q

What is the treatment of choice for advanced

esthesioneuroblastoma?

A

Multimodality treatment including surgical resection and

radiation therapy with or without chemotherapy

39
Q

What is the treatment of choice for most sinonasal

undifferentiated carcinomas?

A

Multimodality treatment including surgical resection and

radiation therapy with or without chemotherapy

40
Q

What is the treatment of choice for sinonasal

diffuse large B-cell lymphoma?

A

Chemoradiation therapy (R-CHOP and IFRT)

41
Q

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

A

Frontal sinus mucocele

42
Q

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

A

Anterior craniofacial resection

43
Q

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

A

Inferior medial maxillectomy

44
Q

What is a common postoperative complication of

medial maxillectomy?

A

Epiphora and/or recurrent dacryocystitis from division of

the nasolacrimal duct

45
Q

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

A

Vascularized pericranium and nasoseptal mucosa flaps

46
Q

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

A

Rectus abdominis

47
Q

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

A

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

ENT H&N (24 decks)

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