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Malignancy Of Paranasal Sinuses

Malignancy is most commonly seen in the maxillary sinus. People working in wood/furniture factories, leather factories, nickel refineries have higher incidence of PNS malignancies.

Histology:- Most common PNS CA is Sq cell CA but peoples working in wood/furniture factories have adeno carcinoma more commonly.
  1. Clinical feature of CA maxilla:
    1. - More common in males   - Age 40 – 60 yrs
    2. - Blood stained nasal discharge  - Facial paraesthesia / pain  - Epiphora / pain or loosing of teeth

Extra Edge. Risk factors associated with nasal and paranasal sinus malignancy are: wood dust, nickel and chromium plat­ing industries, isopropyl oil, volatile hydrocarbons and smoking.

  1. Lymphatic spread
    May spread primarily to retro-pharyngeal Lymph node and than into submandibular and upper deep cervical L/N
  2. Investigation:
    1. X-ray and CT scan to see extend of the disease
    2. Biopsy for confirmation of disease, to see type of CA and for staging of the disease
  3. Classification of Sino-Nasal Tumors:
    1. Ohngren’s Line : Using an imaginary line between medial canthus to the angle of mandible. Growth above this line have poor prognosis and growth below this line have good prognosis.
      1. Above the line:
        1. Suprastructure
      2. Below the line:
        1. Infrastructure
    2. AJC classification:
      T1 : Tumor confined to the antral mucosa of the infrastructure with no bone erosion
      T2: Tumor in the superstructure mucosa without any bony destruction or in the infrastructure with destruction of the medial/inferior bony wall
      T3: Tumor invading the skin of the cheek, anterior ethmoid, pterygoid muscles and orbit
      T4: Involvement of the cribriform plate, posterior ethmoid, sphenoid sinus, nasopharynx skull base, pterygoid plates.
    3. Lederman’s classification: using two line of Sebileau, one passing through floor of antrum the   other through roof of antrum, dividing area into :
      1. Supra structure                            
      2. Meso structure and                                      
      3. Intra structure.
Treatment: In most cases a combination of surgery and radio therapy is requireD. However depending on histopathological nature, therapy may differ.
  1. Features of other tumors:
    1. Olfactory Esthesioneuroblastoma (arise from olfactory neuroepithelium)
      1. Neuroendocrine tumor
      2. Age -  11-20 yrs or 57-60 yrs
      3. Site: Upper part of the nasal cavity
      4. Is slow growing
      5. Is red, polypoidal & bleeds profusely
      6. Treatment: Surgery followed by radiotherapy
    2. Hemangio pericytoma
      1. Arise from pericytes of capillary wall
    3. Squamous Cell Carcinoma:
      1. Age group : > 50 yrs
      2. Sex: Male’s > Female
      3. Maxillary sinus: Most commonly affected
      4. Site of metastasis: Lungs, bone & abdominal viscera
    4. Adenoid - Cystic Carcinoma
      1. Site: Antrum & nose
      2. M/E: Swiss- Cheese pattern
      3. Has a potential of perineural spread

Extra Edge: Commonest soft tissue sarcoma: Rhabdomyosarcoma

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