H&N Evaluation and management of paranasal sinus malignancy Flashcards
Which environmental risk factor is associated with
adenocarcinoma of the ethmoid sinus?
Wood dust (wood workers)
Nickel exposure greatly increases which type of
sinonasal cancer?
Squamous cell carcinoma
Inverted papilloma is associated with malignant
transformation to what type of cancer?
Squamous cell carcinoma
What is the most common sinonasal malignancy?
Squamous cell carcinoma
Which histologic type of sinonasal malignancy is
associated with exposure to wood dust?
Intestinal-type adenocarcinoma
What is the second most common sinonasal
malignancy?
Adenoid cystic carcinoma
What histologic type of sinonasal adenoid cystic
carcinoma is the most common and has the best
prognosis?
Cribriform
What rare sinonasal tumor is thought to arise from
the mucoserous glands of the sinonasal cavity and
stains positive with mucicarmine?
Mucoepidermoid carcinoma
Mucoepidermoid carcinoma
Lateral nasal wall including turbinates
Esthesioneuroblastoma arises from what location?
Olfactory mucosa along the cribriform plate
Which sinonasal tumor has the following histo-
pathologic features: S100-positive sustentacular
cells, Homer-Wright rosettes, and Flexner-Winter-
steiner rosettes?
Esthesioneuroblastoma
What sinonasal tumors can be considered small,
round blue cell tumors?
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
What are common histopathologic features of
sinonasal small cell carcinoma?
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.
What is the most common pediatric malignant
sinonasal tumor?
Rhabdomyosarcoma
Alveolar type rhabdomyosarcoma is associated
with what chromosomal translocation?
t(2;13)(q35;q14), PAX3-FKHR gene fusion
Hemangiopericytomas arise from what cell types?
Extracapillary pericytes (of Zimmerman)
What are typical clinical features of sinonasal
hemangiopericytomas?
Soft, slow-growing tumors typically arising in the nasal
cavity that occasionally metastasize. The most common
presentation is nasal obstruction and epistaxis.
In what anatomical site are sinonasal angiosarco-
mas most frequently found?
Nasal cavity
Which type of tumor is the most common to
metastasize to the nose and paranasal sinuses?
Renal cell carcinoma
What is the most common sinonasal lymphoma in
Western populations?
Diffuse large B-cell lymphoma
What is the most common sinonasal lymphoma in
Asian populations?
Natural kill (NK)/T-cell lymphoma
What is the name of the syndrome in a patient
who has epistaxis, diplopia, decreased visual
acuity, and numbness above the eye?
Orbital apex syndrome
What is the name of the constellation of symptoms that includes ophthalmoplegia, periorbital numbness, ptosis, proptosis, and fixed dilated
pupil?
Superior orbital fissure syndrome
A patient has unilateral nasal obstruction, eye
proptosis, and decreased sensation of his cheek.
Which cranial nerve is affected?
V2 (infraorbital nerve)
Which imaging modalities are most useful in
sinonasal malignancies?
MRI and CT scan
How is CT superior to MRI in evaluation of paranasal sinus masses?
Better bone detail. Better evaluation of skull base and
lamina papyracea erosion
How is MRI superior to CT in the evaluation of
paranasal sinus masses?
● 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
TNM staging for sinonasal cancer includes what
three primary anatomic sites?
Maxillary sinus, ethmoid sinus, and nasal cavity
A squamous cell carcinoma localized to which two
sinonasal sites is automatically stage T4?
Frontal and sphenoid sinuses
What is unique about the AJCC staging of head
and neck mucosal melanoma?
All lesions are considered T3 or T4, reflecting the aggressive
behavior.
What is the Kadish staging system for esthesio-
neuroblastoma?
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
The Hyams grading system of esthesioneuroblastoma has proven to provide significant prognostic information and includes what histologic features?
● Lobular architecture ● Neurofibrillary background ● Rosettes ● Nuclear pleomorphism ● Mitosis ● Necrosis ● Calcification
Which sinonasal sarcoma has the best prognosis?
Chondrosarcoma
Which sinonasal malignancy has the worst prog-
nosis?
Mucosal melanoma
Which sinonasal malignancy has the best prog-
nosis?
Minor salivary gland tumors
Invasion of which structure by a sinonasal malig-
nancy has the worst prognosis?
Brain; 5-year survival is 26% in the largest series.
Which pathologic finding in sinonasal malignancy
has the worst prognosis?
Positive margins are associated with a 24% 5-year survival.
What is the treatment of choice for advanced
esthesioneuroblastoma?
Multimodality treatment including surgical resection and
radiation therapy with or without chemotherapy
What is the treatment of choice for most sinonasal
undifferentiated carcinomas?
Multimodality treatment including surgical resection and
radiation therapy with or without chemotherapy
What is the treatment of choice for sinonasal
diffuse large B-cell lymphoma?
Chemoradiation therapy (R-CHOP and IFRT)
What long-term complication can occur after
resection of a frontal sinus tumor with osteoplastic
flap and frontal sinus obliteration?
Frontal sinus mucocele
What is the surgical procedure best used to treat a
sinonasal malignancy that has invaded through
the cribriform plate?
Anterior craniofacial resection
What is the surgical procedure best used to treat a
sinonasal tumor limited to the medial wall of the
maxillary sinus?
Inferior medial maxillectomy
What is a common postoperative complication of
medial maxillectomy?
Epiphora and/or recurrent dacryocystitis from division of
the nasolacrimal duct
What locoregional flaps are commonly used to close large anterior skull-base defects after ante-
rior craniofacial resection?
Vascularized pericranium and nasoseptal mucosa flaps
What free tissue flap is best for reconstruction of
large anterior skull base defects after craniofacial
resection?
Rectus abdominis
What free tissue flaps are best used for reconstruction of total maxillectomy defects?
Osteocutaneous free flaps for bone stock to reconstruct the orbital floor, orbital rim, and/or alveolar ridge
