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Sinonasal tumours
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Yujay Ramakrishnan, Shahzada Ahmed
Sinonasal undifferentiated carcinoma (SNUC) is a rare aggressive tumour with an overall low incidence of 0.02 per 100,000 person. SNUC demonstrates a predilection for males: 3:1 male-to-female ratio. It tends to present in the 50s but has a broad age range [34]. It is rapidly progressive and typically presents late with local invasion and cervical neck nodes.
Paranasal sinus and nasal cavity neoplasms
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Sinonasal undifferentiated carcinoma (SNUC) is a highly aggressive carcinoma of uncertain histogenesis. It has been reported in patients ranging from 8 to 85 years of age at the time of diagnosis, with a median age of presentation in the sixth decade (38). Males are 2–3 times as likely to be affected as females. Because of the low incidence, no clear aetiological factors have been elucidated (39). The tumour is usually large (>4 cm) at presentation, with locally extensive disease, invasion of adjacent structures, aggressive bone destruction, and rapid growth (40). It is most commonly encountered in the nasal cavity with extension into the paranasal sinuses, ethmoid more so than maxillary. Nodal metastases remain relatively uncommon despite large primary tumour size, occurring in 10%–30% of cases at presentation (41–44). Despite aggressive management, the prognosis is poor, but has improved in recent years, most likely due to the use of trimodality therapy (45). A large series that used data from the Surveillance, Epidemiology, and End Results (SEER) program evaluated 318 cases between 1973 and 2010 and described an overall median survival of 22.1 months and 5- and 10-year relative survival rates of 34.9% and 31.3%, respectively. Median survival improved to 41.9 months following surgery combined with RT (39). Imaging features are non-specific and cannot distinguish SNUC from SCC and other aggressive sinonasal malignancies (46). SNUC has a higher propensity for distant metastases to bone, brain, dura, liver, and cervical nodes than other sinonasal malignancies, and distant metastases have been reported to be the most common cause of death (45). Rapid tumour growth and nodal/distant metastases are helpful in suggesting the diagnosis.
Incidence and survival in sinonasal carcinoma: a Danish population-based, nationwide study from 1980 to 2014
Published in Acta Oncologica, 2018
Sannia Sjöstedt, David Hebbelstrup Jensen, Kathrine Kronberg Jakobsen, Christian Grønhøj, Charlotte Geneser, Kirstine Karnov, Lena Specht, Tina Klitmøller Agander, Christian von Buchwald
The best relative survival between histological groups was seen in the SCC group with five year survival of 56% (95% CI 52;59). This was only significantly higher than the survival in the UC, which had a five year survival of 29% (95% CI 20;40) (Table 1 and Figure 2(A)). The latter containing the sinonasal undifferentiated carcinoma, which is known to carry a poor prognosis [22].
Impact of human papillomavirus in sinonasal cancer—a systematic review
Published in Acta Oncologica, 2021
Sannia Sjöstedt, Christian von Buchwald, Tina Klitmøller Agander, Kasper Aanaes
Sinonasal undifferentiated carcinoma (SNUC) is a rare and aggressive neoplasm, with a poor prognosis [30]. Several histological features are shared with other neoplasms of the sinonasal tract (esthesioneuroblastoma, small-cell undifferentiated neuroendocrine carcinoma, NUT midline carcinoma, malignant mucosal melanoma among others) [8].
Sinonasal undifferentiated carcinoma with metastasis to the extradural spine
Published in British Journal of Neurosurgery, 2023
Samuel Jones, Heather O’Connor, Fraser Henderson, Adriana Olar, Sunil Patel
A 42-year-old Caucasian man experienced sudden anosmia and nosebleeds, which he initially attributed to seasonal allergies. When these symptoms did not subside after two months, he referred himself to our hospital. Computed tomography (CT) showed a large nodular mass extending from the superior nasal cavity to the skull base with erosion of the anterior skull base and cribriform plate. Magnetic resonance imaging (MRI) showed a 5 × 4 cm neoplasm of the ethmoid sinus with extension into the cranium through the cribriform plate (Figure 1). Biopsy and histopathological examination resulted in the diagnosis of sinonasal undifferentiated carcinoma (SNUC). A positron emission tomography (PET) scan on day +20 showed no metastasis and the tumor was surgically resected on day +40. The patient underwent chemoradiotherapy and a subsequent surgery for a cerebrospinal fluid (CSF) leak on day +74. After completing chemoradiotherapy, the patient presented with neck pain radiating down the right arm. A PET scan post-treatment on day +206 showed fluorodeoxyglucose (FDG) uptake along the superior margins of the ethmoid sinus, as well as at the area of the C6 spine (Figure 1H). MRI on day +213 showed a 0.4 × 1.4 × 2.7 cm extradural lesion at C5-C6, correlating with exam findings. Day +256 MRI showed an increasing size of the C5-C7 lesion (Figure 1E & F). There was also a new lesion adherent to the dura at C2. The extradural lesion at C6 was debulked with laminectomy and instrumented fusion on day +262 but was histologically indeterminate. About a month after the surgery, the patient began experiencing increasing weakening and radicular pain in the right shoulder and arm. Subsequent imaging showed a progressive extradural mass at C5-T1. The tumor doubled in size with complete engulfment of the C7 and C8 spinal nerve roots. The patient presented with 0/5 strength in the right triceps with 3/5 grip strength. There was also enlargement of the C2 lesion. On day +302 the patient underwent a re-exploration of the cervical laminectomy site to decompress the affected nerve roots with post-operative improvement in arm strength. Pathology was reported at this time as metastatic, poorly differentiated carcinoma with identical cell morphology to the previous ethmoid SNUC resection specimen. On day +306, MRI showed multiple new extradural masses in the thoracic spine at T7-T8 and T9-T10. The patient underwent further chemoradiotherapy for the new metastases.