Malignant Tumors Of Nose & Pnas

J.KODANDA RAM

MALIGNANT TUMOURS OF NOSE

 INCLUDES NEOPLASMS OF NASAL

CAVITY AND PARA NASAL SINUSES

NEOPLASMS OF NASAL CAVITY

-USUALLY UNCOMMON -SEPARATION FROM TUMOURS OF PARANASAL SINUSES IS HARD EXCEPT IN EARLY STAGES -IN ADD,IT MAY ALSO BE INVADED BY GROWTHS FROM PARA NASAL,NASOPHARYNX,CRANIAL,BUC CAL CAVITY.

VARIETIES  CARCINOMA  MALIGNANT MELANOMA  OLFACTORY NEUROBLASTOMA  HAEMANGIOPERICYTOMA  LYMPHOMA  PLASMACYTOMA  SARCOMA

CARCINOMA -PRIMARY CA RARE.EXTENSION OF MAX OR ETHMOID CA -8O% ARE SQUAMOUS CEL TYPE.REST INCLUDES---ADENOID CYSTIC ---ADENO CA

SQUAMOUS CELL TYPE VESTIBULAR -FROM ITS LAT WALL. -EXT TO COLUMELLA,NASAL FLOOR,UPPER LIP. -METASTASIS PAROTID NODES.

SEPTAL -FROM MUCO CUT JUNCTN -CALLED NOSE PICKERS CANCER

LATERAL WALL -MOST COMMON SITE -EXT INTO ETH ,MAX SINUSES

NASAL SEPTAL TUMOUR

irregularly shaped lobular formation

of vest sq cell ca

Abundant mitotic figures

ADENO AND ADENOID CYSTIC  FROM GLANDS OF MUCOUS

MEMBRANE,MINOR SALIVARY GLANDS

BASAL CELL CARCINOMA  MOST COMMON – SKIN OF NOSE  TIP, ALA –COMMON SITES  CYST/PAPULO PEARLY NODULE /

ULCER WITH ROLLED OUT EDGES  SLOW GROWING  MAY INVADES UNDERLYING BONE / CARTILAGE

MALIGNANT MELANOMA  SEEN IN AGES > 50YRS  BOTH SEXES EQUALLY  SLATY GREY OR BLUISH BLACK

POLYP LIKE MASS  AMELANOTIC VARIETIES SEEN  CERVICAL NODAL METASTASIS AT TIME OF EXAMINATION

OLFACTORY NEUROBLASTOMA  TUMOUR OF OLF.PLACODE.  CHERRY RED POLYPOID MASS IN

UPPER 3RD NASAL CAVITY.  VASCULAR TUMOUR—BLEEDS ON BIOPSY

HAEMANGIOPERICYTOMA a rare vascular tumor believed to derive from perivascular modified smooth muscle cells (pericytes).  It comprises only 1% of all vascular neoplasms and approximately 3 % of all soft tissue sarcomas. 

---LYMPHOMA-NON HODGKINS-SEPTUM ---PLASMACYTOMA-SOLITARY TUMOUR WITHOUT GEN OSS DISEASE. ---SARCOMAS-OSTEOGENIC, CHONDROSARCOMA, RHABDOMYO, ANGIO, MALIGNANT HISTIOCYTOMA.

Right nasal endoscopy.

LYMPHOMAS

Left nasal endoscopy.

The axial CT scan photograph below shows a soft tissue mass resembling adenoids, arising from the vault of the nasopharynx. This mass protrudes into both nasal cavities, completely obstructing the airway.

LYMPHOMA

MALIGNANT TUMOURS OF PARA NASAL SINUSES

 MORE COMMON THAN BENIGN.  MOST FREQ---MAXILLARY TUMOURS  OTHERS ARE RARE.

AETIOLOGY  UNKNOWN  HIGH IN WORKERS OF HARDWOOD

FURNITURE,NICKEL REFINING,LEATHER WORK…..  CA OF MAX—BANTU TRIBES

HISTOLOGY  MAJORITY—SQ CELL TYPE  OTHERS----ADENO,

ADENOID CYSTIC, MELANOMA, SARCOMA.

CA OF MAXILLARY SINUS  FROM SINUS LINING  RAMAIN SILENT FOR LONG TIME,

LOOKS LIKE SINUSITIS  LATER INVADES & DESTRUCTS SURROUNDING STRUCTURES

CLINICAL FEATURES

EARLY1.NASAL STUFFINESS, 2. BL. STAINED DIS, 3.FACIAL PARAESTHESIAS, 4.EPIPHORA

LATE DEPENDS ON DIR OF SPREAD.

 MEDIALLY---NASAL OBST,

DISCHARGE, EPISTAXIS  ANT---CHEEK SWELLING,INV SKIN.  INF----ALVEOLUS – DENT PAIN,GING ULCERS.  SUP--PROPTOSIS, DIPLOPIA, OCC.PAIN, EPIPHORA

 POST---PTERYGO.PAL. FOSSA,

PTERYGOID PLATES, MUSLES---TRISMUS, NASOPH,SPH SINUS,SK.BASE  INTRA CRANIALLY-VIA ETHMOIDS, CRIB PLATE, FOR LACERUM.  LYMPH SPREAD---UNCOMMON ---ONLY LATE STAGE ---SUB MAN,UP JUG  SYST META---LUNGS, BONE

 DIAGNOSIS

X-RAY—OPAQUE EXP & DEST BONY WALL CT SCAN---CORONAL & AXIAL BIOPSY----CALDWELL-LUC OP

CLASSIFICATION  OHNGRENS—  AJCC----ONLY FOR SQ CELL TYPE  LEDERMAN’S----2 HOR LINES

ORB ANTR

-FLOOR OF -FLOOR OF ----2 VERT LINES

Stage grouping of cancer of Maxillary and Ethmoid sinus Stage 1

T1 N0 M0

Stage 2

T2 N0 M0

Stage 3

T3 N0 M0 - T1/ T2/ T3 with N1 M0

Stage 4 A

T4 N0 M0 - T4 N1 M0

Stage 4 B

Any T N2 M0 – Any T N3 M0

Stage 4C

Any T Any N M1

Axial CT showing involvement of the maxillary sinus and ethmoids.

Axial CT showing involvement of the left orbit and proptosis.

ETHMOIDAL SINUS  PRIMARY UNCOMMON  EXT OF PRIM FROM MAX.

CLINICAL FEATURES

EARLY– 1 NASAL OBST, 2 BLOOD DIS, 3 RET ORB PAIN.

LATE— 1BROAD NASAL ROOT 2LAT DIS EYEBALLDIPLOPIA 3MENINGITIS EXT CRIB PLATE.

 DIAGNOSIS------

CT ---INT CRAN SPREAD

FRONTAL SINUS  RARE  C/F---PAIN,SWELL FRONT REGN

---ERODE FLOOR,SWELL ABOVE MED CANTH ---EXT INTO ORBIT THR ETH ---POST---INV DURA OF ANT CR FOSSA.

Axial CT scan showing erosion of the outer table of the left frontal sinus and a density inside the left sinus cavity.

Coronal CT scan showing erosion of the left frontal sinus and proptosis of the left orbit.

This patient presented with proptosis and pain in the left orbit. On xray, there was an erosion of the medial aspect of the superior orbital rim.

SPHENOID SINUS  VERY RARE  DIFF FROM ITS INFMNS  DIAGNOSIS---PLAIN X-RAY

CT-SCAN