Добавил:

Sekretar kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.

Вуз:

Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

Файл:

Книга_4518_Библиотеки_им_академика_М_И_Перельмана

.pdf

Скачиваний:

Добавлен:

31.08.2026

Размер:

30 Мб

Скачать

☆

<<< < Предыдущая 26 27 28 29 30 31 32 33 34 35 36 37 38 39 4041 / 5041 42 43 44 45 46 47 48 49 50 > Следующая >>>

406

https://t.me/medicina_free

A. A. Jategaonkar and M. Khan

• Transoral laser microsurgery typically utilizes a CO2 laser to make cuts in and around the tumor

– Piece-meal tumor resection allows 3D mapping of margins – Such “margin-mapping” requires close collaboration between

pathology and surgical teams

Further Reading

1. Khalili J.Oral cancer: risk factors, prevention and diagnostic. Exp Oncol. 2008;30(4):259–64.

2. Wein RO, Weber RS.Malignant neoplasms of the oral cavity. In: Cummings otolaryngology, vol. 2. 6th ed. Saunders; 2014. p.1359–87.

3. Shah JP. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg. 1990;160(4):405–9. https://doi.org/10.1016/

s0002- 9610(05)80554- 9.

4. Shah JP, Candela FC, Poddar AK.The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity. Cancer. 1990;66(1):109–13. https://doi.org/10.100

2/1097- 0142(19900701)66:1<109::aid- cncr2820660120>3.0.co;2- a.

5. Candela FC, Kothari K, Shah JP.Patterns of cervical node metastases from squamous carcinoma of the oropharynx and hypopharynx. Head Neck. 1990;12(3):197–203. https://doi.

org/10.1002/hed.2880120302.

6. Urken ML, Cheney ML, Blackwell KE, Harris JR, Hadlock TA, Futran N.Atlas of regional and free aps for head and neck reconstruction. Lippincott Williams & Wilkins; 2012.

7. Genden EM, Lee BB, Urken ML. The palatal Island ap for reconstruction of palatal and retromolar trigone defects revisited. Arch Otolaryngol Head Neck Surg. 2001;127(7):837–41.

8. Hao S-P, Tsang N-M, Chang K-P, Chen C-K, Huang S-S.Treatment of squamous cell carcinoma of the retromolar trigone. Laryngoscope. 2006;116(6):916–20. https://doi.org/10.1097/01.

mlg.0000214900.07495.39.

9. D’Cruz AK, Vaish R, Kapre N, et al. Elective versus therapeutic neck dissection in node- negative oral cancer. N Engl J Med. 2015;373(6):521–9. https://doi.org/10.1056/

NEJMoa1506007.

10. Sinha P, Harreus U.Malignant neoplasms of the oropharynx. In: Cummings otolaryngology, vol. 2. 6th ed. Saunders; 2014. p.1432–53.

11. Van Abel KM, Moore EJ.Transoral approaches to malignant neoplasms of the oropharynx. In: Cummings otolaryngology, vol. 2. 6th ed. Saunders; 2014. p.1454–78.

12. Hinni ML, Zarka MA, Hoxworth JM.Margin mapping in transoral surgery for head and neck cancer. Laryngoscope. 2013;123(5):1190–8. https://doi.org/10.1002/lary.23900.

13. Jategaonkar AA, Patel AB, Hinni ML.Laser resection of pharyngeal cancer. In: Biomedical optics in otorhinolaryngology NewYork. NewYork, NY: Springer; 2016. p.33–49. https://doi.

org/10.1007/978- 1- 4939- 1758- 7_3.

14. Parsons JT, Mendenhall WM, Stringer SP, etal. Squamous cell carcinoma of the oropharynx. Cancer. 2002;94(11):2967–80. https://doi.org/10.1002/cncr.10567.

15. Weinstein GS, Quon H, Newman HJ, etal. Transoral robotic surgery alone for oropharyngeal cancer: an analysis of local control. Arch Otolaryngol Head Neck Surg. 2012;138(7):628–34.

https://doi.org/10.1001/archoto.2012.1166.

16. Weinstein GS, O’Malley BW, Rinaldo A, Silver CE, Werner JA, Ferlito A.Understanding contraindications for transoral robotic surgery (TORS) for oropharyngeal cancer. Eur Arch Otorhinolaryngol. 2015;272(7):1551–2. https://doi.org/10.1007/s00405- 014- 3331- 9.

21 Oral Cavity andOropharyngeal Squamous Cell Carcinoma

https://t.me/medicina_free

17. Mourad M, Jetmore T, Jategaonkar AA, Moubayed S, Moshier E, Urken ML.Epidemiological trends of head and neck cancer in the United States: a SEER population study. J Oral Maxillofac Surg. 2017;75(12):2562–72. https://doi.org/10.1016/j.joms.2017.05.008.

18. Monroe MM, Gross ND. Evidence-based practice: management of the clinical nodenegative neck in early-stage oral cavity squamous cell carcinoma. Otolaryngol Clin N Am. 2012;45(5):1181–93. https://doi.org/10.1016/j.otc.2012.06.016.

19. Gillison ML, Koch WM, Capone RB, etal. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst. 2000;92(9):709–20.

407

Chapter 22

https://t.me/medicina_free

Nasal Cavity andParanasal Sinus Cancer

ToddSpock, AlfredMarcIloreta, BrettA.Miles, andMohemmedKhan

Pearls

• Nasal cavity and sinus anatomy is in close proximity to many vital structures

(orbit, brain, carotid artery).

• Lymph drainage:

– Nasal cavity→larger vessels pass posterior to the tonsillar region and directly

to the upper deep cervical nodes.

• Most drain into pharyngeal plexus→retropharyngeal nodes.

– Anterior nose via nares connect with lymphatic vessels of the face. – Maxillary→submandibular gland (SMG). – Ethmoid cells have few lymph capillaries that pass via ostia to connect with

nasal mucosa→SMG.

– Sphenoid—retropharyngeal nodes.

T. Spock (*) · M. Khan Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, USA e-mail: mohemmed.khan@mountsinai.org

A. M. Iloreta Department of Otolaryngology and Neurosurgery, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, USA e-mail: Alfred-Marc.iloreta@mountsinai.org

B. A. Miles Otolaryngology Head and Neck Surgery, Oral and Maxillofacial Surgery, Northwell Health System, New Hyde Park, NY, USA e-mail: bmiles4@northwell.edu

https://doi.org/10.1007/978-3-031-26048-3_22

409

410

https://t.me/medicina_free

• Ohngren’s line (the malignant plane) runs from medial canthus to angle of the

mandible—tumors located superoposterior to this plane have poorer prognosis.

• Thin bone of fovea ethmoidalis, cribriform, and lamina are weak anatomical bar-

riers, more easily allowing for adjacent spread and local invasion.

• Incidence less than 1 per 100,000 persons worldwide, 3–5% of all upper aerodi-

gestive tract tumors, and 0.2% of all cancers.

T. Spock et al.

Anatomy

• Nasal cavity (see Rhinology section for further detail)

– Boundaries

Anterior roof: nasal bone, nasal spine of frontal bone Medial roof: cribriform plate of ethmoid bone Posterior roof: anterior wall of sphenoid sinus and sphenoid bone Medial: septum Anterior oor: palatal process of maxillary bone Posterior oor: horizontal process of palatine bone Lateral

• Uncinate process, ethmoid infundibulum, inferior turbinate, and lateral nasal wall

Epidemiology

• Risk factors:

– Adenocarcinoma: woodworkers, shoe workers, furniture workers because of

exposure to wood dust, preservatives, stains, and paints

– SCC: chromium, nickel, mustard gas, organic bers

• Exposure of epithelial cells to wood dust show overexpression of p53

• Tobacco increased relative risk by 1.5–2.5

• HPV, radiation exposure

Presentation

• Patients may present with facial pain or hypo- or hyperesthesia, headaches, unexplained or recurrent epistaxis, nasal obstruction, hyposmia, visual changes, proptosis

22 Nasal Cavity andParanasal Sinus Cancer

https://t.me/medicina_free

411

Work-Up

• Physical exam—tumor size and location, deep muscle invasion, trismus, bony involvement, ofce nasal endoscopy, cranial nerve examination (sensory and motor disturbances), ocular examination, cervical nodal disease

• Tissue diagnosis

– Appropriate imaging prior to biopsy to rule out vascular lesion or

meningoencephalocele – Biopsy of lesion – FNA of clinical and radiographic apparent LN (incisional or excisional biopsy

should be avoided)

• MRI

– Better for soft-tissue delineation – Assess for cranial nerve involvement, perineural invasion (PNI) – Dural invasion, extension into infratemporal fossa or other regions of

skull base – Differentiate sinuses lled with uid secretions vs. soft-tissue lesion (tumors

appear hyperintense on T1)

• CT

– Visualize osseous remodeling/invasion/erosion – Navigation – Angiography: for potential extension into infratemporal fossa or near carotid,

ophthalmic, basilar, vertebral, spinal, or anterior cerebral arteries, depending

on location of extension into skull base, intracranial cavity, or cervical spine.

• PET

– Less accurate for primary site evaluation – Very sensitive for regional or distant disease – Dotatate Scan (tagged somatostatin-receptor analog found on neuroendocrine

tumor cells) can be used to evaluate SNEC, esthesioneuroblastoma.

Histopathologic Markers

• Esthesioneuroblastoma (ENB): cytokeratin negative (not a carcinoma), +EMA, CHR, SYN

• Sinonasal neuroendocrine carcinoma (SNEC): normal neuronal differentiation though cytokeratin positive—express one or more of these markers diffusely: chromogranin, synaptophysin

• Sinonasal undifferentiated carcinoma (SNUC): undifferentiated small round blue cells, CK, epithelial membrane antigen, neuron-specic enolase

412

https://t.me/medicina_free

T. Spock et al.

Inverted Papilloma (IP)

• EGFT and TGF-alpha expression associated in IP carcinogenesis included with EBV and HPV

• Approximately 10% of IP harbor SCC

• Hyperplastic stratied squamous-to-columnar epithelium w/without atypia

• Unilateral polyp red-to-tan mass nasal cavity

• Most commonly arises from the lateral nasal wall

• CT imaging: classically, hyperostotic bone at the site of attachment

• Mucocutaneous junction: squamous papilloma found anterior, inverted papilloma posterior

• MR: T2-weighted images with convoluted cerebriform appearance T1 enhancement (secretions bright on T2)

• No role for PET scanning unless malignant changes occur

• Krouse staging to describe the extent of involvement (Table22.1).

• Meta-analysis of 32 retrospective studies indicates that endoscopic and open approaches have similar recurrence rates.

• One should address attachment site by drilling down or removing bone

• Posterior table of frontal sinus and lateral sphenoid sites has highest recurrence rate due to access and decreased ability to drill attachment site near critical structures (carotid, frontal dura).

Table 22.1 Krouse staging system for inverted papilloma

T1 Tumor totally conned to the nasal cavity, without extension into the sinuses. The tumor

can be localized to one wall or region of the nasal cavity, or can be bulky and extensive within the nasal cavity, but must not extend into the sinuses or into any extra nasal compartment. There must be no concurrent malignancy

T2 Tumor involving the ostiomeatal complex, and ethmoid sinuses, and/or the medial portion

of the maxillary sinus, with or without involvement of the nasal cavity. There must be no concurrent malignancy

T3 Tumor involving the lateral, inferior, superior, anterior, or posterior walls of the maxillary

sinus, the sphenoid sinus, and/or the frontal sinus, with or without involvement of the medial portion of the maxillary sinus, the ethmoid sinuses, or the nasal cavity. There must be no concurrent malignancy

T4 All tumors with any extranasal/extrasinus extension to involve adjacent, contiguous

structures such as the orbit, the intracranial compartment, or the pterygomaxillary space. All tumors associated with malignancy

22 Nasal Cavity andParanasal Sinus Cancer

https://t.me/medicina_free

413

Squamous Cell Carcinoma

• No standardized staging system for sphenoid or frontal sinuses.

• 80% of malignancy in nasal cavity and PNS

– Maxillary 70% – Intranasal—turbinates 20% – Ethmoid, sphenoid, frontal

• Verrucous, basaloid, spindle, transitional variants

• Regional spread to neck is rare and elective neck dissection is not typically recommended

• Overall 5-year survival (OS) estimated at 60–64% recurrence rate approx. 30% recurrence, stage III, IV disease 25–30%.

• 18% of patients present with distant mets with locoregional (LR) spread in 17–30% of patients

• Early stage I and II disease—surgery ± radiation, either pre- or postsurgical resection.

• Advanced stage III and IV disease=surgery±radiation/chemotherapy, either pre- or postsurgical resection, or concurrent chemoradiation (CRT) considered in unresectable tumor

• Tx nodal disease with radiation therapy (RT) or surgery, depending on initial approach to tumor

• SCC (T4b) involving orbit, brain, dura=induction chemo followed by concomitant CRT or surgery with post-op RT ± chemo

• Clinical outcomes:

– Advanced local stage tumors treated with induction chemo (taxane+plati-

num) trend toward organ preservation of globe and critical neurovascular structures

– Locally advanced tumors (T3/T4) associated with higher incidence of nodal

involvement and nodal relapse

– Postoperative radiotherapy can reduce skull base failure and nodal recurrence

in patients with high-risk features.

Lymphoreticular

• B- and T-cell lymphoma

– Most patients present with locally advanced disease (50% at T4)

• Need sufcient, fresh biopsy for ow cytometry and immunohistochemical analysis

– CRT and RT alone for TX

414

https://t.me/medicina_free

• Extramedullary plasmacytoma

– Involvement of nose, paranasal sinuses (PNS), nasopharynx (NP) in 60%

of cases – Wide local excision with or without CRT – 5-year control rates for early lesions 78 to 48% for T4 lesions

T. Spock et al.

Adenoid Cystic Carcinoma

• Most common salivary gland tumor of nose and PNS

• Skip lesions due to perineural spread

• Propensity to recur locally and distally even several years after tx

• Even with aggressive surgery 64% of cases with+margins

• 5-year OS is 65%, 15-year OS is 28%

• Distant spread to lung, liver, bone

• Primary therapy with surgery (adjuvant RT±chemotherapy for positive margins, PNI, extensive disease)

• RT for palliation in unresectable cases

Adenocarcinoma (AC)

• Can mimic mucoepidermoid or adenocarcinoma of the colon

• Histologic grade affects prognosis and LR metastatic rates

• High-grade AC—OS <35% at 3years

• Low-grade AC—OS at 80% at 5years

• Associated with exposure to wood dust, lacquers

• Surgical excision with wide margins (post-op RT±chemo for advanced disease or positive margins)

• Surgical treatment includes open approaches, endoscopic approaches, or combined open/endoscopic

• Similar survival rates endoscopic vs. open, when patients are well selected for appropriate approaches

Sinonasal Undifferentiated Carcinoma (SNUC)

• High grade, aggressive at presentation with low probability of cure

• 60% with PNI at presentation

• Lacks squamous or glandular differentiation

• Tx: aggressive triple modality therapy w/elective neck dissection (ND), often treated with induction chemotherapy to assess response and potentially preserve critical structures

22 Nasal Cavity andParanasal Sinus Cancer

https://t.me/medicina_free

• 5-year OS 30–60%

• IHC: Cytokeratin (+), S100 (−)

Sinonasal Neuroendocrine Carcinoma (SNEC)

• Prognosis is tumor-type dependent

• Subtypes: Typical, atypical, small cell, large cell

• Can use dotatate PET/CT for work-up and follow-up

• Treatment: aggressive triple modality therapy

• IHC: cytokeratin (+), chromogranin (+), synaptophysin (+)

Sarcoma

• Rare

• Rhabdomyosarcoma frequently found in children

– Embryologic, alveolar, and pleomorphic – Children most often treated with radiation and chemotherapy – Adults wide surgical excision and post-op radiation and chemotherapy

415

• Advanced stage at presentation with bone and extensive soft-tissue destruction

• Optimal treatment is complete resection with negative margins

• Even with low-grade tumors, most patients receive combined modality treatment with radiation and chemotherapy

• No proven efcacy for adjuvant chemotherapy but should be considered for high-grade lesions.

• Pediatric tumors have higher response rate to treatment

Hemangiopericytoma aka Glomangiopericytoma (see also in Vascular Tumor Section)

• Capillary origin

• Rare, very vascular

• Arise from pericytes of Zimmerman

• Nasal cavity>sphenoethmoid>maxilla/NP

• High recurrence rate>50% within 5years

• Surgery is the primary treatment modality; may be combined with adjuvant radiation±chemotherapy

• High recurrence rate>50% within 5years

• Need for long-term follow-up

• Preoperative embolization for large tumors

416

https://t.me/medicina_free

T. Spock et al.

Metastatic Tumors

• Renal carcinoma most common

Chordoma

• Malignant, slow growing, from clivus, extra-axial notochord remnant,

• Arise from notochord remenant and therefore found anywhere along the axial spine. Commonly seen in the clivus.

• Pathology: physaliferous cells.

• Diagnosed on imaging CT, MRI

• Can metastasize; usually to skin, bone, lung, lymph nodes, or also recur

Chondrosarcoma

• Rare, Dx usually by radiographic ndings

• Chondromas usually <3cm, chondrosarcomas usually >3cm

• Grade I–III, well to poor differentiation

– Differentiation dependent on chondroid-to-myxoid ratio, presence of mitosis,

nuclear appearance

• High-grade lesions (II–III) confer worse prognosis

• Lesions at the skull base have worse prognosis due to proximity to critical neurovascular structures

• Wide surgical resection with consideration of postoperative IMRT or proton bean radiation

• Recurrence rate of up to 85%

Olfactory Neuroblastoma (Esthesioneuroblastoma)

• Olfactory epithelium of cribriform plate, septum, or superior turbinate.

• Differentiation from other small blue-cell tumors with staining.

• Staging (Table22.2)

– Kadish=extent of disease within and beyond nasal cavity and PNS.

Table 22.2 Kadish staging for esthesioneuroblastoma

Stage A Tumor limited to the nasal cavity Stage B Tumor extends to paranasal sinuses Stage C Tumor extends beyond paranasal sinuses

<<< < Предыдущая 26 27 28 29 30 31 32 33 34 35 36 37 38 39 4041 / 5041 42 43 44 45 46 47 48 49 50 > Следующая >>>

Соседние файлы в папке Библиотека им академика М.И. Перельмана

#
31.08.202634 Мб0Книга_4506_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202634 Мб0Книга_4507_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202632 Мб0Книга_4510_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202631 Мб0Книга_4512_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202631 Мб0Книга_4517_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202630 Мб0Книга_4518_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202630 Мб0Книга_4520_Библиотеки_им_академика_М_И_Перельмана.djvu
#
31.08.202630 Мб0Книга_4522_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202630 Мб0Книга_4523_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202630 Мб0Книга_4524_Библиотеки_им_академика_М_И_Перельмана.pdf
#
31.08.202630 Мб0Книга_4525_Библиотеки_им_академика_М_И_Перельмана.pdf