xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

with LGNPPAc. Three patients underwent endoscopic surgery alone and two patients underwent endoscopic surgery and postoperative RT. All five patients were fol lowed up for 6 months to 8.8 years, without recurrence or metastasis. Booth et al. queried the SEER database and reported out comes of surgery versus RT alone in LGNPPAc. 1730 Five year DSS rates were significantly improved for patients who had surgical resection as compared with RT alone. DSS rates for LGNPPAc were 100% for surgery alone, 100% for surgery combined with RT, and 33% for RT alone, indicating that LGNPPAc is relatively radioresistant. Kuan et al. 1715 also conducted a retrospective cohort study of LGNPPAc using the SEER database, which reported that OS and DDS for LGNPPAc were 226.9 and 444.0 months, respectively. There are no dedicated studies on chemother apy for treatment of LGNPPAc or comparison of open versus endoscopic approaches. Overall, NPPAC is a slow-growing tumor with excel lent prognosis. Surgery can be an effective treatment for early-stage disease and adjuvant RT can reduce tumor recurrence when positive margins are obtained. There are insufficient data to assess clinic outcomes of advanced LGNPPAc. A B and T cell lymphomas Sinonasal lymphomas are rare and represent < 1% of all head and neck cancers. 1759,1760 Lymphomas are classically divided into Hodgkin and non-Hodgkin subtypes. Non Hodgkin lymphomas are additionally divided into mature B-cell, mature T-cell, or natural killer (NK)/T-cell phe notypic subtypes, based on cell of origin, histopathology, andIHC. 3 When compared to other extranodal lymphoma sites, paranasal sinus lymphoma has a worse OS, higher rate of primary recurrence, and higher likelihood for disease dissemination. 1761–1763 BCLs make up the majority of cases and have a more favorable prognosis, whereas NK/T-cell lymphomas (ENKTL) represent a minority of cases and are often more aggressive. 1764,1765 BCLs have multiple subtypes, with DLBCL being the most common (42%–94%). 1766–1769 EBV seems to have a causative role in ENKTL development that has been described by multiple groups. 1770–1772 ENKTLalso commonly causes extensive midface destruction and can also occur in the aerodigestive tract or elsewhere in the body. 1773–1777 XXVI SINONASAL LYMPHOMA

There have been consistent geographic associations with sinonasal lymphomas; Western populations have mainly B-cell subtypes, while Asian and South Ameri can populations have predominantly NK/T-cell and T cell subtypes. 1778–1780 ENKTL is the most common sub type of sinonasal lymphoma in the Asian population, whereas DLBCL is more common in patients in West ern countries. 1775,1781 Interestingly, BCLs have been noted to arise more commonly from the paranasal sinuses and ENKTL more commonly involving the nasal cavity. 1782 Sinonasal lymphomas often present with either local or systemic manifestations of disease. In local disease, patients generally present with nonspecific sinonasal symptoms. 1783 In systemic disease, generalized constitu tional symptoms occur, including fever, night sweats, weight loss, and regional lymphadenopathy. 1784 Given the nonspecificity of presentation, there is often significant delay in diagnosis. 1785,1786 B Diagnostic considerations The cornerstone of any patient evaluation centers around complete history and physical examination (Table XXVI.1). Sinonasal lymphoma is no different with most patients ini tially being evaluated for sinonasal symptoms as their chief complaint. 1787 The most likely subtype of lymphoma varies with geography, with B-cell being more common in Europe and North America and ENKTL arising more frequently in Asia and South America. 1774,1788,1789 Regardless of the location of consultation, history should focus on the nature of the symptoms and duration. A retrospective series examining the most common present ing symptoms suggests that most patients present with nonspecific complaints, most often sinonasal symptoms that can be easily confused for CRS. 1785,1787,1790–1792 Inter estingly, there has been report of the impact of comorbid CRS on ENKTL stage finding that the duration of CRS symptoms correlated with the stage of disease at the time of diagnosis. 1793 Whether the milieu of chronic inflamma tion predisposes to tumorigenesis or if ENKTL symptoms are simply misdiagnosed for CRS and present later after progress remains unknown. Systemic symptoms may be present in BCL (especially in cases with systemic involvement), while they are relatively rare in ENKTL. 1794 In a series of head and neck lymphoma patients, only 13% of ENKTL patients were diagnosed with B symptoms at the time of presentation. 1795 Unfortunately, diagnosis remains difficult in many circumstances due to the rarity of the tumor and lack of specific presenting symptoms. 1796,1797