xRead - Nasal Obstruction (September 2024) Full Articles

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49

ICAR SINONASAL TUMORS

TABLE V.4 List of known occupational exposures surrounding sinonasal malignancies.

ITAC (RR) 29.43

SCC (RR)

Agent

Occupation

AF

20% 58,85

Wooddust

Logging and sawmill workers; pulp and paper, and paperboard industry; woodworking trades (e.g., furniture industries, cabinet making, carpentry, and construction); used as a filler in plastic and linoleum production Shoe manufacturers (scouring, roughing, buffing, spitting, skiving, cutting, trimming) Production; pathologists; medical laboratory technicians; plastics; textile industry Production; used as lubricant by metal workers, machinists, engineers, printing industry (ink formulation); used in cosmetic, medicinal, and pharmaceutical preparations Chromate production plants dyes and pigments; plating and engraving; chromium ferro-alloy production; stainless-steel welding; in wood preservatives; leather tanning; water treatment; inks; photography; lithography; drilling muds; synthetic perfumes; pyrotechnics; corrosion resistance

1.46

3%–13% 120

Leather dust

35.26

2.09

0.31% 120

Formaldehyde

3.81

2.37

13.84% (total) 120

Mineral oils

3.50

0.85

5.7% 120

Chromium

0

66.3

Abbreviations: AF, attributable fraction; RR, relative risk.

period to wood dust and significantly increases for low intensity exposure. 88 Efforts to limit exposure to wood dust and other potentially causal substances in the workplace appear to be impacting the incidence and mortality of SNM at the population level, with significantly decreas ing rates evident over recent years, predominantly in developed countries. 28 Based on this evidence, in many European countries, ITAC is officially considered a profes sional disease. 89 Additionally, a significant dose–response relationship was found between adenocarcinoma risk and exposure period to leather dust: the risk increased among workers over 5 years’ exposure by almost 60-fold as compared to those unexposed. 55 Similarly, an association between exposure to formalde hyde and SNM has been observed. Formaldehyde has wide use as an adhesive and binder for wood products, pulp and paper manufacture, the production of plastics and coat ings, and textile finishing. High-formaldehyde-exposure occupations include textile operations and wood product manufacture/processing (with co-exposure to wood dust); short-term high-exposure episodes have been reported for embalmers, pathologists, and paper industry workers. 90 Apart from wood, leather dust, and formaldehyde, chemical substances such as glues, chrome, nickel, and various compounds used in the textile industry have been associated with sinonasal carcinomas, mainly SCC. E Smoking Cigarette smoking and environmental tobacco smoke are established risk factors principally for SCC (Table V.5). 58,91

Evidence suggests that smoking tobacco has an increased risk for development of SCC with increasing number of pack-years up to twofold to threefold. 92,93 The risk peaked at OR of 4.11 in exposure to 21.75 pack-years or more. 94 In smokers quitting within 15 years, there was an obvious decrease from OR 1.11 to OR 0.44 as compared to those who quit 28 or more years ago. 94 F Link to viral infections HPV types 16 and 18 have been associated with SCC, which is also discussed in Section XXI (Table V.6). HPV infection is more prevalent in nonkeratinizing (50%) than in kera tinizing SCC (16%–19%). 65,95 The role of HPV in SNM is still debated. Interestingly, a meta-analysis found that 39% of patients with IP tested positive for HPV, where malignant transformation occurs in 2%–27%. 95–97 The association of EBV with NPC is also well-established and is covered in Section XXV.A.II. G Genetic and other inherited traits Sinonasal SCC and ITAC have aneuploid genomes— harboring multiple genetic aberrations—that are distinct from each other and from histologically similar tumors (head and neck SCC and colorectal adenocarcinoma, respectively; Table V.7). 98 TP53 is the most frequently mutated gene (40%–86%), while APC , KRAS , and BRAF mutations are less common. 99 Similarly, TP53 mutation is detected up to 70% in SCC. 100–102 In addition, several