24 Neoplastic - Nose/NP Flashcards by brian langford

NP CA accounts for what % of all CA dx in Kwangtung province of southern China

20%

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Incidence of NP CA among native born Chinese vs Caucasians

118x higher

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Incidence of NP CA among North American born Chinese vs Caucasians

7x higher

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What EBV product is likely to play a role in malignant transformation of NP epithelium

Latent membrane protein (LMP-1)

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What environmental factor is most strongly linked to NP CA

Frequent consumption of dried salted fish

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What is the 5 yr survival of pts with WHO II or III dz

70%

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5 yr survival of pts with WHO I dz

30%

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M/c site of origin of NP CA

fossa of rosenmuller

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Which nodal groups does NP CA spread to

Retropharyngeal nodes of Rouviere, jugulodigastric nodes, spinal accessory chain

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In the staging system described by Ho, poorer prognosis is associated with cervical mets to which area of the neck

Inferior to a plane spanning from CONTRA sternal head of clavicle to IPSI superior margin of trapezius

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T/F: The presence of unilateral vs b/l nodal dz in pts with NP CA has no prog significance

True

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Incidence of skull base erosion on pts w/ NP CA

25%

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M/c site of distant mets from NP CA

bone

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Smooth, submucosal NP masses located in the midline are most often what

Embryologic remnants (Thornwaldt’s cysts, pharyngeal bursa remnants)

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What factors described by Ho and Neel are regarded as important adverse prognostic indicators in pts with NP CA

Length and symptomatology of dz
extension of tumor outside of NP
presence of inferior cervical nodes
keratinizing histo architecture (WHO I)
cranial nerve and skull base extension
distant mets
low ADCC titers

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Extension into which space is a/w worst prog in pts with NP CA

Anterior masticator space

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What is the primary tx modality for NP CA

RT to the NP (66-70 Gy) and neck (60 Gy)

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Why is the clinically negative neck treated in NP CA

Studies have shown improved local control and dz-free survival for ppx irradiation of the clinically negative neck in pts w/ NP CA

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What are the complications from RT over-dosage in the tx of NP CA

Osteoradionecrosis, brain necrosis, transverse myelitis (45 Gy), hearing loss, hypopituitarism, hypoT, optic necrosis

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What is the role of induction chemo for tx of NP CA

No survival advantage has been proven

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What is the standard tx protocol for stage III and IV NP CA

Concomitant cisplatin and RT followed by adjuvant chemo with cisplatin and 5-FU

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How does tx failure usu manifest in NP CA

Dz at both primary site and cervical LN

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What is m/c site of recurrent/persistent NP CA

Lateral wall of NP

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What are the tx options for recurrent/persistent NP CA at primary site

Reirradiation w/ larger therapeutic dose that initial tx; stereotactic RT; brachytherapy w/ split plate implantation of radioactive gold grains; surgical resection

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What is m/c benign sinonasal neoplasm

Inverting papilloma

What is m/c malig sinonasal neoplasm

SCCa (80%)

What is 2nd m/c malign sinonasal neoplasm

Adenocarcinoma

M/c location of sinonasal SCCa

Maxillary sinus > nasal cavity > ethmoids

Are elective ND warranted in pts with sinonasal SCCa

No, incidence of occult cervical mets is 10%

Percent of sinonasal tumors attributable to occupational exposures

44%

Where do these tumors most often originate

Lateral nasal wall, adjacent to MT

Which substances are thought to predispose to sinonasal neoplasms

Nickel, chromium, isopropyl oils, volatile hydrocarbons, organic fibers from wood, shoe, and textile refineries

Which of these is classically a/w SCCa

Nickel

Which of these are classically a/w adenoCA

Hardwood dust and leather tanning substances

Which virus is thought to play a role in etiology of sinonasal tumors

HPV, 6 and 12

T/F: Smoking by itself is not a significant etiologic factor for sinonasal tumors

True

Which nasal masses should not be biopsied in clinic

Masses in kids or adolescents and masses suspicious for angiofibroma some recommend delaying bx of any nasal mass until after imaging has been obtained

What are the 3 subtypes of Schneiderian papillomas

Fungiform, inverting, and cylindrical

Where do inverting papillomas most commonly arise

Lateral nasal wall

What factor is most related to the chance of recurrence for IP

Method of removal

What is incidence of recurrence after resection of IP via lateral rhinotomy/medial maxillectomy

13-15%

In pts who undergo resection of IP via lateral rhinotomy/medial maxillectomy, what is most imp factor related to risk for recurrence?

Mitotic index

What is ddx of small cell sinonasal tumor

- Esthesioneuroblastoma - Plasmacytoma - Melanoma - Lymphoma - Sarcoma - Poorly differentiated SCCa - Ewing's sarcoma - Peripheral neuroectodermal tumor (PNET) - SNUC

What is a SNUC

Sinonasal undifferentiated carcinoma -- a very aggressive small cell sinonasal tumor

What are the poor prognostic factors for SNUC

Orbital involvement and neck mets Tumors in the paranasal sinuses have a worse prog than those arising in the nasal cavity

SNUC tumors have Ab's to what substances

- Cytokeratin - Epithelial membrane Ag - Neuron-specific enolase

What is tx for SNUC

Preop CRT followed by surgical resection for those tumors w/o distant mets or extensive intracranial involvement

In what age group is olfactory neuroblastoma usu seen

Bimodal -- 20s and 50s

Esthesioneuroblastom involving ethmoids is what Kadish stage

What are the 3 m/c malig bone tumors of the paranasal sinuses

Multiple myeloma, osteogenic sarcoma, and chondrosarcoma

Pathophysiology of fibrous dysplasia

Nl medullary bone is replaced by collagen, fibroblasts, and osteoid

Where is fibrous dysplasia most commonly found in H&N

maxilla

Where is ACC of the H&N most commonly found

Palate > major salivary glands > paranasal sinuses

Where is melanoma m/c found in nose and paranasal sinuses

nasal septum

How does nasal melanoma differ from cutaneous melanoma

More aggressive with a worse prognosis and an unpredictable course -- local recurrence is the m/c cause of failure

What is the m/c type of lymphoma of nose and paranasal sinuses

Non-hodgkin's lymphoma

What is Ohngren's line and how is it significant

Imaginary line from medial canthus to angle of mandible; tumors below the line have a better prognosis than tumors above the line (w/ palate as an exception)

comprises only 3% of schneiderian papillomas

cylindrical

M/c type of schneiderian papilloma, typically seen on nasal septum

Fungiform

2-13% of these benign nasal tumors have malig potential

Has a predilection for mandible and sunray appearance on X-ray

osteogenic sarcoma

More than 90% will have invaded through at least one wall of the involved sinus at presentation

SCCa

Benign tumor m/c seen in pts less than 20 yo and has a ground glass appearance on x-ray

fibrous dysplasia

Benign tumor m/c found in the frontal sinus

osteoma

Encapsulated benign tumor that arises from surface of nerve fibers

neurilemoma

unencapsulated tumor that arises from w/in a nerve; 15% become malig

neurofibroma

2nd m/c malig sinonasal tumor; tend to be located superior to Ohngren's line

AdenoCA

Arise from pericytes of Zimmerman and considered neither benign nor malig

Hemangiopericytoma

Arise from cells of neural crest that differentiate into olfactory sensory cells; Homer Wright rosettes are characteristic

Esthesioneuroblastoma

May progress to multiple myeloma

extramedullary plasmacytoma

M/c tumor to met to sinonasal area

renal cell

Well circumscribed mobile painless lesion m/c found on tongue that has malig potential and histopath shows poygonal cells w/ abundant eosinophils

Granular cell tumor

Met to the brain more frequently than any other soft-tissue sarcoma

Alveolar soft part sarcoma

What sinonasal neoplasms remodel rather than erode bone

Sarcomas, minor salivary gland carcinomas, hemangiopericytomas, extramedullary plasmacytomas, large cell lymphomas, and olfactory neuroblastomas

Primary modality of tx for extramedullary plasmacytomas

After benign lymphoid hyperplasia, what is m/c benign NP tumor

JNA

From which site in NP does JNA develop

Trifurcation of the palatine bone, horizontal ala of the vomer, and the root of the pterygoid process

What is the stage of a JNA eroding the skull base with minimal intracranial extension

IIIA

Main blood supply to JNA

IMAX or ascending pharyngeal artery

24 Neoplastic - Nose/NP Flashcards

(79 cards)