Clinicopathological analysis of primary nasopharyngeal melanomas in elderly patients / 中华老年医学杂志

Objective:To investigate the clinicopathologic features and molecular genetics characteristics of sinonasal tract mucosal malignant melanomas(STMMMs)in elderly patients.Methods:The clinicopathological features, immunohistochemical features and BRAF, C-KIT, NRAS mutations of STMMM in ten elderly patients were retrospectively analyzed.Results:Among the 10 patients, 5 were female and 5 were male.The patients were aged 65-81 years, with an average age of(72.5 ± 8.5)years.The lesions in 7 cases were located in the nasal cavity and paranasal sinuses, and in the other 3 cases were located in the nasopharynx.The morphologies of tumor cells under microscope was complex and diverse, showing plasma cell-like, rhabdomyoblast-like, small cell-like, epithelial-like, and spindle cell-like morphologies.Immunohistochemically, HMB-45 and S-100 were generally positive in 10 cases, and the positive rate of Melan A was 70.0%.The genes detection data showed no mutations in BRAF or NRAS genes in all the 10 cases, while C-KIT exon 11 c. 1666_1667insA mutation was found in one case, and the remaining 9 cases were wild-type for C-KIT.All the 10 cases were followed up for 4~50 months.Three cases survived so far.Conclusions:STMMM in elderly patients are rare and easy to be misdiagnosed.Immunohistochemistry and genetic testing provide guidance for accurate diagnosis and targeted therapy.

A Retrospective Clinicopathological Study Of Sinonasal Adenoid Cystic Carcinoma In A Tertiary Care Hospital Of Central Uttar Pradesh

INTRODUCTION: Adenoid cystic carcinoma (ACC) of the sinonasal tract is a rare cancer that accounts for 10% of all malignancies at this site. The objective of the current study was to evaluate prognostic factors, treatment outcomes, recurrence patterns, and survival rates for sinonasal adenoid cystic carcinoma. METHODS: A retrospective chart review was performed at a tertiary referral center between 2010 and 2015, 15 patients were evaluated for ACC of the sinonasal tract at a single institution. demographics, presentation, anatomic site, tumor, lymph node, metastasis (TNM) classification, pathology, treatment, recurrences, and survival were evaluated. RESULTS: The median age of patients was 52 years, and the mean follow–up was 36 months. The maxillary sinus (46.6%) and the nasal cavity (33.3%) were the most common primary tumor sites. The majority of patients presented with T3/T4 (73.3.7%) without any nodal and distant metastasis. All the patients underwent surgery and received postoperative radiation as treatment for their primary disease. The local recurrence rate was 40%. CONCLUSION–ACC of the sinonasal tract is a rare tumor. Poor prognostic factors that affect survival include tumor site, extent of invasion, stage, histopathologic type and grade. The current data suggested that surgical resection with postoperative radiation therapy offers durable local control and compares favorably with historic data. Since local recurrences develop in a significant percentage of patients, therefore, the ideal treatment paradigm has yet to be defined. However survival from this disease exceeds that of other sinonasal malignancies.

Fibrosis angiocéntrica eosinofílica intranasal asociada a enfermedad relacionada con IgG4 / Intranasal eosinophilic angiocentric fibrosis associated with an IgG4-related disease

Resumen La fibrosis angiocéntrica eosinofílica es una lesión tumoral infrecuente de la órbita ocular y del tracto respiratorio superior. Presentamos el caso de un hombre de 44 arios, con antecedentes de severa congestión y obstrucción nasal, y síntomas de sinusitis. Una TAC de senos paranasales mostró una masa focal de tejidos blandos de alta densidad que crecía desde la cara anterior del septum nasal. Se resecó parte del tabique. Los cortes histológicos mostraron una fibrosis concéntrica densa con patrón angiocéntrico y células inflamatorias mixtas. Se demuestra la presencia de fibrosis angiocéntrica eosinofílica. El dosaje sérico de IgG: 1.421 mg/dl (valor normal: 540-1.822) y el de IgG4: 168,70 mg/dl (valor normal: 6,1-121). Los preparados histológicos fueron inmunomarcados para IgG4 mostrando 50 plasmocitos IgG4(+)/HPF.

Abstract Eosinophilic angiocentric fibrosis is an uncommon tumefactive lesion of the ocular orbit and upper respiratory tract. We present a 44-year old man with a history of severe nasal congestion and nasal obstruction. The patient also reported symptoms of sinusitis. Submucous thickening tissue had been locally resected and the involved anterior nasal septum cartilage partially removed. Histopathological examination of the biopsy indicated eosinophilic angiocentric fibrosis. A CT scan of the sinuses showed a high-density focal mass of soft tissue arising from the anterior aspect of the nasal septum. Examination under low power view showed dense concentric fibrosis and mixed inflammatory cells. The fibrosis was in an angiocentric pattern, resembling an onionskin. High power view showed a mixture of lymphocytes, plasma cells, numerous eosinophils, and proliferating fibroblasts. A test for serum IgG performed ten years after the patient's initial presentation was 1421 mg/dl (normal range 540-1822 mg/dl), and the serum concentration of IgG4 was 168.70 mg/dl (normal range 6.1121 mg/dl). A review of the original haematoxylin and eosin-stained slides revealed that this case was stained immunohistochemically with an IgG4 stain showing 50 IgG4-positive plasma cells/HPF.

Eosinophilic angiocentric fibrosis of nasal septum: a case report.

Eosinophilic Angiocentric Fibrosis (EAF) is an uncommon benign condition involving the sinonasal tract and rarely the larynx and orbit. Its etiology still remains unclear, although some studies have hypothesized it as a form of IgG4-related systemic disease. Histologically EAF is characterised by the presence of mixed inflammatory cells with eosinophil predominance in the early stage, followed by concentric layers of sclerosis around the small caliber vessels in the late stage. The rarity of this condition, tumor like presentation and oblivious etiology, makes it an interesting entity. We hereby report one such rare case of EAF, since the awareness of this entity is essential to make an accurate diagnosis.

A Case of Sinonasal Adenoid Cystic Carcinoma Presenting as a Huge Nasal Polyp / 대한이비인후과학회지

Adenoid cystic carcinoma (ACC) is the second most common malignancy in sinonasal tract occurring in the minor salivary gland of paranasal sinuses. It is also an aggressive neoplasm that results in a high incidence of both local recurrence and distant metastasis by perineural invasion. A 67-year-old woman had developed progressive nasal obstruction and facial pain for over two years. The imaging study showed a huge polypoid mass in the paranasal sinuses bulging into the nasal cavity without any adjacent bony erosion and orbital extension. The pathology was reported as a cribriform type of ACC. The mass was removed by endonasal endoscopic surgery and "Mini" Caldwell-Luc operation. Considering local recurrence due to perineural lymphatic invasion, postoperative radiation therapy was performed. We discuss here how the combination of endonasal endoscopic surgery and radiotherapy could provide the best chance for disease control in the selected stages of ACC.

Basaloid Squamous Cell Carcinoma in Nasal Cavity

Basaloid squamous cell carcinoma (BSCC) is often founded in the head and neck region. However, BSCC in the sinonasal tract is rare. We report here on the case of a 58-yr-old woman who presented with nasal obstruction and epistaxis. Computed tomography and examination of the nasal cavity revealed a tumor mass that originated from the right inferior turbinate with erosion of the nasal floor. The tumor that was attached to the inferior turbinate, the lateral nasal wall and the eroded right side hard palate, and so all this was resected. Histopathologic examination of the excised tumor confirmed BSCC in the nasal cavity. We report here on a nasal cavity BSCC that was treated with partial maxillectomy only.

Two Cases of Diffuse Large B-cell Lymphoma of Sinonasal Tract

Nasal lymphoma is an uncommon neoplasm in the sinonasal tract. The NK/T-cell type of lymphoma is more commonly found in Asian populations. However, B-cell lymphoma is more common in the western countries whereas it is rare in Asia. Recently, we experienced two cases of sinonasal B-cell lymphoma, which are rare cases in Korea, one in an advanced stage and one in an early stage. Both patients had no specific nasal symptoms or systemic B symptoms (fever, night sweat, weight loss). As our cases demonstrate, diagnosis of B cell lymphoma is often delayed in many cases because B-cell lymphoma does not show any specific symptoms. Thus, careful physical examination and biopsy under suspicion of malignancy are important for early diagnosis of nasal lymphoma.

A Case of Psammomatoid Ossifying Fibroma of Sinonasal Tract Presenting with a Facial Deformity and Choanal Atresia / 대한이비인후과학회지

The psammomatoid ossifying fibroma consisted of numerous cellular fibrous stroma, various bony trabeculae and calcified spherules (psammoma bodies) is known to typically involve the sinonasal tract. It is more destructive than the other benign fibroosseous lesions. Clinical manifestations vary from proptosis, nasal obstruction and headache to cosmetic disfigurement, depending on the location and the size of lesion. Complete surgical excision is the treatment of choice because of its tendency to recur. The author recently experienced a psammomatoid ossifying fibroma of sinonasal tract in a 37-year-old male with a facial deformity and choanal atresia, had a history of incomplete surgical excision. The choanal atresia was completely removed by endoscopic approach and the mass in the sinonasal tract was removed by midfacial degloving approach. We report this case with review of the literature.

Leiomyosarcoma of the Nose and Paranasal Sinuses / 대한이비인후과학회지

Leiomyosarcoma is an uncommon tumor of smooth-muscle origin, and has rarely been described in reference to the head and neck region. There have been 30 previously reported cases of this tumor involving the sinonasal tract in the literature. We present a case of leiomyosarcoma involving the nasal cavity, ethmoid, and sphenoid sinus. We also review here the characteristics, diagnosis and treatment of this tumor.