Malignant tumors of the maxillary sinus: Prognostic impact of neurovascular invasion in a series of 138 patients.

BACKGROUND: Maxillary sinus cancer is a rare disease with heterogeneous biologic behavior. The pattern of neurovascular invasion is known to be an important prognosticator in head and neck cancers, but has not been studied in maxillary malignancies. MATERIALS AND METHODS: Patients undergoing surgery-based treatment with curative intent for a malignancy of the maxillary sinus at the Unit of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia between November 2000 and October 2018 were included. A description of the characteristics of the patients, tumors, and treatments has been performed along with uni- and multi-variate analysis of prognostic factors. Tumors were classified based on the presence of perineural (P0/P1) and lymphovascular invasion (V0/V1) in 4 categories: P0V0, P1V0, P0V1, and P1V1. RESULTS: One hundred-thirty-eight patients were included. Mean age at surgery was 61.0 years. Most patients (60.1%) were affected by non-salivary carcinomas, and most tumors (73.9%) were high-grade cancers. One hundred-seven (77.5%) tumors were classified as pT4. The large majority of patients received bi- or tri-modality treatment. Sixty-three (45.7%) cases were classified as P0V0, 32 (23.2%) as P1V0, 7 (5.1%) as P0V1, and 36 (26.1%) as P1V1. T category, nodal status, and neurovascular invasion were significantly associated with prognosis. Perineural and lymphovascular invasion were associated with the topographical growth of the tumor. CONCLUSIONS: Maxillary cancer is often diagnosed at an advanced stage and in most cases requires a multimodal approach. Perineural and lymphovascular invasion are frequent and have a different impact on prognosis and topographical extension of the tumor.

Extranodal diffuse large B cell lymphoma of maxillary sinus presenting as a palatal ulcer.

A multitude of disease processes ranging from periodontitis to malignancies can lead to formation of solitary ulcer on the palate. Hence solitary ulcers of palate can often be a challenging one to diagnose. We report an interesting case of a diffuse large B cell lymphoma of the maxillary sinus which perforated the palatal bone and presented clinically as a palatal ulcer. Initially the lesion manifested as a small ill-defined swelling in the posterior palatal slope in relation to 24and25 which were mobile and hence was erroneously diagnosed as chronic periodontal abscess. This paper is intended to stress the relevance of including non-Hodgkin's lymphoma in the differential diagnosis of solitary palatal ulcers as it may be often misdiagnosed as more common reactive or inflammatory lesions.

Sinonasal inverted papilloma associated with small cell neuroendocrine carcinoma: A case report and literature review of rare malignancies associated with inverted papilloma.

We report a rare case of sinonasal inverted papilloma (IP) associated with small cell neuroendocrine carcinoma (SNEC). To our knowledge, this is the first report to describe SNEC found during the treatment of sinonasal IP. Surgery and five cycles of cisplatin plus etoposide with concurrent intensity modulated radiation therapy were performed. Neither local recurrence nor distant metastasis was noted during 6 years of post-diagnostic follow-up. The prognosis of SNEC is very poor. Treatment planning for sinonasal IP should consider a possible association with this rare but aggressive malignancy, whose treatment is completely different from that of squamous cell carcinoma, a malignancy which is commonly associated with IP. We also performed a PubMed review of the literature to identify the incidence and pathological diagnosis of associated malignancy. Among a total of 5286 cases of sinonasal IP (61 studies), the incidence of associated malignancy was 8.02% in squamous cell carcinoma, 0.19% in transitional cell carcinoma, 0.04% in mucoepidermoid carcinoma, 0.02% in verrucous cell carcinoma and 0.02% in adenocarcinoma. The incidence of associated malignancy was significantly higher in East and Southeast Asia (11.0%) and North America (10.4%) than in Europe (3.9%) (p=0.04 and p=0.03, respectively; T-test).

Adenoid Cystic Carcinoma of the Maxillary Sinus with Isolated Trigeminal Anesthesia.

Adenoid cystic carcinoma (ACC) is a rare malignant secretory gland tumor. It is characterized by slow growth, long clinical course, local recurrences, and distant metastases. In the sinonasal tract, it most commonly arises in the maxillary sinus. It often presents at an advanced stage with perineural spread (PNS). Our patient presented with left-sided facial numbness without other symptoms. The numbness was localized to the left cheek, left side of nose, and left upper lip. Magnetic resonance imaging (MRI) of the brain revealed an enhancing lesion involving the left maxillary sinus with orbital invasion and posterior extension into the cavernous sinus. Transnasal endoscopic exploration with tissue removal revealed ACC. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan revealed no evidence of distant metastases. Presentation of sinonasal ACC (SNACC) is variable depending on the involved structures. Characteristic PNS with ACC may cause neuropathic symptoms. This case displays a unique presentation of an advanced ACC of the maxillary sinus manifesting as isolated unilateral trigeminal anesthesia without sinonasal symptoms. The patient also failed to demonstrate any ocular or oculomotor symptoms despite extensive involvement of the orbit and surrounding structures. This case highlights the importance of recognizing ACC due to its association with late symptomatic manifestations. It also reinforces the need for clinical diligence with the workup of new onset neuropathic symptoms in the maxillary distribution of the trigeminal nerve.

Undifferentiated sarcoma presenting as a slowly enlarging facial mass.

Head and neck sarcomas are rare and consist of a variety of histologic subtypes. We present a case of undifferentiated/unclassified sarcoma (UUS) of the maxillary sinus, a tumor subtype historically known as malignant fibrous histiocytoma (MFH) or undifferentiated pleomorphic sarcoma (UPS). A 50-year-old female patient presented with worsening facial pain and dysphagia. Physical examination demonstrated a large, ulcerated mass protruding from the oral cavity. Computed tomography demonstrated a large, enhancing mass centered in the right maxillary sinus with local invasion. The initial biopsy was read as "central giant cell granuloma." Conservative management yielded no improvement, and the tumor grew steadily. The patient underwent a total maxillectomy with resection of the orbital floor and an anterior ethmoidectomy, followed by radiation and chemotherapy. In addition to treatment of this patient, we discuss a review of the literature and the clinical presentation, radiologic, and histologic findings of this disease.

Destructive Fibrosarcoma of the Maxillary Sinus.

Paranasal fibrosarcoma of nasal cavity and paranasal sinuses is a very rare malignant tumor. It is usually presented with nasal obstruction and epistaxis. In this clinical report, clinical symptoms, pathogenesis, and treatment principles of a paranasal fibrosarcoma originating from the right maxillary sinus and obstructing the right nasal passage are discussed.A 55-year-old male patient was admitted to the authors clinic with complaints of nasal obstruction and epistaxis lasting for 2 years. Anterior rhinoscopy revealed a mass lesion which obstructed the right nasal passage and caused frequent epistaxis. An opacity consistent with soft tissue lesion which was originated from the right maxillary sinus and filled the right nasal passage was observed in paranasal tomography. Magnetic resonance imaging revealed that the mass lesion was contrasted. Tumor was seen to erode orbital floor, and lateral and anterior walls of the maxillary sinus. Biopsy result was reported as papilloma. The patient was treated with Denker approach as anterior wall of the maxillary sinus was eroded by the tumor lesion and the mass lesion was excised. The patient received postoperative radiotherapy as pathological diagnosis was reported as paranasal fibrosarcoma.

Clinical management of squamous cell carcinoma associated with sinonasal inverted papilloma.

OBJECTIVE: The aim of this study was to investigate the clinical features and prognosis of patients with squamous cell carcinoma (SCC) associated with sinonasal inverted papilloma (IP). METHODS: The medical records of 95 patients who were diagnosed with IP or SCC associated with IP were retrospectively reviewed. Out of 95 patients, 15 were diagnosed with SCC associated with IP. The clinical characteristics, treatment modalities, and survival outcomes of the patients were analyzed. RESULTS: The incidence of SCC associated with IP was 15.8%. Although differential diagnosis between IP and SCC associated with IP is difficult, epistaxis may be the specific symptom in SCC associated with IP cases. The 3-year disease-specific survival rate was higher in cases with T1, 2 and 3 than in cases with T4. There was no significant difference in survival rate between maxillary sinus and other primary sites. On the other hand, there was a significant difference in survival rate between the microscopic SCC with IP cases and the other cases. In addition, the patients with <70 years old better than those with >70 years old with a 3-year disease free survival of 80% versus 0%. CONCLUSIONS: Some T4 patients were found to have a highly aggressive disease. Therefore, complete surgical resection followed by chemo-radiation therapy is the recommended treatment for patients with T4 disease to control of the primary tumor site.

Sinonasal carcinoma presenting as chronic sinusitis and sequential bilateral visual loss.

Sinonasal undifferentiated carcinoma-related rhinogenic optic neuropathy is rare and may lead to visual loss. To the best of our knowledge, this is the first report of bilateral sequential visual loss induced by this etiology. It is important to differentiate between chronic sinusitis and malignancy on the basis of specific findings on magnetic resonance images. Surgical decompression with multidisciplinary therapy, including steroids, chemotherapy, and radiotherapy, is indicated. However, no visual improvement was noted in this case, emphasizing the rapid disease progression and importance of early diagnosis and treatment.

Sarcoma de Ewing: una rareza en la región nasosinusal / Ewing's sarcoma: A rarity in sinonasal region

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Benign sinonasal capillary haemangioma.

Haemangiomas are benign fibrovascular tumours relatively that are common in the head and neck, where 60% of them occur Among the various categories of haemangiomas, lobular capillary haemangiomas (LCH) occur frequently on the skin, lips, buccal mucosa, tongue and gingiva. However, they are vanishingly rare in the paranasal sinuses. The imaging features of LCH are non-specific. The histological characteristics of LCH can also make diagnosis difficult as sometimes resemble highly vascular malignant tumours. This leads to the false preoperative diagnosis of suspected malignancy in many cases, which places the patient under unnecessary distress and anxiety. We present a case of LCH appearing as a suspicious nasal lesion of the lateral nasal wall with unilateral nasal obstruction, necrotic centre and epistaxis. The tumour was excised endoscopically in one operation including endoscopic medial maxillectomy. Further education about this lesion is deemed important as preoperative embolisation may be needed for a safe operation.

Mesenchymal phosphaturic tumour: early detection of recurrence.

The case of a recurrent phosphaturic mesenchymal tumour of the maxillary sinus 10 years after the first surgical excision is reported. The neoplasm first presented with paraneoplastic osteomalacia causing a pathological femur fracture. A right maxillary sinus tumour was identified and treated thereafter. The patient had no local symptoms and serum electrolytes returned to normal after surgical removal of the tumour. However, 10 years later, the patient's urine Ca and P levels increased and an octreoscan detected a new tumour in the right maxillary sinus. Early diagnosis prevented the effects of the paraneoplastic activity of the neoplasm. This case emphasises the importance of specific, close follow-up, because the neoplasm rarely produces local signs indicating its position. To our knowledge, this is the first reported case of a late relapse presenting without relevant symptoms (local pain or swelling or pathological fractures).