Paranasal sinusanatomy

Sphenoid

Nasopharynx

Respiratory mucosaPseudostratified, goblet & ciliated cells

Seromucinous glands

Nasopharyngeal mucosa/carcinoma

Squamous metaplasia (?) with CIS

Normal respiratory mucosaWith lymphocyte trafficking

Nasopharyngeal carcinoma expressingEBV early RNA transcripts (EBER1)

Sinonasal carcinomas0.2% of malignancies

3% of head & neck carcinomas50% 5-yr survival

1% eachFrontal/sphenoid

10%Ethmoid

30%Nasal cavity

58%Maxillary antrum

W.H.O.AdenocarcinomaIntestinal-type adenocarcinomaPapillary adenocarcinoma

Adenosquamous carcinomaLymphoepithelial carcinomaSmall cell carcinomaSpindle cell carcinomaVerrucous squamous cell carcinomaCylindrical cell carcinoma

Squamous cell carcinomaSinonasal carcinoma

Origin of nasal/paranasal sinus tumors

Lung carcinomaBreast carcinomaRenal carcinomaIntestinal adenocarcinoma

Mucoepidermoid carcinomaAcinic cell carcinoma, etc.

Adenoid cystic carcinomaPleomorphic adenoma, etc.

Adenocarcinoma low & high-grade

Squamous cell carcinomaIntestinal-type adenocarcinoma & low-grade papillary

Ductal/acinar salivary gland-type

(6% of mets)

Metastasis

3%

Biphasic salivary gland-type

Seromucinous glands/surface

Surface columnar epithelium

Distribution of minor histologic tumor types among paranasal sinus carcinomas

Lund 1980-2004

00Sphenoid

Ethmoid

Maxillary

61

212

Seromucinous adenocarcinoma

N=8

Salivary gl type

N=13

Salivary gland-type carcinomasmucoepidermoid

Intermediate cells

Mucus cells

Adenocarcinoma – seromucinous, low grade

Nerve with tumor infiltrate

Adenocarcinoma – seromucinous, high grade

Distribution of major histologic types among paranasal carcinomas

Lund 1980-2004

10Sphenoid

Ethmoid

Maxillary

18182

45555

IT-adenocarcinomaN=23

SSCN=57

Intestinal-type adenocarcinoma

• M:F 5:1• Mean age 50 – 65 yr, range 3rd to

9th decade • Predominantly ethmoid sinus

followed by nasal cavity & maxillary sinus

• Metastasis to lateral neck nodes <20%, distant metastases occur

• Death by intracranial spread• Etiology: hardwood & leather dust,

chrome

Carcinoma filling nasal cavity, ethmoid sinus with penetration of cribriform plate

CT courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital

Ethmoid sinus cancer• CT primary• MR complement

CT courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital

Penetration of posterior antrum

Middlecranialfossa

Skeletal filter

Well-differentiated intestinal-type adenocarcinoma, papillary pattern

Muscularis mucosae

Well-differentiated intestinal-type adenocarcinoma

component cells

Paneth cells

Goblet cells

Well-differentiated intestinal-type

adenocarcinomaneuroendocrine cells

Chromogranin A

Gastrin

Somatostatin

High-grade intestinal-type adenocarcinoma

High-grade intestinal-type adenocarcinoma

Cribriform pattern Partial regression

Mucinous intestinal-type adenocarcinoma

Tumor spread

Courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital

Sinonasal squamous cell carcinoma

• M:F 2:1• Most >50 yr, rarely <40 yr • Predominantly nasal cavity &

maxillary sinus, rarely ethmoid• Usually well to moderately

differentiated• Metastasis to lateral neck nodes

in ~15%, especially if bone is penetrated

• Etiology: nickel, softwood dust, mustard gas production, Thorotrast

Öhngren's plane throughantrumW

orse

pro

gnos

is

Wor

se p

rogn

osis

Bette

r pro

gnos

is

Bette

r pro

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is

Squamous cell carcinoma, maxillary sinus

Squamous metaplasia

Invasive cancer

Bone invasion

Squamous cell carcinoma, perineural growth

SummaryMetaplasia – neoplasia sequence

Non-lymphoid respiratory mucosaSquamous metaplasia

Squamous cell carcinoma

Concomitant intestinal metaplasia/neoplasia

Carcinomaof Paranasal Sinuses

Michael Dictor, MD, PhD

Department of PathologyLund University Hospital

Lund, Sweden

Ethmoid sinus cancerCourtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital

Penetration of antrum,orbit/base of skull

Molecular lesions in sinus carcinoma of intestinal type

• c-erbB-2 expression

Molecular lesions: RAS

Perez et al. Cancer 1999;86:255-264Saber et al. Cancer Lett 1998;126:59-65

5G12VCodon 35 g>tEthmoidH-RAS1G13CCodon 37 g>t

1G13DCodon 38 g>aEthmoid

3G12DCodon 35 g>aSinonasalK-RAS2NAmino AcidNucleotide

adenoca, intestinal type

adenoca, intestinal type

adenoca, intestinal type (both blocks, bl c min material)

adenoca, intestinal type

adenoca, seromucinous type, high grade (5 blocks)

adenoca, intestinal type

adenoca, intestinal type (sparse, post-radiation)

adenoca, intestinal type (2 blocks)

adenoca, papillary (2 blocks, mostly benign)

adenoca, intestinal type, mucinous (blocks 1 & 2 benign only)

adenoca, seromucinous type, high grade (2 blocks)

adenoca, seromucinous type, high grade (block 1 benign)

malignant tumor, r/o rhabdomyosarcoma (2 blocks)

adenoca, seromucinous type, low grade

adenoca, intestinal type, <50% (blocks 1 & 2 benign only)

adenoca, intestinal type, mucinous

adenoca, intestinal type (block 2 benign; no. 1 is 2 blocks))

adenoca, papillary

adenoca metastases in brain (blocks A-D)

adenoca metastases in brain (blocks A-D)

malignant tumor, lymphoma? melanoma? carcinoma?

adenoca, papillary (mucinous epithelium)

adenoca, papillary (mucinous epithelium)

adenoca, seromucinous type, low grade

adenoca, papillary (mucinous epithelium)

adenoca, papillary

adenoca, seromucinous type, low grade

mucoepidermoid ca, low grade (3blocks, better represented)

adenoca, papillary (mucinous epithelium)

adenoca, intestinal type with marked regression

adenoca, NOS, moderate-poorly diff (intestinal type?)

adenoca, intestinal type

adenoca, intestinal type, <20%

adenoca, intestinal type

Nasopharyngeal carcinoma – CT & MR

T1 T1 with contrastCT courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital

T2 512

Nasopharyngeal carcinoma – CT & MR

CT courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital

Ethmoid sinus cancerCourtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital

Soft parts filter without contrast

Ethmoid sinus cancer - MR

T2-STIR 256 T2-tse 512Courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital

Ethmoid sinus cancer

Courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital

Nasopharyngeal carcinoma – CT & MR

CT courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital

Paranasal sinusanatomy

Sphenoid

Nasopharynx Drainage:

Frontal - nasofrontal duct into the ethmoid infundibulum of the middle meatus

Antrum – near middle meatus

Anterior ethmoid – middle meatus

Sphenoid - sphenoethmoid recess

Ethmoid sinus cancer - MR

T2-tse 512 Courtesy of Dr. Mårten AnnertzDept. of RadiologyLund University Hospital

Invasion of nasal cavity, sphenoid bone & optic chiasm