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Sinonasal cancers (SNCs) are rare and heterogeneous diseases. Most patients present with locally advanced stage due to the insidious symptoms. In the majority of cases, the treatment strategy relies on the combination of surgery and radiotherapy, supplemented with or without chemotherapy. However, postoperative organ preserving rate is low, quality of life and clinical prognosis are poor. With recent advancement of surgical techniques, radiotherapy and chemotherapy techniques, certain progress has been reached in the diagnosis and treatment of SNCs. Nevertheless, the specific treatment regimen remains controversial. In this article, advances and controversies in SNC were reviewed.
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Objective To investigate the clinicopathological characteristics, differential diagnosis and biological features of natural killer (NK)/T cell lymphoma in nasal cavity. Methods The data of 17 cases of nasal NK/T-cell lymphoma from Department of Pathology in the Affiliated Hospital of Yangzhou University between September 2007 and July 2017 were collected. Pathologic analysis including clinical symptoms, pathomorphism and immunophenotyping was performed, and the literatures were also analyzed. Results The clinical symptoms of the patients with nasal NK/T cell lymphoma were not obvious, which were accompanied by nasal congestion,runny nose,and blood in the runny nose.Pathologic examination showed obvious necrosis and inflammatory background of different levels. There were allotypic lymphocytes in the inflammatory background, nuclear irregular distortion or folding, unapparent nucleoli and visible nuclear fission, tumor cell growth for the center with blood vessels resulting in invasion and damage to blood vessels, in which normal lymphocytes,plasma cells and tissue cells could be seen.CD3,CD43,CD56,TIA-1,granzyme B,perforin and other markers were expressed in the tumor cells, and EB virus in situ hybridization was positive. Conclusions Nasal NK/T cell lymphoma is rare,with high incidence of invasive tumor, high recurrence rate, poor prognosis and easy misdiagnosis, which needs immunohistochemistry for differential diagnosis. Treatment is mainly based on radiotherapy and chemotherapy.
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Objective To study the clinical characteristics and treatment of primary nasal B-cell lymphoma (PNBCL). Methods A retrospective analysis was performed based on the clinical records of 18 PNBCL cases who were treated from January 2009 to June 2015. The clinical manifestations, imaging features, diagnosis approaches and treatment of them were analyzed. Results The main symptoms were nasal obstruction and rhinorrhea. Of all patients, 15 cases were in Ann Arbor stageⅠE-ⅡE, and 3 cases were in Ann Arbor stageⅢE-Ⅳ. The median age was 51 years (12-76 years). The ratio of men to women was 11:7. Only 1 patient had B symptoms. Elevated LDH levels were observed in 4 patients. 13 patients were diffuse large B-cell lymphoma(DLBCL), 3 patients were mantle cell lymphoma, and 2 patients were Burkitt lymphoma. CT examination showed the abnormal nasal soft tissue shadow, with unilateral location and light to moderate enhancement. 14 patients received combination chemotherapy only, and 3 patients received chemotherapy and radiotherapy. Total effective rate was 82.3 % (14/17). At the time of last follow-up, 5 patients died, and the 3-year OS rate was 54.5%(6/11). Conclusions Most PNBCL patients are in Ann Arbor stageⅠE-ⅡE and B symptoms are rare, and the most common pathological types is DLBCL. The treatment for PNBCL is chemotherapy, radiotherapy can assist, but the prognosis is poor, and innovative chemotherapy regimens are necessary.
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Objective To analyze the expressions and clinical significance of human epidermal growth factor receptor-2 (C-erbB-2) protein in sinonasal squamous cell cancer cells.Method Immunohistochemical and RT-PCR methods were used to detect the expression of C-erbB-2 in 62 cases of sinonasal squamous carcinoma tissues,30 cases of nasal polyps and 25 cases with normal nasal mucosa.The relationships between the expression of C-erbB-2 in sinonasal squamous carcinoma tissues and clinical pathological characteristics were analyzed.Results There was significant difference in the expression of C-erbB-2 in sinonasal squamous carcinoma tissues, nasal polyps and normal nasal mucosa tissues(P <0.05).The expression of C-erbB-2 was positively correlated with the clinicopathologic stage, tumor classification and lymph node involvement(P<0.05).Conclusion The expression of C-erbB-2 is correlated with tumorigenesis,invasion and metastasis of sinonasal squamous cell carcinoma.It can be used as an auxiliary diagnostic and prediction maker as well as a new therapeutic target of sinonasal squamous cell cancer.
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Objective To explore the expression and significance of Dickkopf-1 (Dkk-1) and cell lymphoma/leukemia-2 (Bcl-2) protein in sinonasal squamoucell carcinoma(SNSCC) .MethodThe immunohistochemical SP method and Western blomethod were adopted to determine the expression of Dkk-1 and Bcl-2 in 30 specimenof SNSC(SNSCgroup) ,38 specimenof sinonasal inverted papillomas(SNIP group) and 20 specimenof middle turbinate mucosa(control group) .ResultThe expression of DKK-1 protein in the SNSCgroup wasignificantly down-regulated compared with the SNIP group and the control group ,while the expression of Bcl-2 protein in the SNSCgroup wasignificantly up-regulated compared with the SNIP group and the control group;in the SNSCgroup ,the positive rateof DKK-1 protein and Bcl-2 protein in the high and middle differentiation group and the low differentiation group were 100 .00% ,68 .75% ,33 .33% and 50 .00% ,62 .50% ,100 .00% respectively ,the differencewere statistically significan(P＜0 .05) .Conclusion Dkk-1 protein may play an importanpromoting role in the developmenand pro-gression procesof SNSC,the expression of Dkk-1 protein hanegative correlation with the expression of Bcl-2 protein in SNSC,which may become new targespoof SNSCgene therapy .
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Objective To detect the clinical features and prognostic factors of nasal cavity malignancy with breast metastasis.Methods 846 Patients with nasal cavity malignancy from January 1999 to December 2011 were enrolled,the clinical and pathological features,clinical diagnostic methods and prognostic factors for breast metastasis patients were analyzed.Results Six female cases (median age 25) were diagnosed with breast metastasis,including 3 rhabdomyosarcoma and 3 olfactory neuroblastoma; consisting 0.7％ of the total 846 cases of primary nasal malignancy group.The metastasis were more likely to be multiple breast lesions with/without metastasis in other site.For the primary tumor,five patients received 66-72 Gy/30-33f of radical radiotherapy,one patient with rest rhabdomyosarcoma received 58 Gy of palliative radiation since breast metastasis was found after 14 Gy of radiation and breast mass resection were performed right after.For the breast metastasis,five of 6 patients received breast surgery,one patients with olfactory neuroblastoma received 6 cycles cyclophosphamide + adriamycin + vincristine chemotherapy.Median survival was 12.7 months.Conclusions For nasal cavity malignancy,breast metastasis more likely occur in younger female patients.Ultrasound may provide useful information in evaluating breast metastasis.Cases combined with metastasis except breast have unfavorable prognosis.