Sinonasal malignancy

Franquemont DW, Mills SE. Sinonasal malignant melanoma a clinicopathologic and immunohistochemical study of 14 cases. Am J Clin Pathol. 1991 96 689-697. 

Ling FT, Kountakis SE (2006) Advances in imaging of the paranasal sinuses. Curr Allergy Asthma Rep 6 502-507 Lloyd G, Lund VJ, Howard D, Savy L (2000) Optimum imaging for sinonasal malignancy. J Laryngol Otol 114 557-... 

Selected Case-Control Studies. Luce et al. (1993b) attempted to detennine whether occupational exposure to fonnaldehyde was associated with an increased risk of sinonasal cancer in humans. Case subjects were patients with primary malignancies of the nasal and paranasal sinuses. Odds ratios for squamous cell carcinomas in formaldehyde-exposed workers, when adjusted for wood dust and glue exposure, were not significantly elevated. The odds ratio for adenocarcinomas was confounded by the frequent co-exposure to wood dust, a known carcinogen. However, in those exposed to wood dust, an increased odds ratio was noted in those also exposed to formaldehyde. The authors concluded that the data did not support an increased risk of nasal cancers due to formaldehyde alone. 

Many of the tumors of the nasal cavity and paranasal sinuses fall under the category of round cell neoplasms. Among these are olfactory neuroblastoma, sinonasal undifferentiated carcinoma, malignant melanoma, neuroendocrine carcinoma-small cell neuroendocrine carcinoma, malignant lymphoma, extramedullary plasmacytoma, invasive-ectopic pituitary adenoma, rhabdomyosarcoma, and Ewing s sarcoma (ES)-peripheral neuroectodermal tumor (ES/ PNET). But there is also a host of other epithelial lesions that are unique to the sinonasal tract. 

Malignant melanomas (MMs) of the sinonasal tract are uncommon and typically occur in patients older than 50 years of age. Most arise intranasally from the anterior nasal septum or lateral wall in the vicinity of the inferior or middle turbinates. Although they may originate in a sinus, the sinuses are most often involved secondarily from a nasal primary. 

MMs are invariably positive for vimentin, which may be a pitfall in dealing with amelanotic spindle cell MMs. As a general rule, in diagnosing a spindle cell lesion of the sinonasal tract one must consider MM, spindle cell carcinoma, and a malignant myoepithelioma before soft tissue sarcomas. Rare MMs may also be focally positive for CAM 5.2 and EMA, which poses a problem when dealing with an epithelioid MM. 

ITACs have features of a sinonasal-derived tumor but also share some immunohistochemical markers seen in the colorectal tumors that they resemble. For example, most ITACs will stain positive for CK7, which is the typical epithelial marker of the Schneiderian membrane. 456 They are also usually positive for CK20 and CDX2, which are typical of intestinal-derived malignancies.Villin and MUC2 have also been described in... 

Prasad ML, Jungbluth AA, Iversen K, et al. Expression of melano-cytic differentiation markers in malignant melanomas of the oral and sinonasal mucosa. Am J Surg Pathol. 2001 25(6) 782-787. 

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