Nasal cavity, paranasal sinuses, nasopharynx
Sinonasal carcinoma
Sinonasal carcinoma-general
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Last staff update: 17 May 2023 (update in progress)
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PubMed Search: Sinonasal carcinoma[TIAB]
Table of Contents
Definition / general | Epidemiology | Sites | Etiology | Clinical features | Diagnosis | Prognostic factors | Treatment | Microscopic (histologic) description | Microscopic (histologic) imagesCite this page: Mannan, A.A.S.R. Sinonasal carcinoma-general. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/nasalcarcinomageneral.html. Accessed May 29th, 2023.
Definition / general
- Rare and heterogenous malignancy of sinonasal tract
Epidemiology
- 3 - 5% of head and neck cancers (Laryngoscope 2002;112:1964)
- No race or gender predilection
- Most cases present in elderly; mean age at diagnosis is sixth decade (Am J Surg 1989;158:328)
Sites
- Usually maxillary sinus, 20% in ethmoid sinuses
- < 1% originate in frontal and sphenoid sinuses
Etiology
- 5x increased risk with heavy smoking
- Exposure to wood dust strongly associated with adenocarcinoma of ethmoid sinus (Cancer 1984;54:482)
- Other occupational exposures with increased risk include:
- Nickel and chrome refining (Scand J Work Environ Health 1983;9:315)
- Shoe workers (Acta Otorhinolaryngol Ital 2004;24:199)
- Asbestos
- Chlorophenol
- Formaldehyde
- Leather dust
Clinical features
- Usually nonspecific, often mimics benign diseases
- Nasal obstruction, rhinorrhea, headache, facial pressure, hyposmia
- 9 - 12% of patients with sinonasal malignancies are asymptomatic (Ear Nose Throat J 2001;80:272) - delayed diagnosis is common
- 75% of paranasal sinus tumors are stage T3 or T4 at diagnosis (Otolaryngol Clin North Am 2004;37:473)
Diagnosis
- Low threshold for radiologic investigation is important due to nonspecific nature of symptoms
- CT / MRI helpful in delineating nature / extent of disease
- Biopsy is useful for histologic confirmation
Prognostic factors
- Tumor stage is most important prognostic variable
- Bony destruction and invasion of adjacent head and neck structures are associated with poor prognosis
- Cranial nerve involvement portends poor outcome
Treatment
- Most Stage T1 or T2 maxillary sinus carcinomas are treated by surgery alone, with adequate resection margins
- T3 and T4 lesions are treated by combination therapy with surgery and radiation
Microscopic (histologic) description
- 75 - 90% are squamous cell carcinoma (Head Neck 2002;24:821)
- Other subtypes include sinonasal adenocarcinoma (intestinal and nonintestinal subtypes), adenoid cystic carcinoma, sinonasal undifferentiated carcinoma
Microscopic (histologic) images
Contributed by Eman Abdelzaher, M.D., Ph.D.
Sinonasal adenoid cystic carcinoma
