Paranasal sinusanatomy
Sphenoid
Nasopharynx
Respiratory mucosaPseudostratified, goblet & ciliated cells
Seromucinous glands
Nasopharyngeal mucosa/carcinoma
Squamous metaplasia (?) with CIS
Normal respiratory mucosaWith lymphocyte trafficking
Nasopharyngeal carcinoma expressingEBV early RNA transcripts (EBER1)
Sinonasal carcinomas0.2% of malignancies
3% of head & neck carcinomas50% 5-yr survival
1% eachFrontal/sphenoid
10%Ethmoid
30%Nasal cavity
58%Maxillary antrum
W.H.O.AdenocarcinomaIntestinal-type adenocarcinomaPapillary adenocarcinoma
Adenosquamous carcinomaLymphoepithelial carcinomaSmall cell carcinomaSpindle cell carcinomaVerrucous squamous cell carcinomaCylindrical cell carcinoma
Squamous cell carcinomaSinonasal carcinoma
Origin of nasal/paranasal sinus tumors
Lung carcinomaBreast carcinomaRenal carcinomaIntestinal adenocarcinoma
Mucoepidermoid carcinomaAcinic cell carcinoma, etc.
Adenoid cystic carcinomaPleomorphic adenoma, etc.
Adenocarcinoma low & high-grade
Squamous cell carcinomaIntestinal-type adenocarcinoma & low-grade papillary
Ductal/acinar salivary gland-type
(6% of mets)
Metastasis
3%
Biphasic salivary gland-type
Seromucinous glands/surface
Surface columnar epithelium
Distribution of minor histologic tumor types among paranasal sinus carcinomas
Lund 1980-2004
00Sphenoid
Ethmoid
Maxillary
61
212
Seromucinous adenocarcinoma
N=8
Salivary gl type
N=13
Salivary gland-type carcinomasmucoepidermoid
Intermediate cells
Mucus cells
Adenocarcinoma – seromucinous, low grade
Nerve with tumor infiltrate
Adenocarcinoma – seromucinous, high grade
Distribution of major histologic types among paranasal carcinomas
Lund 1980-2004
10Sphenoid
Ethmoid
Maxillary
18182
45555
IT-adenocarcinomaN=23
SSCN=57
Intestinal-type adenocarcinoma
• M:F 5:1• Mean age 50 – 65 yr, range 3rd to
9th decade • Predominantly ethmoid sinus
followed by nasal cavity & maxillary sinus
• Metastasis to lateral neck nodes <20%, distant metastases occur
• Death by intracranial spread• Etiology: hardwood & leather dust,
chrome
Carcinoma filling nasal cavity, ethmoid sinus with penetration of cribriform plate
CT courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital
Ethmoid sinus cancer• CT primary• MR complement
CT courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital
Penetration of posterior antrum
Middlecranialfossa
Skeletal filter
Well-differentiated intestinal-type adenocarcinoma, papillary pattern
Muscularis mucosae
Well-differentiated intestinal-type adenocarcinoma
component cells
Paneth cells
Goblet cells
Well-differentiated intestinal-type
adenocarcinomaneuroendocrine cells
Chromogranin A
Gastrin
Somatostatin
High-grade intestinal-type adenocarcinoma
High-grade intestinal-type adenocarcinoma
Cribriform pattern Partial regression
Mucinous intestinal-type adenocarcinoma
Tumor spread
Courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital
Sinonasal squamous cell carcinoma
• M:F 2:1• Most >50 yr, rarely <40 yr • Predominantly nasal cavity &
maxillary sinus, rarely ethmoid• Usually well to moderately
differentiated• Metastasis to lateral neck nodes
in ~15%, especially if bone is penetrated
• Etiology: nickel, softwood dust, mustard gas production, Thorotrast
Öhngren's plane throughantrumW
orse
pro
gnos
is
Wor
se p
rogn
osis
Bette
r pro
gnos
is
Bette
r pro
gnos
is
Squamous cell carcinoma, maxillary sinus
Squamous metaplasia
Invasive cancer
Bone invasion
Squamous cell carcinoma, perineural growth
SummaryMetaplasia – neoplasia sequence
Non-lymphoid respiratory mucosaSquamous metaplasia
Squamous cell carcinoma
Concomitant intestinal metaplasia/neoplasia
Carcinomaof Paranasal Sinuses
Michael Dictor, MD, PhD
Department of PathologyLund University Hospital
Lund, Sweden
Ethmoid sinus cancerCourtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital
Penetration of antrum,orbit/base of skull
Molecular lesions in sinus carcinoma of intestinal type
• c-erbB-2 expression
Molecular lesions: RAS
Perez et al. Cancer 1999;86:255-264Saber et al. Cancer Lett 1998;126:59-65
5G12VCodon 35 g>tEthmoidH-RAS1G13CCodon 37 g>t
1G13DCodon 38 g>aEthmoid
3G12DCodon 35 g>aSinonasalK-RAS2NAmino AcidNucleotide
adenoca, intestinal type
adenoca, intestinal type
adenoca, intestinal type (both blocks, bl c min material)
adenoca, intestinal type
adenoca, seromucinous type, high grade (5 blocks)
adenoca, intestinal type
adenoca, intestinal type (sparse, post-radiation)
adenoca, intestinal type (2 blocks)
adenoca, papillary (2 blocks, mostly benign)
adenoca, intestinal type, mucinous (blocks 1 & 2 benign only)
adenoca, seromucinous type, high grade (2 blocks)
adenoca, seromucinous type, high grade (block 1 benign)
malignant tumor, r/o rhabdomyosarcoma (2 blocks)
adenoca, seromucinous type, low grade
adenoca, intestinal type, <50% (blocks 1 & 2 benign only)
adenoca, intestinal type, mucinous
adenoca, intestinal type (block 2 benign; no. 1 is 2 blocks))
adenoca, papillary
adenoca metastases in brain (blocks A-D)
adenoca metastases in brain (blocks A-D)
malignant tumor, lymphoma? melanoma? carcinoma?
adenoca, papillary (mucinous epithelium)
adenoca, papillary (mucinous epithelium)
adenoca, seromucinous type, low grade
adenoca, papillary (mucinous epithelium)
adenoca, papillary
adenoca, seromucinous type, low grade
mucoepidermoid ca, low grade (3blocks, better represented)
adenoca, papillary (mucinous epithelium)
adenoca, intestinal type with marked regression
adenoca, NOS, moderate-poorly diff (intestinal type?)
adenoca, intestinal type
adenoca, intestinal type, <20%
adenoca, intestinal type
Nasopharyngeal carcinoma – CT & MR
T1 T1 with contrastCT courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital
T2 512
Nasopharyngeal carcinoma – CT & MR
CT courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital
Ethmoid sinus cancerCourtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital
Soft parts filter without contrast
Ethmoid sinus cancer - MR
T2-STIR 256 T2-tse 512Courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital
Ethmoid sinus cancer
Courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital
Nasopharyngeal carcinoma – CT & MR
CT courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital
Paranasal sinusanatomy
Sphenoid
Nasopharynx Drainage:
Frontal - nasofrontal duct into the ethmoid infundibulum of the middle meatus
Antrum – near middle meatus
Anterior ethmoid – middle meatus
Sphenoid - sphenoethmoid recess
Ethmoid sinus cancer - MR
T2-tse 512 Courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital
Invasion of nasal cavity, sphenoid bone & optic chiasm