Primary chemotherapy followed by anterior craniofacial resection and radiotherapy for paranasal cancer.
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BACKGROUND: To study prospectively the activity of primary chemotherapy with cisplatin, fluorouracil and leucovorin (PFL) in patients with paranasal cancer receiving surgery and postoperative radiotherapy. PATIENTS AND METHODS: Forty-nine patients, previously untreated, with resectable paranasal carcinoma were enrolled. PFL (leucovorin 250 mg/m2/day for 5 days as a 120 h continuous infusion (c.i.), 5-fluorouracil 800 mg/m2/day from day 2 as a 96 h c.i. and cisplatin 100 mg/m2 day 2 q 3 weeks) was planned for five courses. RESULTS: Thirty-two patients (65%) completed three or more chemotherapy courses. Two deaths from thrombotic events were observed after the first cycle. Eight cardiac toxicities were recorded during chemotherapy causing treatment discontinuation. Objective response to PFL was observed in 21 patients [43%; 95% confidence interval (CI) 29% to 58%], including four complete responses (CRs) (8%; 95% CI 2% to 20%) and 17 partial responses (PRs) (35%). Pathological complete remission (pCR) was achieved in eight of 49 patients (16%). At 3 years, overall survival was 69% and event-free survival 57%. Overall and event-free survival in patients achieving pCR is 100%. CONCLUSIONS: PFL is active in paranasal cancer. Patients who attain a pathological complete remission have a favorable prognosis. Cardiovascular complications represent the limiting toxicity. Primary chemotherapy combined with surgery-sparing treatment approaches deserves further investigation. (+info)
HPV infections in benign and malignant sinonasal lesions.
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This review updates the evidence that the human papillomavirus (HPV) is involved in the development of benign and malignant sinonasal lesions. Since the early 1980s, when evidence was provided on the possible involvement of HPV in the aetiology of both benign respiratory papillomas and squamous cell carcinomas, a substantial number of studies have explored this issue. To date, 33.3% of sinonasal papillomas and 21.7% of sinonasal carcinomas analysed have been shown to be positive for HPV. Many elements of the data parallel the observations made in HPV lesions at other mucosal sites, such as malignant transformation and frequent recurrence after radical treatment; the fact that low risk HPV types 6 and 11 are usually confined to benign lesions, whereas the reverse is true for the oncogenic HPV types 16 and 18; and the presence of squamo-columnar junctions and squamous cell metaplasia in the sinonasal system. The discrepancies reported by several studies might result in part from technical reasons, but it is also possible that sinonasal lesions have a heterogeneous aetiology (HPV related and non-related) and/or that some novel (yet unidentified) HPV types exist in these lesions, which are detected by some studies but not by others. (+info)
Fine-needle aspiration biopsy cytology of malignant neoplasms of the sinonasal tract.
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BACKGROUND: Primary and metastatic malignancies that originate in the sinonasal tract are rare and histologically diverse. The role of fine-needle aspiration biopsy (FNAB) and the cytomorphologic features of these tumors have not been specifically addressed. METHODS: The authors reviewed 22 cytology cases (20 FNABs, 1 sputum sample, and 1 pleural fluid sample) from 18 patients with malignancies originating in the sinonasal tract (17 carcinomas, 3 melanomas, and 2 sarcomas) and assessed the cytomorphology, cytohistologic correlation, and ability of cytology to render a specific diagnosis. RESULTS: Primary and metastastic sites sampled by FNAB included masses in or around the nose (n = 2), orbit (2), maxillary sinus (2), frontal sinus (1), intraoral area (1), preauricular area (1), soft tissue neck masses, parotid and lymph nodes (10), and cervical spine (1). Exfoliative cytology was positive in two samples of sputum and pleural fluid, representing the initial cancer diagnosis before the sinonasal primary tumor was detected. Seventeen of 22 (77.3%) cases were classified as carcinoma not otherwise specified, carcinoma with specific differentiation, sarcoma, or melanoma. Cytology failed to correctly classify the specific subtype of three carcinomas. The cytologic features that were evaluated included cellularity, cellular arrangement, nuclear features, nuclear-to-cytoplasmic ratio, and the background appearance. CONCLUSIONS: Sinonasal tract malignancies demonstrate a wide range of cytologic findings but specific features allowing for an accurate and definitive diagnosis are often present in many tumors. Fine-needle aspiration cytology is an important diagnostic tool in the management of sinonasal malignancies and can be complemented by the use of ancillary studies for the diagnosis of poorly differentiated or nonepithelial tumors. (+info)
Sinonasal intestinal-type adenocarcinoma involvement of the paranasal sinuses.
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We present a patient with a biopsy-proved sinonasal intestinal-type adenocarcinoma who presented with moderate confusion. He was found to have bifrontal hemorrhages, which to our knowledge has not been previously described in the literature for this entity. Intestinal-type adenocarcinoma should be in the differential diagnosis of aggressive lesions in the base of the skull with intracranial spread from the paranasal sinuses. (+info)
Inflammatory myofibroblastic tumour of paranasal sinuses with fatal outcome: reactive lesion or tumour?
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Inflammatory myofibroblastic tumours (IMTs) are clinicopathologically distinctive but biologically controversial entities, which have been described in the lungs, abdomen, retroperitoneum, and extremities, but rarely affect the head and neck region. IMT usually follows a benign clinical course after radical excision, but invasive, locally recurrent, and metastatic forms of abdominal and mediastinal IMT have also been described. This report describes a case of IMT of the paranasal sinuses with a fatal outcome. A 22 year old woman was admitted to hospital as a result of epistaxis. Computed tomography scan and magnetic resonance imaging showed an expansive process in the paranasal sinuses, extending into the nasal cavity, orbita, and endocranium. The tumour progressed despite several surgical procedures. Radiotherapy, corticosteroids, and chemotherapy were unsuccessful, and the patient died four years after diagnosis, as a result of extensive intracranial spread of the tumour. This is the first known case of an IMT of the head and neck region with a fatal outcome. It shows that the aggressive behaviour of IMTs is not limited to abdominal and mediastinal locations, and supports recent observations that at least a subset of IMTs represents true neoplasia rather than reactive myofibroblastic proliferation. (+info)
Chondroid chordoma presenting with hypopituitarism.
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A 28-year-old man with chondroid chordoma, an uncommon variant of chordoma, is reported. The patient presented with visual disturbance and hypopituitarism. The latter is a rare complication of intracranial chordoma. The preoperative diagnosis of chondroid chordoma of the skull base was based on unique findings on computed tomography and magnetic resonance imaging studies. The development of the tumor over six years suggests that the prognosis of chondroid chordoma may be poor in younger patients, as recently reported. Although chondroid chordoma is very rare, it should be included in the differential diagnosis of hypopituitarism. (+info)
Sinonasal ossifying fibroma with fluid-fluid levels on MR images.
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Ossifying fibroma is a rare benign neoplasm that usually affects mandibular and maxillary bones. In this report, we present a case of sinonasal ossifying fibroma with fluid-fluid levels and posterior extension toward the torus tubarius on MR images. (+info)
Intraarterial cisplatin with intravenous paclitaxel and ifosfamide as an organ-preservation approach in patients with paranasal sinus carcinoma.
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BACKGROUND: The objectives of this study were to determine the efficacy, organ-preservation rate, and safety of intraarterial (IA) cisplatin in combination with intravenous paclitaxel and ifosfamide in patients with locally advanced carcinoma of the paranasal sinuses who required orbital exenteration or major craniofacial resection for complete tumor resection. METHODS: Patients were treated with intravenous paclitaxel (135 mg/m(2)) on Day 1, ifosfamide (1000 mg/m(2)) on Days 1-3, sodium mercaptoethanesulfonate (600 mg/m(2)) on Days 1-3, and IA cisplatin (100 mg/m(2)) on Day 1 every 21 days. RESULTS: Of 24 study participants, 20 patients received at least 1 course of IA cisplatin, 1 patient had an early death, and 19 patients were evaluable for response. Five of those 19 patients (26%) achieved a complete response (CR), 6 patients (32%) achieved a partial response, and 8 patients (42%) had stable disease or developed progressive disease. Eye-sparing surgery followed by radiotherapy (RT) was feasible in 7 of 24 patients, RT was offered to only 7 patients, whereas 3 patients received chemotherapy and RT, 2 patients refused further therapy, 3 patients underwent craniofacial resection with orbitectomy, and 1 patient was treated systemically for metastatic disease. At the completion of treatment, 14 of 23 patients (61%) with locally advanced disease were disease free, and the orbit was preserved in 21 of 24 patients (88%). The overall survival, progression-free survival, and disease-free survival rates at 2 years were 60%, 50%, and 84%, respectively. Toxicity was substantial, with two patients experiencing cerebrovascular ischemia (one transient and one cerebrovascular accident) and three patients experiencing cranial neuropathy, which was reversible in two patients. CONCLUSIONS: Despite the encouraging organ-preservation rate, the approach studied resulted in substantial toxicity, and more effective adjunctive therapy is needed. Alternative approaches, including the integration of targeted therapy agents in induction chemotherapy regimens followed by concomitant chemotherapy and RT or eye-sparing surgery, need further exploration. (+info)