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Description : A brief introduction of TUMOURS OF NOSE & PNS, collected from all sources available

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Published on : Aug 22, 2022 | Views : 4500 | Downloads : 22

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Slide 1-

Dr Harjitpal Singh Assistant Professor(ENT), Dr RKGMC, Hamirpur TUMORS OF NOSE & PNS
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TUMOURS OF NOSE & PNS Environmental Factors associated with sinonasal malignancy Wood dust (Hardwood-Adeno, Softwood- SCC) Nickel, Hydrocarbons Chromium, Organic oils, Isopropyl oil Mustard Gas Many of these products are found in the furniture-making industry, the leather industry, and the textile industry.
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TUMOURS OF NOSE & PNS Cancers arising in the paranasal sinuses are rare, constituting approximately 3 % of head and neck malignancies Sinonasal malignancies (SNM) are the second most common head and neck cancer behind nasopharyngeal carcinoma. Men are affected 1.5 times more often than women. 80% of these tumors occur in people aged 45-85 years.
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TUMOURS OF NASAL CAVITY Approximately 60-70% of sinonasal malignancies (SNM) occur in the maxillary sinus and 20- 30% occur in the nasal cavity itself. An estimated 10-15% occur in the ethmoid air cells Human papillomavirus (HPV) also has a frequent role in the development of sinonasal SCC
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TUMOURS OF EXTERNAL NOSE
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TUMOURS OF NASAL CAVITY
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BENIGN TUMORS OF NOSE Benign lesions are usually smooth, localised and covered with mucous membrane. In addition to primary tumours, nasal cavity can be invaded by growths from paranasal sinuses, nasopharynx, cranial or buccal cavity.
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BENIGN TUMORS OF NOSE 1. Squamous Papilloma : Verrucous lesions similar to skin warts arise from the nasal vestibule or lower part of nasal septum. Single or multiple, pedunculated or sessile. Treatment : Local excision with cauterisation of the base. Cryosrugery Laser.
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ENDOSCOPIC VIEW NASAL PAPILLOMA
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BENIGN TUMORS OF NOSE 2) Inverted Papilloma (Transitional Cell Papilloma or Ringertz Tumour) Neoplastic epithelium is seen to grow towards underlying stroma rather than on the surface. 40-70 years male preponderance (5:1). Arises from the lateral wall of nose Always unilateral, red or grey masses Translucent and oedematous marked tendency to recur after surgical removal. Associated with squamous cell carcinoma in 10- 15% of patients.
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BENIGN TUMORS OF NOSE Inverted Papilloma Modified Krause Staging A – Inverted papilloma (IP) confined to the nasal cavity, ethmoid sinus, or medial maxillary wall B – Inverted papilloma (IP) with involvement of any maxillary wall (other than the medial wall) or frontal sinus or sphenoid sinus C – Inverted papilloma (IP) with extension beyond the paranasal sinuses Treatment : Wide surgical excision by Medial maxillectomy and enbloc ethmoidectomy or Lateral rhinotomy.
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BENIGN TUMORS OF NOSE 3) Schwannoma and Meningioma : Treatment : Surgical excision by lateral rhinotomy. 4) Pleomorphic Adenoma : Arises from the nasal septum. Treatment : Wide surgical excision. Both the above mentioned are rare tumours
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PLEOMORPHIC ADENOMA Nasal pleomorphic adenoma contains greater cellularity, most epithelial component are low stromal component and absence of a capsule as compared to major salivary gland tumours. On computed tomography polypoid, pleomorphic adenoma appears to be spherical. Treatment modality is surgery with wide margins to prevent recurrence depending on the size of tumour. Small lesions can be resected with endoscopic endonasal approach and large tumours external lateral rhinotomy, midfacial degloving approach is considered
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BENIGN TUMORS OF NOSE 5) Haemangioma : 1. Capillary Haemangioma (Bleeding Polypus): Soft, dark red, pedunculated or sessile tumour arising from anterior part of nasal septum. Present with recurrent epistaxis and nasal obstruction. Treatment : Local excision with a cuff of surrounding mucoperichondrium.
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BLEEDING POLYPUS
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BLEEDING POLYPUS
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BENIGN TUMORS OF NOSE 5) Haemangioma : 2. Cavernous Haemangioma : Arises from the turbinates on the lateral wall of nose. Treatment : Surgical excision with preliminary cryotherapy.
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BENIGN TUMORS OF NOSE 6) Intranasal Meningoencephlocele : Herniation of brain tissues and meninges through foramen caecum or cribriform plate. Smooth polyp in the upper part of nose between the septum and middle turbinate. Seen in Infants and young children. Mass increases in size on crying or straining. CT scan is essential to demonstrate a defect in the base of skull. Treatment is frontal craniotomy, severing the stalk form the brain, and repair of dural and bony defect. Intranasal mass is removed as secondary procedure after cranial defect has sealed.
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INTRANASAL MENINGOENCEPHLOCELE
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BENIGN TUMORS OF NOSE 7) Chondroma : Arise from the ethmoid, nasal cavity or nasal septum. Pure chondromas are smooth, firm and lobulated. Others may be mixed type fibro-, osteo-, or angiochondromas. Treatment is wide surgical excision Tendency to malignant transformation after repeated interference. 8) Gliomas : Seen in infants and children. Of all the gliomas, 30% are intranasal and 10% both intra and extranasal. An intranasal glioma presents as a firm polyp.
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BENIGN TUMORS OF NOSE 9) Angiofibroma: It is included in nasal tumours because its primary site of origin is supposed to be posterior part of nasal cavity near the sphenopalatine foramen(bounded by palatine bone, horizontal ala of vomer and root of pterygoid process). It a is a locally invasive benign tumor. Juvenile nasopharyngeal angiofibroma: In an adolescent male, profuse recurrent episodes nosebleed suggest juvenile nasopharyngeal angiofibroma until proven otherwise. Angiofibroma consists of varying amount of vascular and fibrous tissues. Vessels do not have muscle coat and are just endothelium lined.
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BENIGN TUMORS OF NOSE 9) Juvenile nasopharyngeal Angiofibroma:
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BENIGN TUMORS OF NOSE 10) Nasal Dermoid : Types: It is of two types-simple and with sinus. Simple dermoid: It presents as a midline swelling over the nasal bones and does not have any external opening. Dermoid cyst with sinus: - External pit: Infants and children present with a pit or a sinus over the dorsum of nose. Hair may be protruding out from the sinus. Intracranial connection: The sinus track communicate intracranially. It presents as widening of upper part of nasal septum with splaying of nasal bones and hypertelorism.
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BENIGN TUMORS OF NOSE 10) Nasal Dermoid : Treatment: Surgery consists of splitting of the nasal bones and removal of cyst along with its extension in the upper part of the nasal septum. Intracranial extension needs associated neurosurgical approach.
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NASAL DERMOID CYST
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NASAL DERMOID CYST
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NASAL DERMOID CYST
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BENIGN TUMORS OF NOSE 11) Nasolabial (nasoalveolar, Klestadt’s) cyst: This squamous epithelium-lined cyst arises from the epithelial rests situated at the junction of globular, lateral nasal and maxillary processes. It lies on the bone and causes an excavation. It is closely attached to the floor of the nose. Globulomaxillary cyst is intrabony. Clinical features: It presents as a smooth and soft bulge in the lateral wall and floor of nasal vestibule anterior to inferior turbinate. Large cyst obliterates the alar facial fold (nasolabial sulcus). The fluctuation and fluid thrill is best felt with one finger in vestibule and second under the lip.
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BENIGN TUMORS OF NOSE 11) Nasolabial (nasoalveolar, Klestadt’s) cyst:
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BENIGN TUMORS OF NOSE Treatment: The cyst is excised through sublabial approach from gingivobuccal sulcus near the midline. A portion of nasal mucosa may be removed because cyst is adherent to it. 11) Nasolabial (nasoalveolar, Klestadt’s) cyst:
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BENIGN TUMORS OF NOSE 12. Rhinophyma or potato tumor: This slow growing benign tumor occurs due to the hypertrophy of sebaceous glands in the region of nasal tip. Most of the patients are men past middle age. It is usually seen in long-standing cases of acne rosacea. Patient presents with pink and lobulated mass over the nose with superficial vascular dilation, which gives unsightly appearance to the face.
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BENIGN TUMORS OF NOSE 12. Rhinophyma or potato tumor:
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BENIGN TUMORS OF NOSE 12. Rhinophyma or potato tumor: The big tumors can cause nasal obstruction and obstructed vision. Treatment: Paring down of the bulk of tumor may be done with sharp knife or carbon dioxide laser. The raw area may be allowed to re-epithelialize. The complete excision of tumor is usually followed by skin grafting.
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BENIGN TUMORS OF NOSE 13. Glioma: It is a nipped off portion of encephalocele during embryonic development. Most of them (60%) are extranasal and present as firm subcutaneous swellings on the bridge, side of nose or near the inner canthus. Purely intranasal (30%), while 10% are both intra and extranasal. Extranasal gliomas are encapsulated and can be easily removed by external nasal approach. An endoscopic approach was indicated to remove the intranasal gliomas.
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INTRANASAL GLIOMA
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EXTRANASAL GLIOMA
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MALIGNANT TUMORS OF NOSE Primary carcinoma per se is rare. It may be an extension of maxillary or ethmoid carcinoma Squamous cell variety, adenoid cystic carcinoma or an adenocarcinoma. They are usually friable, have a granular surface and tend to bleed easily.
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MALIGNANT TUMORS OF NOSE 1) Squamous cell carcinoma It may arise from the vestibule, anterior part of nasal septum or the lateral wall of nasal cavity. Most of them are seen in men past 50 years of age. (i) Vestibular: It arises from the lateral wall of nasal vestibule and may extend into the columella, nasal floor and upper lip with metastases to parotid nodes. (ii) Septal: Mostly arises from mucocutaneous junction and causes burning and soreness in the nose. It has often been termed as "nose-picker's cancer. Usually, it is of low grade malignancy. (iii) Lateral wall: This is the site most commonly involved. Easily extends into ethmoid or maxillary sinuses. Grossly, it presents as a polypoid mass in the lateral wall of nose. Treatment is combination of radiotherapy and surgery.
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MALIGNANT TUMORS OF NOSE 2) Adenocarcinoma and adenoid cystic carcinoma: They arise from the glands of mucous membrane or minor salivary glands. Mostly involve upper part of the lateral wall of nasal cavity. 3) Lymphoma: Rarely a non-Hodgkin lymphoma presents on the septum.
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MALIGNANT TUMORS OF NOSE 4) Plasmacytoma: Plasmacytoma is an uncommon malignant tumor originating either from plasma cells located in the bone marrow also known as the solitary bone plasmacytoma, Or from plasma cells located outside the bone for e.g. In mucosal surfaces, referred to as the extramedullary plasmacytoma also called the solitary extramedullary plasmacytoma. It shows a preference for the upper respiratory tract, especially the nasal cavity and paranasal sinus. It accounts for less than 1% of head and neck tumours. It predominantly affects males over 40 years.
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MALIGNANT TUMORS OF NOSE 4) Plasmacytoma: Treatment is by radiotherapy followed three months later by surgery if total regression does not occur. Long-term follow up is essential to exclude development of multiple myeloma.
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MALIGNANT TUMORS OF NOSE 5) Malignant Melanoma: Seen in persons about 50 years of age. Both sexes equally affected. Grossly, it presents as a slaty-grey or bluish black polypoid mass. Amelanotic varieties are non pigmented. Within the nasal cavity, most frequent site is anterior part of nasal septum followed by middle and inferior turbinate. Tumour spreads by lymphatics and blood stream.
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MALIGNANT TUMORS OF NOSE 5) Malignant Melanoma:
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MALIGNANT TUMORS OF NOSE 5) Malignant Melanoma: Cervical nodal metastases may be present at the time of initial examination. Treatment is wide surgical excision Radiotherapy and chemotherapy suppress the immune processes and are avoided. A five-year survival rate of 30% can be expected after surgical excision
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MALIGNANT TUMORS OF NOSE 6) Haemangiopericytoma: It is a rare tumour of vascular origin. Age group of 60-70 years. It arises from the pericyte-a cell surrounding the capillaries. It presents with epistaxis. Brisk bleeding may occur on biopsy. The tumour may be benign or malignant but it cannot be distinguished histologically. Treatment is wide surgical excision. Radiotherapy is used for inoperable or recurrent lesions.
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HAEMANGIOPERICYTOMA
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MALIGNANT TUMORS OF NOSE 7) Olfactory Neuroblastoma: It is a tumour of olfactory placode seen in persons of either sex at any age group. It presents as a cherry red, polypoidal mass in the upper third of the nasal cavity. It is a vascular tumour and bleeds profusely on biopsy. Lymph node or systemic metastases can occur. Presently, favoured treatment is surgical excision followed by radiation. Craniofacial resection may be required for tumours of the cribriform plate.
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OLFACTORY NEUROBLASTOMA
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OLFACTORY NEUROBLASTOMA
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OLFACTORY NEUROBLASTOMA
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MALIGNANT TUMORS OF NOSE 8) Sarcomas: Osteogenic sarcoma, chondrosarcoma, rhabdomyosarcoma ,angiosarcoma, malignant histiocytoma are other rare tumours affecting the nose. rare tumours affecting the nose.
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NEOPLASMS OF PARANASAL SINUSES
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NEOPLASMS OF PARANASAL SINUSES OSTEOMAS: Most commonly seen in the frontal sinus discovered incidentally on X-rays Surgical excision for rapidly growing osteomas Complete removal of tumour with its base attachment is done by bicoronal osteoplastic flap technique
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FRONTAL SINUS OSTEOMA
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NEOPLASMS OF PARANASAL SINUSES Ossifying fibroma Histologically it looks similar to fibrous dysplasia. Age: It is seen in young adults. Radiology: The sclerotic bony margin can be seen. Treatment: It can be shelled out easily.
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NEOPLASMS OF PARANASAL SINUSES Ossifying fibroma
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NEOPLASMS OF PARANASAL SINUSES Monostotic Fibrous Dysplasia: In this disease, bone isreplaced by fibrous tissue. The most common site is maxilla followed by ethmoid and frontal sinuses. Clinical features: Patient develops disfigurement of the face, nasal obstruction and displacement of the eye. Treatment: Wide removal (surgical resculpturing) provides good cosmetic and functional results.
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NEOPLASMS OF PARANASAL SINUSES Fibrous dysplasia of Sphenoid bone Patient with (L) proptosis
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NEOPLASMS OF PARANASAL SINUSES Odontogenic Tumors: These rare tumors account for only 1% of all jaw tumors. Odontogenic tumors are a heterogeneous group of lesions of diverse clinical behavior and histopathologic types, ranging from hamartomatous lesions to malignancy. Types: Ameloblastoma (adamantinoma) and calcifying epithelial tumor of Pindborg. Origin: These locally aggressive tumors arise from the odontogenic tissue and usually involve maxillary sinus. Treatment: It is surgical excision
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NEOPLASMS OF PARANASAL SINUSES Odontogenic Tumors:
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Clinical Features: Early: Facial pain, nasal obstruction and epistaxis. Eye and Orbit: Diplopia (double vision) and squint due to involvement of oculomotor nerves and extraocular muscles. Loss of vision due to the involvement of optic. Proptosis due to tumor compression of periorbita (orbital fascia). Epiphora due to involvement of lacrimal duct.
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Clinical Features: Facial numbness due to involvement of branches of infraorbital nerve (CNV2). Facial swelling due to involvement of facial soft tissue Cranial nerves involvement: CN II, III, IV, V1 and V2, VI. Malocclusion, widening of upper alveolus, loose and nonvital teeth due to involvement of upper alveolus. Trismus due to involvement of pterygoid muscles.
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Clinical Features: Neck swelling due to involvement of jugular chain lymph nodes. Deafness. Serous otitis media due to involvement of nasopharynx. Mass: Necrotic intranasal mass and/or alveolar/palatal mass or ulceration.
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Diagnosis: Radiographs: CT scan has replaced plain X-rays, which show opacity of sinus with expansion and destruction of the bony walls. CT scan: Axial and coronal planes show bony and soft tissue extent of tumor and help in the staging of disease Endoscopy: Endoscopy of the nose and maxillary sinus provides not only detailed examination but also facilitates an accurate biopsy.
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Diagnosis: 4. Biopsy: Biopsy is taken from the growth in the nose or mouth. In early suspected cases, sinus may be explored through Caldwell-Luc operation but preferred approach is endoscopic intranasal. Direct visualization of the tumor site helps in staging.
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Nasal Mass
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Cheek Swelling
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Alveolar & palatal swelling
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Ohngren’s classification: Ohngren’s line is an imaginary line (OL), which extends between medial canthus and the angle of mandible, divides the maxilla into two regions anteroinferior (AI) and posterosuperior (PS). AI growths are easy to manage and have better prognosis than PS tumors
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Lederman’s classification: Two horizontal lines of Sebileau, one passing through the orbit floors (I) and other through antral floors (II), divide the area into three regions: 1)Suprastructure (SS), 2)Mesostructure (MS), and 3)Infrastructure (IS). 4)The vertical line (III) at the plane of medial wall of orbit separates ethmoid sinuses and nasal fossa from the maxillary sinuses
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Staging of cancer of nose and paranasal sinuses
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Treatment: T1 & T2: surgery or radiotherapy T 3: surgery + radiotherapy T4 : surgery + radiotherapy+ chemotherapy
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Treatment: Maxillary Sinus Surgery: It is the mainstay therapy. Complete radical maxillectomy includes removal of maxilla along with the nasal bone, the ethmoid sinus, and in some cases pterygoid plates. It is adequate when tumor is confined to maxilla, or extends to facial soft tissues, palate, or anterior orbit. But without invasion of the ethmoidal roof, posterior orbit, or pterygoid region- Weber-Ferguson incision.
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WEBER-FERGUSON’S INCISION It starts at the upper lip philtrum on the operative side and goes up to the columella. It continues round the margin of the ala and up the lateral border of the nose. Near the medial canthus of eye it turns laterally in a rounded fashion to go 5 mm below the lower lid margin
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Treatment: Maxillary Sinus Radiotherapy: It is given either before or after surgery. Curative radiotherapy or chemoradiation may make the inoperable tumors operable. Neutron beam irradiation is most suited to adenoid cystic carcinomas. Preoperative radiotherapy: A full course of preoperative radiotherapy is followed 4–6 weeks later by total or extended maxillectomy.
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Treatment: Maxillary Sinus Radiotherapy: Indications of postoperative radiotherapy - Large tumors, Positive margins Perineural or perivascular invasion Lymph node metastasis. Adverse affects of radiotherapy – 5,800 rad: Severe panophthalmopathy with severe corneal ulceration in 100% cases. 2,800–5,400 rad: Cataracts and visual disturbances in 86% cases.Prognosis Overall, 5-year survival is about 30%.
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Treatment: Ethmoid Sinus Early cases: Preoperative radiotherapy, followed by total ethmoidectomy through lateral rhinotomy approach. Late stages: Craniofacial resection, when cribriform plate is involved, exposes anterior cranial fossa and facilitates total exenteration of the growth in one piece. Prognosis Overall, 5-year survival is about 30%.
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Frontal Sinus: It is uncommon and usually seen in males of 40–50 years age group. Presenting features: Pain, swelling of the frontal region and swelling above the medial canthus (erosion of floor of frontal sinus). Treatment: Preoperative radiation followed by surgery, which includes removal of frontal and ethmoid sinuses and orbital exenteration. This neurosurgical approach resects the dura of anterior cranial fossa.
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MALIGNANT NEOPLASMS OF PARANASAL SINUSES Sphenoid Sinus: Very rare. Clinical features similar to the inflammatory lesions of sphenoid sinus. CT and MRI scan and biopsy through sphenoidectomy confirm the diagnosis and extent of disease. Treatment: Radiotherapy is the mainstay of treatment.
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HarjitpalSingh

About : Associate Professor (ENT) at Dr Radhakrishnan Govt Medical College, Hamirpur(H P)
Occupation : Medical Professional
Specialty : MD
Country : India
Website :

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