Paranasal sinus anatomy Sphenoid Nasopharynx
Respiratory mucosa Pseudostratified, goblet & ciliated cells Seromucinous glands
Nasopharyngeal mucosa/carcinoma Squamous metaplasia (?) with CIS Normal respiratory mucosa With lymphocyte trafficking Nasopharyngeal carcinoma expressing EBV early RNA transcripts (EBER1)
Sinonasal carcinomas 0.2% of malignancies 3% of head & neck carcinomas 50% 5-yr survival Maxillary antrum 58% Nasal cavity Ethmoid Frontal/sphenoid 30% 10% 1% each
W.H.O. Adenocarcinoma Intestinal-type adenocarcinoma Papillary adenocarcinoma Squamous cell carcinoma Sinonasal carcinoma Cylindrical cell carcinoma Verrucous squamous cell carcinoma Spindle cell carcinoma Small cell carcinoma Lymphoepithelial carcinoma Adenosquamous carcinoma
Origin of nasal/paranasal sinus tumors Surface columnar epithelium Squamous cell carcinoma Intestinal-type adenocarcinoma & low-grade papillary Seromucinous glands/surface Adenocarcinoma low & high-grade Biphasic salivary gland-type Ductal/acinar salivary gland-type Adenoid cystic carcinoma Pleomorphic adenoma, etc. Mucoepidermoid carcinoma Acinic cell carcinoma, etc. 3% Metastasis Lung carcinoma Breast carcinoma Renal carcinoma Intestinal adenocarcinoma (6% of mets)
Distribution of minor histologic tumor types among paranasal sinus carcinomas Lund 1980-2004 Maxillary Ethmoid Sphenoid Salivary gl type N=13 12 1 0 Seromucinous adenocarcinoma N=8 2 6 0
Salivary gland-type carcinomas mucoepidermoid Intermediate cells Mucus cells
Adenocarcinoma seromucinous, low grade Nerve with tumor infiltrate
Adenocarcinoma seromucinous, high grade
Distribution of major histologic types among paranasal carcinomas Lund 1980-2004 Maxillary Ethmoid Sphenoid SSC N=57 55 2 0 IT-adenocarcinoma N=23 4 18 1
Intestinal-type adenocarcinoma M:F 5:1 Mean age 50 65 yr, range 3rd to 9th decade Predominantly ethmoid sinus followed by nasal cavity & maxillary sinus Metastasis to lateral neck nodes <20%, distant metastases occur Death by intracranial spread Etiology: hardwood & leather dust, chrome
Carcinoma filling nasal cavity, ethmoid sinus with penetration of cribriform plate CT courtesy of Dr. Mårten Annertz Dept. of Radiology Lund University Hospital
Ethmoid sinus cancer CT primary MR complement CT courtesy of Dr. Mårten Annertz Dept. of Radiology Lund University Hospital Penetration of posterior antrum Middle cranial fossa Skeletal filter
Well-differentiated intestinal-type adenocarcinoma, papillary pattern Muscularis mucosae
Well-differentiated intestinal-type adenocarcinoma component cells Paneth cells Goblet cells
Well-differentiated intestinal-type adenocarcinoma neuroendocrine cells Chromogranin A Gastrin Somatostatin
High-grade intestinal-type adenocarcinoma
High-grade intestinal-type adenocarcinoma Cribriform pattern Partial regression
Mucinous intestinal-type adenocarcinoma
Courtesy of Dr. Mårten Annertz Dept. of Radiology Lund University Hospital Tumor spread
Sinonasal squamous cell carcinoma M:F 2:1 Most >50 yr, rarely <40 yr Predominantly nasal cavity & maxillary sinus, rarely ethmoid Usually well to moderately differentiated Metastasis to lateral neck nodes in ~15%, especially if bone is penetrated Etiology: nickel, softwood dust, mustard gas production, Thorotrast Worse Worse prognosis prognosis Better Better prognosis prognosis Öhngren's plane through antrum
Squamous cell carcinoma, maxillary sinus Squamous metaplasia Invasive cancer Bone invasion
Squamous cell carcinoma, perineural growth
Summary Metaplasia neoplasia sequence Squamous metaplasia Non-lymphoid respiratory mucosa Concomitant intestinal metaplasia/neoplasia Squamous cell carcinoma
Carcinoma of Paranasal Sinuses Michael Dictor, MD, PhD Department of Pathology Lund University Hospital Lund, Sweden
Ethmoid sinus cancer Courtesy of Dr. Mårten Annertz Dept. of Radiology Lund University Hospital Penetration of antrum,orbit/base of skull
Molecular lesions in sinus carcinoma of intestinal type c-erbb-2 expression
Molecular lesions: RAS Nucleotide Amino Acid N K-RAS2 Sinonasal Codon 35 g>a G12D 3 Ethmoid Codon 38 g>a G13D 1 Codon 37 g>t G13C 1 H-RAS Ethmoid Codon 35 g>t G12V 5 Saber et al. Cancer Lett 1998;126:59-65 Perez et al. Cancer 1999;86:255-264
adenoca, papillary adenoca metastases in brain (blocks A-D) adenoca metastases in brain (blocks A-D) malignant tumor, lymphoma? melanoma? carcinoma? adenoca, papillary (mucinous epithelium) adenoca, papillary (mucinous epithelium) adenoca, seromucinous type, low grade adenoca, papillary (mucinous epithelium) adenoca, papillary adenoca, seromucinous type, low grade mucoepidermoid ca, low grade (3blocks, better represented) adenoca, papillary (mucinous epithelium) adenoca, intestinal type with marked regression adenoca, NOS, moderate-poorly diff (intestinal type?) adenoca, intestinal type adenoca, intestinal type, <20% adenoca, intestinal type adenoca, intestinal type (block 2 benign; no. 1 is 2 blocks)) adenoca, intestinal type, mucinous adenoca, intestinal type, <50% (blocks 1 & 2 benign only) adenoca, seromucinous type, low grade malignant tumor, r/o rhabdomyosarcoma (2 blocks) adenoca, seromucinous type, high grade (block 1 benign) adenoca, seromucinous type, high grade (2 blocks) adenoca, intestinal type, mucinous (blocks 1 & 2 benign only) adenoca, papillary (2 blocks, mostly benign) adenoca, intestinal type (2 blocks) adenoca, intestinal type (sparse, postradiation) adenoca, intestinal type adenoca, seromucinous type, high grade (5 blocks) adenoca, intestinal type adenoca, intestinal type (both blocks, bl c min material) adenoca, intestinal type adenoca, intestinal type
Nasopharyngeal carcinoma CT & MR T1 CT courtesy of Dr. Mårten Annertz Dept. of Radiology Lund University Hospital T1 with contrast
Nasopharyngeal carcinoma CT & MR CT courtesy of Dr. Mårten Annertz Dept. of Radiology Lund University Hospital T2 512
Ethmoid sinus cancer Courtesy of Dr. Mårten Annertz Dept. of Radiology Lund University Hospital Soft parts filter without contrast
Ethmoid sinus cancer - MR T2-STIR 256 T2-tse 512 Courtesy of Dr. Mårten Annertz Dept. of Radiology Lund University Hospital
Ethmoid sinus cancer Courtesy of Dr. Mårten Annertz Dept. of Radiology Lund University Hospital
Nasopharyngeal carcinoma CT & MR CT courtesy of Dr. Mårten Annertz Dept. of Radiology Lund University Hospital
Paranasal sinus anatomy Sphenoid Nasopharynx Drainage: Frontal - nasofrontal duct into the ethmoid infundibulum of the middle meatus Antrum near middle meatus Anterior ethmoid middle meatus Sphenoid - sphenoethmoid recess
Ethmoid sinus cancer - MR Invasion of nasal cavity, sphenoid bone & optic chiasm T2-tse 512 Courtesy of Dr. Mårten Annertz Dept. of Radiology Lund University Hospital