Malignant Sinonasal Tumors

Biopsy

• Endoscopic biopsies prior to definitive surgical procedure and radiological evaluation

Classification

• WHO classification for malignant sinonasal tumours

1. Malignant epithelial: (a) SCC, (b) adenoid cystic carcinoma, (c) adenocarcinoma

2. Neuroendocrine: (a) carcinoid

3. Malignant soft tissue: (a) sarcomas

4. Borderline and low malignant potential tumors of soft tissue: (a) hemangiopericytoma

5. Malignant tumors of bone and cartilage: (a) chondrosarcoma

6. Hematolymphoid: (a) lymphoma

7. Neuroectodermal: (a) olfactory neuroblastoma, (b) mucosal melanoma

8. Germ cell

9. Secondary: (a) renal, (b) lung, (c) breast

Epithelial

• Squamous cell carcinoma: >80%; most common in maxillary sinus (70%) >nasal cavity (20%) >ethmoid (10%); lymph node metastases rare

• Adenoid cystic: 10%—tubular, cribriform, and solid; solid = worse prognosis; perineural involvement 40% to 60%; cervical disease rare; high local recurrence rates

• Adenocarcinoma: 5%; mainly ethmoid and nasal cavity; risk factors inclue hardwood dust, lacquers, organic compound; local invasion common; cervical and distant metastases uncommon

• Esthesioneuroblastoma: 3%—olfactory epithelium origin near cribriform plate, advanced presentation common (Kadish C in >60%); high rate of intracranial extension; Kadish Grading System (Table 26–1)

TABLE 26–1. Kadish Staging System for Olfactory Neuroblastoma