Características epidemiológicas, clínicas, radiológicas y anatomopatológicas de los tumores nasosinusales malignos en pacientes hondureños / Epidemiological, clinical, radiological and anatomopathological characteristics of malignant sinonasal tumors in Honduran patients

Introducción: Los tumores de la cavidad nasal y senos paranasales son neoplasias poco frecuentes. La histopatología y características clínicas son diferentes al resto de las neoplasias de cabeza y cuello. Objetivo: Caracterizar desde el punto de vista clínico-epidemiológico, radiológico y anatomopatológico a los pacientes mayores de 18 años con tumores nasosinusales malignos atendidos en un hospital hondureño. Métodos: Estudio observacional, descriptivo y transversal, mediante una técnica de muestreo no probabilístico por conveniencia se tomó una muestra de 30 pacientes que estaban hospitalizados en sala de otorrinolaringología del Hospital Escuela de la Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, en el periodo enero del 2017-diciembre del 2019. Los pacientes estudiados habían sido diagnosticados con cáncer de nariz y senos paranasales. Resultados: El estudio incluyó 30 pacientes, de los cuales el 47 por ciento eran mayores de 50 años, de sexo femenino un 53 por ciento, amas de casa el 40 por ciento y agricultores el 20 por ciento. Los principales síntomas y signos fueron obstrucción nasal (50 por ciento), rinorrea (30 por ciento) y masa (20 por ciento), con localización principalmente en cavidades nasales (67 por ciento). Las características radiológicas más importantes fueron su vascularidad (43 por ciento) y unilateralidad (33 por ciento), la estirpe histológica que predominó fue el linfoma (30 por ciento). Conclusiones: Los tumores nasales predominaron en el sexo femenino, siendo la obstrucción nasal, rinorrea y masa sus síntomas y signos principales. El aumento de la vascularidad en la imagen por tomografía computarizada orienta a sospechar malignidad. Se evidenció que el factor económico y el desconocimiento de la enfermedad demoró la asistencia del paciente a un centro hospitalario(AU)

Introduction: Tumors of the nasal cavity and paranasal sinuses are infrequent neoplasms. Their histopathology and clinical characteristics are different from those of other head and neck neoplasms. Objective: Carry out a clinical-epidemiological, radiological and anatomopathological characterization of patients aged over 18 years with malignant sinonasal tumors attending a Honduran hospital. Methods: A cross-sectional observational descriptive study was conducted. Nonprobability convenience sampling technique was applied to select a sample of 30 patients staying at the otolaryngology ward of the Medical Sciences Hospital School at the National Autonomous University of Honduras from January 2017 to December 2019. These patients had been diagnosed with nose and paranasal sinus cancer. Results: The study included 30 patients, of whom 47 percent were aged over 50 years, 53 percent were female, 40 percent were housewives and 20 percent were farmers. The main signs and symptoms were nasal obstruction (50 percent), rhinorrhea (30 percent) and mass (20 percent), with most common location in the nasal cavity (67 percent). The most important radiological characteristics were their vascularity (43 percent) and one-sidedness (33 percent), with lymphoma as the prevailing histological type (30 percent). Conclusions: Nasal tumors prevailed in the female sex, with nasal obstruction, rhinorrhea and mass as their main signs and symptoms. Increase in vascularity in computed tomography images leads to suspecting malignancy. Evidence was found that the economic factor and poor knowledge about the disease delayed patient attendance to a hospital institution(AU)

Sinonasal inverted papilloma: rate of recurrence and malignant transformation in 44 operated patients / Papiloma invertido nasossinusal: taxa de recorrência e transformação maligna em 44 pacientes operados

Abstract Introduction: Although sinonasal inverted papillomas are benign lesions, they are locally aggressive and have a potential malignant transformation ranging from 5% to 15%, with a high recurrence rate. Objective: The aim of this article is to describe the rate of recurrence and malignant transformation in patients with a diagnosis of inverted papilloma who underwent surgery in a tertiary hospital in São Paulo. Methods: We performed a retrospective analysis of patients diagnosed with sinonasal papilloma who had undergone surgery in a tertiary hospital in São Paulo, between August 1998 and August 2017. A patient chart review was conducted to assess data of patients' demographics, tumors characteristics, follow-up appointments, recurrence and malignancy. Inverted papillomas were analyzed and classified under the Krouse staging system. Results: A total of 69 surgeries were performed in patients with diagnosis of sinonasal papilloma. Inverted papilloma was the most prevalent subtype (49 cases ‒ 80.33%), followed by exophytic papilloma (6 cases ‒ 9.84%) and by oncocytic papilloma (6 cases - 9.84%). The recurrence rate was 34.09% for inverted papilloma (15/44) and the mean time of recurrence was 24.6 months. Malignant transformation occurred in 6 patients (13.64%). Three of these patients presented carcinoma in the first surgery and three patients developed carcinoma during the follow-up. Conclusion: The high recurrence rate and malignancy potential allow us to consider inverted papillomas as aggressive tumors. In a tertiary hospital in São Paulo the recurrence rate the mean time to recurrence is 24.6 months. The recurrence after 10 years implies was 34.09% and the need for long-term follow up. It is possible that the high recurrence rate and the high malignant transformation rate we found are due to the large number of tumors discovered at an advanced stage (most of them staged T3 and T4), secondary to poor access to health system, in developing countries.

Resumo Introdução: Embora os papilomas invertidos nasossinusais sejam lesões benignas, eles são localmente agressivos e apresentam uma potencial transformação maligna que varia de 5% a 15%, com alta taxa de recorrência. Objetivo: Descrever a taxa de recorrência e transformação maligna em pacientes com diagnóstico de papiloma invertido submetidos à cirurgia em um hospital terciário em São Paulo. Método: Análise retrospectiva dos pacientes diagnosticados com papiloma nasossinusal submetidos a cirurgia em um hospital terciário em São Paulo, entre agosto de 1998 e agosto de 2017. Uma revisão de prontuários dos pacientes foi realizada para avaliar dados demográficos, características dos tumores, consultas de seguimento, recorrência e malignidade. Os papilomas invertidos foram analisados e classificados de acordo com o sistema de estadiamento de Krouse. Resultados: Foram realizadas 69 cirurgias em pacientes com diagnóstico de papiloma nasossinusal. O papiloma invertido foi o subtipo mais prevalente (49 casos - 80,33%), seguido pelo papiloma exofítico (6 casos - 9,84%) e pelo papiloma oncocítico (6 casos - 9,84%). A taxa de recidiva foi de 34,09% para o papiloma invertido (15/44) e o tempo médio de recorrência foi de 24,6 meses. Transformação maligna ocorreu em seis pacientes (13,64%); três desses pacientes apresentaram carcinoma na primeira cirurgia e três pacientes desenvolveram carcinoma durante o seguimento. Conclusão: A alta taxa de recorrência e o potencial de malignidade nos permitem considerar os papilomas invertidos como tumores agressivos. Em um hospital terciário de São Paulo, a taxa de recorrência foi de 34,09% e o tempo médio de recorrência de 24,6 meses. A recorrência após 10 anos implica na necessidade de acompanhamento a longo prazo. É possível que a alta taxa de recorrência e a alta taxa de transformação maligna que encontramos sejam devidas à grande extensão dos tumores (a maioria deles nos estágios T3 e T4), decorrente do acesso precário ao sistema de saúde nos países em desenvolvimento.

Sinonasal neoplasms in 49 dogs: clinical, macroscopic, and histopathological aspects / Neoplasmas nasossinusais em 49 cães: aspectos clínicos, macroscópicos e histopatológicos

This study aimed to quantify nasosinusal neoplasms diagnosed in dogs in 20 years (2000-2019) and characterize the main clinical, macroscopic, and histological aspects of these neoplasms. The sex, breed, age, skull conformation, the main clinical signs, and the anatomopathological characteristics (distribution, macroscopy, and histology) were computed. During this period, 49 dogs were affected by neoplasms in these regions, totaling 50 neoplasms (one dog had two neoplasms of different locations and histogenetic origins). Similar amounts of mixed-breed dogs (25/49) and purebred dogs (24/49) were affected, these distributed in 16 breeds. Among purebreds, it was noted that dogs with mesocephalic cranial conformation (12/24) were the most affected, followed by dolichocephalic (10/24) and brachycephalic (2/24). There were 22 cases in males and 27 in females, making a proportion of 1:1.23. There was an age variation from 11 months to 16 years old. The epithelial neoplasms have occurred in older dogs compared to those of other histogenic origins (mesenchymal and other origins/round cells). The main clinical signs were similar between the histogenetic categories, related to the involvement of the upper respiratory tract, sometimes accompanied by nervous signs (when there was brain invasion of nasal neoplasms or vice versa). The possible origin site was mostly in the nasal cavity concerning the paranasal sinuses (and other locations). Invasions occurred in different tissues adjacent to the nasal cavity and paranasal sinuses, resulting in cranial and facial deformities (21/49). The frequency was 48% of epithelial neoplasms, 32% of mesenchymal neoplasms, and 10% of neoplasms with other origins and round cells. The neoplasms most frequently observed, in decreasing order of frequency, were: adenocarcinoma (9/50), squamous cell carcinoma (9/50), transmissible venereal tumor (5/50), osteosarcoma (5/50), chondrosarcoma (4/50), and undifferentiated sarcoma (4/50). Through this study, it was possible to establish the frequency of these neoplasms in 20 years and their clinical, macroscopic, and histological characteristics.(AU)

Este estudo teve como objetivo quantificar os neoplasmas nasossinusais diagnosticados em cães em 20 anos (2000-2019) e caracterizar os principais aspectos clínicos, macroscópicos e histológicos desses neoplasmas. Foram computados sexo, raça, idade, conformação do crânio, principais sinais clínicos e características anatomopatológicas (distribuição, macroscopia e histologia). Nesse período, 49 cães foram acometidos por neoplasmas nessas regiões, totalizando 50 neoplasmas (um cão tinha dois neoplasmas de localização e origens histogenéticas distintas). Foram acometidas quantidades semelhantes de cães sem raça definida (25/49) e de cães com raça definida (24/49), estes distribuídos em 16 raças. Entre os cães com raça definida, notou-se que os cães com conformação craniana mesocefálica (12/24) foram os mais acometidos, seguidos pelos dolicocefálicos (10/24) e braquicefálicos (2/24). Foram observados 22 casos em machos e 27 em fêmeas, perfazendo a relação de 1:1,23. Ocorreu uma variação de idade de 11 meses a 16 anos; tendo os neoplasmas epiteliais ocorrido em cães mais velhos quando comparado aos de outras origens histogênicas (mesenquimais e outras origens/células redondas). Os principais sinais clínicos foram semelhantes entre as categorias histogenéticas, sendo relacionados ao comprometimento do trato respiratório superior, por vezes acompanhados de sinais nervosos (quando houve invasão encefálica de neoplasmas nasais ou vice-versa). O possível local de origem em sua maioria foi na cavidade nasal em relação aos seios nasais (e de outras localizações). Ocorreram invasões para diferentes tecidos adjacentes à cavidade nasal e seios paranasais, tendo como consequência deformidades cranianas e faciais (21/49). A frequência foi de 48% de neoplasmas epiteliais, 32% de neoplasmas mesenquimais e 10% de neoplasmas com outras origens e de células redondas. Os neoplasmas mais frequentemente observados, em ordem decrescente de frequência, foram: adenocarcinoma (9/50), carcinoma de células escamosas (9/50), tumor venéreo transmissível (5/50), osteossarcoma (5/50), condrossarcoma (4/50) e sarcoma indiferenciado (4/50). Com isso, pode-se estabelecer a frequência desses neoplasmas em 20 anos, bem como suas características clínicas, macroscópicas e histológicas.(AU)

Cirugía endoscópica nasal en el tratamiento de papiloma invertido: a propósito de 18 casos / Endoscopic sinus surgery in the management of inverted papilloma: an analysis of 18 cases

RESUMEN Introducción El papiloma invertido nasosinusal es un tumor benigno con tendencia a la recidiva, y con riesgo de malignización. El tratamiento habitual es la extirpación quirúrgica. Objetivo Describir y analizar las características clínicas, epidemiológicas, y resultados del tratamiento quirúrgico por vía endoscópica. Material y método Estudio retrospectivo, descriptivo, incluyendo pacientes con papiloma invertido nasosinusal sometidos a extirpación quirúrgica endoscópica entre los años 2012 y 2016. Se analizaron variables epidemiológicas, clínicas, complicaciones quirúrgicas, recurrencias y transformación maligna. El grado de extensión se evaluó con tomografia computarizada según la clasificación de Krouse. Resultados La serie está constituida por 18 pacientes, con una edad promedio de 57,4 años. La clínica se caracterizó por obstrucción nasal unilateral 72,2% (13/18 pacientes), rinorrea 33,3% (6/18 pacientes), hiposmia 27,8% (5/18 pacientes) y epistaxis 27,8% (5/18 pacientes). Según la clasificación de Krouse, las lesiones iniciales se describen como estadio T1 en 7/18, T2 en 5/18, T3 en 5/18 y T4 en 1/18 pacientes. En el período de seguimiento, se observa recurrencia en 4 pacientes en un período promedio de seguimiento de 5,6 meses, y un caso de transformación maligna. No hubo complicaciones quirúrgicas, excepto un caso de epífora por obstrucción de la vía nasolagrimal. Conclusiones El abordaje endoscópico fue efectivo para el tratamiento de papilomas invertidos nasosinusales.

ABSTRACT Introduction Sinonasal inverted papillomas are benign tumors with a tendency to recur and a potential for malignant transformation. Surgical resection is the treatment of choice. Aim To describe and analyze the clinical characteristics, epidemiology, and surgical results from an endoscopic endonasal approach. Material and method Retrospective and descriptive study of all patients who underwent endoscopic sinus surgery for the treatment of a sinonasal inverted papilloma between the years 2012 and 2016. Variables analyzed include demographics, signs and symptoms, surgical complications, recurrence rate and malignant transformation. Tumor extension was evaluated with the Krouse staging system on computed tomography imaging. Results This series includes 18 patients, with a mean age of 57.4 years. Clinically, patients presented with unilateral nasal obstruction 72.2% (13/18 patients), followed by rhinorrhea 33.3% (6/18 patients), hyposmia 27.8% (5/18 patients) and epistaxis 27.8% (5/18 patients). Based on the Krouse staging system, 7/18 were T1, 5/18 were T2, 5/18 were T3 and 1/18 was T4 on initial evaluation. On follow-up, 4 patients presented with a recurrence at a mean period of 5.6 months, and one patient exhibited malignant transformation. No surgical complications were observed except for one case of epyphora as a consequence of nasolacrimal obstruction. Conclusions The endoscopic approach was effective for the treatment of sinonasal inverted papillomas.

Manejo endoscópico de papiloma invertido nasosinusal: experiencia de 15 años en Hospital Clínico Regional de Concepción / Endoscopic management of sinonasal inverted papilloma: 15 years experience in Concepción Clinical Hospital

Introducción: El papiloma invertido es uno de los tumores benignos más frecuentes de la región nasosinusal. Los principales problemas en su manejo son la recurrencia y transformación maligna. Su tratamiento es la extirpación quirúrgica. Objetivos: Describir y analizar las caracterfsticas cínicas y epidemiológicas, así como el resultado del tratamiento endoscópico practicado en el Hospital Clínico Regional de Concepción. Material y método: Se realizó un estudio retrospectivo, descriptivo, de todos los pacientes con diagnóstico de papiloma invertido nasosinusal operados vfa abordaje endoscópico entre los años 1997 y 2012. Se analizaron variables epidemiológicas y clínicas, incluyendo análisis de las recurrencias y transformación/asociación a cáncer. Resultados: Se encontraron 57 casos de papiloma invertido nasosinusal, 55 de los cuales se abordaron endoscópicamente, 65,5% hombres, 54,7 años en promedio de edad. La obstrucción nasal fue el principal síntoma. La mayor cantidad se concentró en estadio 2 (47,3%) y 3 (32,7%) de Krouse. Complicaciones relevantes 7,8%, las cuales fueron resueltas sin secuelas. Seguimiento promedio de 4,1 años, con una recurrencia de 5 (9,1%) casos, una persistencia (1,8%). Asociación con carcinoma escamoso en el 5,5% de los casos. Conclusión: La experiencia con la resección endoscópica en el papiloma invertido nasosinusal ha demostrado ser efectiva en nuestro medio, con baja tasa de complicaciones y recurrencias.

Introduction: The inverted papilloma is one of the most common benign tumors of the sinonasal region. The main problems in their management are the recurrence and malignant transformation. Their treatment is surgical removal. Aim: To describe and analyze the clinical and epidemiological characteristics, as well as the results of endoscopic treatment in a tertiary hospital. Materials and methods: A retrospective, descriptive study of all patients with diagnosis ofsinonasal inverted papilloma operated by endoscopic approach between 1997 and 2012 was carried out. Epidemiological and clinical variables were analyzed, including analysis of recurrences and transformation to / association with cancer. Results: 57 cases of sinonasal inverted papilloma were found, 55 of which were endoscopically resected, 65.5% male, 54.7 years old on average. Nasal obstruction was the main symptom. Most of them were in Krouse stage 2 (47.3%) and 3 (32.7%); 7.8% of major complications, which were resolved without sequels. The follow up average was 4.11 years, with a recurrence of 5 (9.1%) cases, and (1.8%) persistence. Association with squamous-cell carcinoma was found in 5.5% of cases. Conclusion: The clinical and epidemiological characteristics do not differ greatly from those reported in the literature. Experience with endoscopic resection in sinonasal inverted papilloma has proven effective in our clinical practice, with a low rate of complications and recurrences, this approach currently being the first choice in most cases.

clinical profile of benign tumours of nose and paranasal sinuses

To analyse the sex and age incidences, clinical presentations and histopathological picture of the benign tumours of nose and paranasal sinuses. Prospective, Longitudinal, Descriptive. GMS Memorial Academy of ENT and HNS,TUTH, Kathmandu, Nepal. 2 years, September 2008 to August 2010. All cases of benign masses of nose and paranasal sinuses who visited the Outpatient department and were undergoing surgical intervention were included. The histological proven malignant masses were excluded from the study. Out of 49 patients, majority of the patients were between 13-20 years [34.69%]. Male:female ratio was 3.9:l.The most common presenting symptoms were unilateral nasal obstruction and nasal bleeding [65.29%]. Inverted papilloma and angiofibroma were the most common tumours [42.84%]. All masses of nose and paranasal sinuses should be subjected to histopathological examination and followed up for two years for assessment of outcome of treatment and monitoring recurrences

Epstein-Barr virus-associated extranodal non-Hodgkin's lymphoma of the sinonasal tract and nasopharynx in Thailand.

Epstein-Barr virus (EBV) infection is highly associated with specific subtypes of malignant lymphoma. In our previous report on nodal malignant lymphoma in Thailand, we found that 64% of classical Hodgkin's lymphoma (cHL), 51% of non-Hodgkin's lymphoma, T-cell (NHL-T), and 13% of non-Hodgkin's lymphoma, B-cell (NHL-B) were EBV-related. In the present research, we conducted a retrospective study of primary extranodal non-Hodgkin's lymphoma of the sinonasal tract (e-NHL-ST) and primary extranodal non-Hodgkin's lymphoma of the nasopharynx (e-NHL-NP) in Southern Thailand, between 1997 and 2004. EBV-encoded RNA (EBER) expression by in situ hybridization was performed in all cases and a T-cell receptor (TCR)-g gene rearrangement study was performed in NHL-T cases. There were 18 cases of e-NHL-ST and 42 cases of e-NHL-NP detected by histologic and immunohistochemistry examinations. The percentages of e-NHL-ST and e-NHL-NP as compared to nodal malignant lymphoma were 3.7% and 6.8%, respectively. Sixteen cases (88.9%) of e-NHL-ST and 7 cases (16.7%) of e-NHL-NP were NHL-T, and the remainder were NHL-B. All of the NHL-T cases in both sites were EBER-positive. Two (5.4%) of the NHL-B cases in the nasopharynx showed EBER positive. Monoclonal bands of the TCR-gamma gene were detected in 71.4% of the extranodal NK/T-cell lymphomas, nasal type, patients; 50.0% of peripheral T-cell lymphoma, unspecified, patients; and one case of angioimmunoblastic T-cell lymphoma. This study indicates a very strong association of NHL-T in the sinonasal tract or nasopharynx with EBV infection, the link apparently being weaker in NHL-B patients. The study also indicates that most cases of extranodal NK/T-cell lymphoma, nasal type, are not the germline configuration of the TCR genes.

Malignant tumours of nasal cavity and paranasal sinuses in north of Iraq a fifteen years retrospective study

To identify the different pathological types of malignant tumors of nasal cavity and paranasal sinuses, their different clinical aspects, treatment received and prognosis in north of Iraq. Retrospective study. Files of patients treated in the hospital of oncology and nuclear medicine in Mosul over 15 years period [1980-1994]. Types, incidence, age and sex distribution, anatomical sites, clinical presentation, staging, method of treatment and prognosis. They consitiuted 0.51 percent of all malignancies and 2.13 percent of head and neck cancers. Sinus tumours affected both sexes equally as well as both sides. Nasal cavity tumours were more common in male [male/female=1.4/1] and in the right side [right/left=1.33/1]. The commonest age at presentation was the fifth decade. The most common presenting symptom was facial and nasal pain with average delay in diagnosis of about 8.5 months. Tumours of epithelial origin formed the majority of cases [85.68 percent]. All maxillary and ethmoidal cases were advanced at time of diagnosis [T3 or T4], while 60 percent of nasal cavity tumours were T1 and T2. 21.87 percent of patients had palpable cervical lymph nodes at presentation. The majority of patients received radiotherapy alone, few cases had surgery alone or both, but prognosis was generally unsatisfactory. Malignant tumours of nose and sinuses are rare in north of Iraq, are usually advanced at presentation, and carry poor prognosis

Malignant tumors of nose and paranasal sinuses

It is a study of 20 cases of sinonasal malignancies seen over a period of 5 years. The commonest age affected was fifth [35%] and sixth [30%] decades. The disease was more frequently seen amongst males compared to females with a ratio of 3:1. The commonest histological variant was squamous cell carcinoma [70%] followed by adenocarcinoma [15%], adenoid cystic carcinoma [5%], non-Hodgkin's lymphoma [5%] and haemangiopericytoma [5%]

Tumours of nose and paranasal sinuses: the boolean experience

This is an analysis of 21 cases of nose and paranasal sinuses tumours, presented at Bolan Medical College, Quetta, during the two year period [1996 and 1997]. Pre-operative evaluation and extent of tumour was assessed by clinical examination, radiology and histopathology in all the cases. The commonest pathology was squamous cell carcinoma [11 cases]. Early lesions were rare and most cases presented in III and IV stage. The commonest site of origin was the antero-lateral compartment of maxillary antrum. The Afghan population had significant higher preponderance in the younger age group. All these cases were treated by surgery with or without post-operative radiation therapy. In 12 cases there was no recurrence after one year follow-up with satisfactory improvement

Cancer de fosas nasales y senos paranasales / Cancer of nose and paranasal sineses

Se revisaron 34 casos de cancer de fosas nasales y senos paranasales en tres hospitales de La Paz, en cuanto a su epidemiologia, formas histoliticas y en 12 casos, los datos clinicos mas importantes. Llama la atencion el mnumero elevado de melanoma maligno, al parecer, primarios de fosas nasales y la presencia de un liposarcoma en una fosa nasal. Por ultimo, se comenta sobre la elevada incidencia de cancer de fosas nasales en nuestra poblacion, de acuerdo al Registro de Cancer de La Paz, en relacion a la incidencia de otras poblaciones consideradas de alta frecuencia para este grupo de neoplasias.