SINONASAL CARCINOMA
RARE—0.2% OF ALL CA
USUALLY OLDER MALES
?HX OF CHRONIC RHINOSINUSITIS AS A RISK FACTOR?
MAXILLARY SINUS (80%) > NASAL CAVITY > ETHMOID SINUSES > SHENOID
MUST R/O WITH TRIAD OF UNILAT NASAL PAIN, NAO, AND EPISTAXIS
USUALLY PRESENT LATE WITH NECK MASS OR LOCAL SYMPTOMS
1933 OHNGREN NOTED THAT INF MEDIAL MAXILLARY TUMORS DO BETTER (OHNGREN’S LINE—-REALLY A PLANE)
SPHENOID TUMORS OFTEN PRESENT WITH DEEP SEATED PAIN OR OCULAR PARALYSIS AND DIPLOPIA—-THINK PALLIATIVE HERE
FRONTAL SINUS CANCERS MOST OFTEN REQUIRE A COMBINED CRANIOFACIAL RESECTION AND POST OP RT—USUALLY WAIT A YEAR FOR RECONSTRUCTION TO R/O RECURRENCE
SCCA (70%)—NICKEL WORKERS ARE AT INCREASED RISK (LONG LATENCY)
ADENOCA (10%)—WOODWORKERS (FURNITURE MAKERS), AND LEATHERWORKERS—PRIMARILY IN THE ETHMOIDS
ADENOID CYSTIC (10%)—HIGH INCIDENCE OF PERINEURAL SPREAD—40% DISTANT METS (CAN LIVE A LONG TIME)—14% REGIONAL METS
OTHERS:
MET CA—PRIMARILY RENAL CELL CA (USUALLY TO MAXILLARY)
TRANSITIONAL CELL CA
MALIGNANT MELANOMA
USUALLY IN THE NASAL CAVITY ON THE ANT NASAL SEPTUM—-LOCAL RECURRENCE IS THE PRIMARY CAUSE OF FAILURE—ONLY 25% 5 YR SURVIVAL—–Rx IS WLE WITH POST OP RT
SARCOMAS
MUCOEPITHELIAL CA
OLFACTORY ESTHESIOBLASTOMA
SNUC (SINONASAL UNDIFFERENTIATED CA)—POOR Px