Tumours Of The Nasal Cavity And Paranasal Sinuses

Front 1

What is the epidemiology of SCCA of the head and neck?

Back 1

<1% of malignant tumours
Japan has higher rate
Extremely rare in children
M:F = 1.5
55-65 years of age

Front 2

What is the etiology?

Back 2

1) exposure to nickel,
2) chlorophenols
3) textile dust,
4) Thorotrast instillation
5) Smoking,
6) History or concurrence of
HPV associated INVERTED sinonasal (Schneiderian) papilloma.

Front 3

What is the most common site of occurrence greatest to least?

Back 3

Maxillary sinus (60-70%)
Nasal cavity (12-25%)
Ethmoid sinus (10-15%)
Sphenoid and frontal sinuses ( 1%)

Front 4

Is SCCA of the nasal vestibule considered carcinoma of the mucosal epithelium?

Back 4

Squamous cell carcinoma of
the nasal vestibule should be considered a carcinoma of the skin rather than sinonasal mucosal epithelium.

Front 5

What are the features of verrucous carcinoma?

Back 5

Verrucous carcinoma of the nasal and paranasal sinuses is very rare. It is a lowgrade variant of squamous cell carcinoma characterized by a papillary or warty exophytic mass of very well-differentiated, keratinized epithelium. The maxillary sinus is the
most common site, followed by the nasal fossa. Rare nasopharyngeal lesions have encroached on the nasal sinus

Front 6

What is the most common site for verrucous carcinoma of the nasal and paranasal sinuses?

Back 6

The maxillary sinus is the followed by the nasal fossa.

Front 7

What are the types of SCCA of the nasal and paranasal sinuses?

Back 7

1) Verrucous
2) Paiillary
3) Basaloid
4) Spindle
5) Adenosquamous
6) Acantholytic

Front 8

What is a precursor lesions for sinonasal squamous
cell carcinomas?

Back 8

The sinonasal Schneiderian (inverted) papilloma appears to be a precursor lesion; the frequency of association has been estimated at about 10%.

Front 9

Is squamous metaplasia a precurser lesion for sinonasal squamous
cell carcinomas?

Back 9

Although squamous
metaplasia may precede the
development of sinonasal squamous
carcinoma, a predisposing role for such metaplasia in the development of carcinoma has not been clearly established.

Front 10

Does maxillary or sinonasal SCCA have a better 5 year survival?

Back 10

Sinonasal = 60%.
Maxillary = 42%

Front 11

Do patients with keratinizing or non-keratinizing SCCA do better?

Back 11

Patients with the non-keratinizing type of carcinoma tend to do better than those with the keratinizing type

Front 12

What is Lymphoepithelial carcinoma?

Back 12

Poorly differentiated squamous cell carcinoma or histologically undifferentiated carcinoma
accompanied by a prominent reactive lymphoplasmacytic infiltrate, morphologically
similar to nasopharyngeal
carcinoma.

Front 13

What is the epidemiology Lymphoepithelial carcinoma?

Back 13

rare, most cases reported in SE Asia, (like nasopharyngeal carcinoma)
M:F = 3:1 Age = 40-60

Front 14

What is the etiology of Lymphoepithelial carcinoma?

Back 14

A strong association with the EBV.

Front 15

What is an important cancer that must be distinguished from lymphoepithelial carcinoma?

Back 15

Sinonasal lymphoepithelial carcinoma must be distinguished from the vastly more aggressive sinonasal undifferentiated
carcinoma (SNUC). The presence of
lymphoplasmacytic infiltrates, although helpful, cannot be relied on solely in making the distinction. SNUC is characterized
by tumour cells with nuclear pleomorphism, high mitotic rate and frequent necrosis. EBV status is also helpful since SNUC, except for rare cases from Asians, are EBV-negative.

Front 16

Prognosis and predictive factors of lymphoepithial carcinoma?

Back 16

The tumour responds favourably to local regional radiotherapy even in the presence of cervical lymph node metastasis. Distant metastasis
(most often to bone), however, is associated with a poor prognosis.

Front 17

What is Sinonasal undifferentiated carcinoma?

Back 17

A highly aggressive and clinicopathologically distinctive carcinoma of uncertain histogenesis that typically presents with locally extensive disease. It is composed
of pleomorphic tumour cells with frequent necrosis, and should be differentiated from lymphoepithelial carcinoma and olfactory neuroblastoma.

Front 18

What is the epidemiology of Sinonasal undifferentiated carcinoma?

Back 18

Rare, with fewer than 100
reported cases. The age range is broad (third to ninth decade), and the median age is in the sixth decade.
M:F= 2-3:1

Front 19

What is the etiology of SNUC?

Back 19

Negative for EBV. Some cases have occurred after radiation therapy for nasopharyngeal carcinoma

Front 20

What is the localization of SNUC?

Back 20

The nasal cavity, maxillary antrum, and ethmoid sinus are involved
alone or in combination. The neoplasm also commonly extends to other contiguous sites.

Front 21

What are some of the symptoms of SNUC?

Back 21

Patients have multiple nasal/paranasal
sinus symptoms, usually of relatively
short duration, including nasal obstruction,
epistaxis, proptosis, periorbital
swelling, diplopia, facial pain, and symptoms
of cranial nerve involvement

Front 22

Is SNUC positive for NSE

Back 22

Less than 50% of cases tested show NSE positivity

Front 23

What is the IHC profile for SNUC?

Back 23

AE1/AE3, CK7, CK8 and CK19 Positive
CK4,CK5/CK6, CK14 and CEA Negative.
< 50% Positive for positive for EMA,
NSE, or p53.
The tumour is negative for CEA, while
positivity for synaptophysin, chromogranin,
or S100 protein is only rarely
observed

Front 24

Is SNUC positive for synaptophysin chromogrannin, S-100?

Back 24

Rarely

Front 25

How does Olfactory Neuroblastoma IHC differ form SNUC?

Back 25

ONB expresses NSE as well as synapto/chromo while SNUC does not.
SNUC expresses pancytokeratins and rarely EMA while ONB does not.

Susentacular cells in the periphery of presumed ONB nests express S-100

Front 26

What is the IHC profile of Lymphepithelial CA?

Back 26

AE1/AE3, EMA and EBER positive (strongly).