Tumor of Nasal cavity and Tumor of Nasal cavity and Paranasal sinusesParanasal sinuses

Department of Otolaryngology, Affiliated Ninth People’ s Hospital of Shanghai Jiaotong University,

School of Medicine Wang Peihua

BenignBenign Tumor of Nasal Tumor of Nasal cavity and Paranasal sinusescavity and Paranasal sinuses

Papilloma Papilloma （（ p107) p107) etiology unknownetiology unknown

human papilloma virus, HPVhuman papilloma virus, HPV

Pathology:Pathology: Hard type Hard type

1 small, hard, gray, local, single, mulberry-1 small, hard, gray, local, single, mulberry-shapedshaped

2 usually located in nasal vestibule, anterior 2 usually located in nasal vestibule, anterior nasal septum, hard palatenasal septum, hard palate

3 squamous epithelium3 squamous epithelium

Soft typeSoft type11 comparatively large, soft, red, diffuse comparatively large, soft, red, diffuse

growth, with pedicle/wide base.growth, with pedicle/wide base.

22 Schneiderian membraneSchneiderian membrane

33 Inverting papilloma recurrent tendency ①Inverting papilloma recurrent tendency ①malignant change multiple growth and ② ③malignant change multiple growth and ② ③

histoclasiahistoclasia

Clinical manifestation

>40y, male>female>40y, male>female Unilateral Unilateral Persistent, progressive nasal Persistent, progressive nasal

obstructionobstruction mucopurulent discharge, mucopurulent discharge,

sometimes with bloodsometimes with blood Headache and dysosmiaHeadache and dysosmia Rhinosinusitis and nasal Rhinosinusitis and nasal

polypspolyps

Examination Examination

with different size and hardness, Polypoid, red-with different size and hardness, Polypoid, red-gray, scobinate, easy-bleeding, usually located in gray, scobinate, easy-bleeding, usually located in nasal wall.nasal wall.

Treatment Treatment

radical resectionradical resection

lateral rhinotomy/ sublabrum approach, lateral rhinotomy/ sublabrum approach, Maxillectomy+ ethmoidotomy( if necessary)Maxillectomy+ ethmoidotomy( if necessary)

Endoscopic Sinus Surgery.Endoscopic Sinus Surgery.

Malignant Tumor of Nasal Malignant Tumor of Nasal cavity and Paranasal sinusescavity and Paranasal sinuses

（（ p109p109 ））

Statistics:: ENT: 20% in total Malignant ENT: 20% in total Malignant

Tumor.Tumor. Nasal and sinonasal MT: Nasal and sinonasal MT:

21.74%--49.22% in ENT MT.21.74%--49.22% in ENT MT. Male: female Male: female

=3 1∶=3 1∶ ，， predilection age: 40predilection age: 40 ～～6060y.y.

Features:

1.1. predilection site is maxillary sinus(predilection site is maxillary sinus(6060 ～～ 80%80%), ), 1/3 with ethmoid sinus MT.1/3 with ethmoid sinus MT.

2.2. ethmoid sinus>frontal sinus>sphenoid sinus.ethmoid sinus>frontal sinus>sphenoid sinus.

3.3. primary tumor>>metastatic tumor.primary tumor>>metastatic tumor.

4.4. advanced stage> primary stageadvanced stage> primary stage

5.5. invasion of adjacent tissue( orbit, skull base)invasion of adjacent tissue( orbit, skull base)

Etiological factor ImmunocompromiceImmunocompromice

Stimulation of chronic inflammationStimulation of chronic inflammation

Canceration of benign tumorCanceration of benign tumor

Exposure to oncogensExposure to oncogens

Pathology

1.1. SCC(35%-66%)SCC(35%-66%) ，， other: adenocarcinoma( only in other: adenocarcinoma( only in paranasal sinuses), lymphoepithelial carcinoma, paranasal sinuses), lymphoepithelial carcinoma, transitional epithelioma, BCC, sarcoma. transitional epithelioma, BCC, sarcoma.

2.2. Carcinoma> Sarcoma( 3.5-9.6 : 1).Carcinoma> Sarcoma( 3.5-9.6 : 1).

3.3. Most of sarcoma is malignant lymphoma(>60%). Most of sarcoma is malignant lymphoma(>60%).

clinical manifestation

11 ．． Nasal obstructionNasal obstruction

22 ．． Epistaxis or hemic secretionEpistaxis or hemic secretion

Carcinoma of maxillary sinus

anterointernal anterointernal ：： odontic odontic symptoms in early stage, symptoms in early stage, prognosisprognosis↑↑

anteroexternalanteroexternal ：： posterointernalposterointernal ：→ ：→ orbit/ orbit/

skull base, prognosisskull base, prognosis↓↓↓↓ posteroexternalposteroexternal ： → ： → orbit/ orbit/

pars zygomatica, prognosispars zygomatica, prognosis↓↓

Carcinoma of maxillary sinus

Clinical manifestation: Clinical manifestation: 11. . Unilateral nasal discharge with Unilateral nasal discharge with

pus and bloodpus and blood2. Unilateral ache and numbness of 2. Unilateral ache and numbness of

buccal regionbuccal region3. Unilateral progressive nasal 3. Unilateral progressive nasal

obstructionobstruction4. Unilateral Odontalgia and 4. Unilateral Odontalgia and

odontcseisis of superior teethodontcseisis of superior teeth

Carcinoma of maxillary sinus

1. Oncoides of buccal region1. Oncoides of buccal region2. Eye symptom2. Eye symptom3. Oncoides of hard palate3. Oncoides of hard palate4. Difficult in opening mouth4. Difficult in opening mouth5. Basicranial invasion5. Basicranial invasion6. Cervical lymphnode 6. Cervical lymphnode

metastasismetastasis

Clinical manifestation of advanced stage:Clinical manifestation of advanced stage:

Carcinoma of ethmoid sinus

medial orbital wall →medial orbital wall → proptosis, displacement of proptosis, displacement of globe→diplopia, hypopsia, globe→diplopia, hypopsia, swelling/ diabrosis of swelling/ diabrosis of endocanthion/nasal rootendocanthion/nasal root

Usually caused by Carcinoma Usually caused by Carcinoma of maxillary sinus, minority is of maxillary sinus, minority is primary(epithelioma/ sarcoma). primary(epithelioma/ sarcoma).

local sore pain, epistaxis, oncoides of forehead local sore pain, epistaxis, oncoides of forehead and superior/inner orbital margin, displacement of and superior/inner orbital margin, displacement of globeglobe

Carcinoma of frontal sinus

Carcinoma of sphenoid sinus

PrimaryPrimary

secondarysecondary

1. Case history and signs:40y, unilateral1. Case history and signs:40y, unilateral

2. Anterior-posterior nasal cavity examination: 2. Anterior-posterior nasal cavity examination: neoplasm, diabrosis, necrotic tissue, bleeding. neoplasm, diabrosis, necrotic tissue, bleeding.

Posterior rhinoscopyPosterior rhinoscopy

3. Nasal endoscopy3. Nasal endoscopy

Diagnosis

4. Imaging detection: X-ray, CT scan, MRI4. Imaging detection: X-ray, CT scan, MRI and so on.and so on.

5. Biopsy5. Biopsy

6. TNM classification6. TNM classification （（ UICC,1997)UICC,1997)

Treatment Treatment

key point- first time treatment key point- first time treatment

①①chemotherapy/ radiotherapy+ surgerychemotherapy/ radiotherapy+ surgery

② ②surgery+ chemotherapy/ radiotherapysurgery+ chemotherapy/ radiotherapy

Combined modality therapy( based on surgery)

modus operandi :modus operandi :

1. lateral rhinotomy( Moure incision)1. lateral rhinotomy( Moure incision)

2. total maxillectomy( Weber-Fergusson incision)2. total maxillectomy( Weber-Fergusson incision)

3. “T” incision in nasal root( Presinger incision)3. “T” incision in nasal root( Presinger incision)

4. external frontal sinusotomy (Lynch incision)4. external frontal sinusotomy (Lynch incision)

5. sublabial approach ( Denker incision)5. sublabial approach ( Denker incision)

6. midfacial degloving6. midfacial degloving

7. combined craniofacial approach7. combined craniofacial approach

Radiotherapy:Radiotherapy:1.1. Simple radical radiation therapy—Simple radical radiation therapy—

sarcoma, undifferentiated carcinoma sarcoma, undifferentiated carcinoma 2.2. palliative radiation therapy—advanced palliative radiation therapy—advanced

stagestage3.3. Preoperative radical radiation therapy--Preoperative radical radiation therapy--

60Cobalt, linear accelerator, 4-6 weeks, 60Cobalt, linear accelerator, 4-6 weeks, 50-60Gy. 50-60Gy.

Chemotherapy:Chemotherapy: