To through a light on the sinonasal

tumors.
Classification:
Tumors of the nose and Para nasal sinuses are
classified into:
A-Benign tumors:
 Epithelial e.g. papilloma, adenoma

 Non-epithelial e.g. osteoma, angioma,

chondroma, fibroma.
B-Malignant tumors:
 Epithelial e.g. squamous cell carcinoma,
adenocarcinoma, malignant melanoma,
adenoid cystic carcinoma.
 Non-epithelial e.g. fibrosarcoma, osteosarcoma,
angiosarcoma rhabdomyosarcoma, lymphoma
Inverted papilloma(Schneiderian papilloma)
 It is the most common benign tumor of the
nose and paranasal sinuses. Almost exclusively
arise from lateral nasal wall and may extends
to maxillary and ethmoidal sinuses.
 Pathologically the tumor covered by inverted mucosal
surface extending into the stroma .
 Clinically causes unilateral nasal obstruction,
rhinorrhoea and epistaxis usually occurs in males(3:1)
over 50 years, examination shows mass in the nasal
cavity.Endoscopy showes fleshy mass
 Diagnosed by:
1- CT scaning (opacity of the maxillary sinus and
could extends to the ethmoid and nasal cavity and
thinning of the bone but no frank erosion)
2- Histopathology to exclude malignancy (malignant
changes occur in 2-10%).
 Treatment is by wide excision endoscopically or
external approach to avoid recurrance.
B-Benign non-epithelial tumors:
Osteoma:
1-it is slowly growing tumor.
2- It often occurs in young adult and mostly in the
frontal sinuses.
3- Usually they are asymptomatic and found
incidentally by routine radiographs.
4- When osteoma become large may cause
headache
 Diagnosis: by radiology.
 Treatment is by surgical removal if the osteoma is
symptomatic , If it is symptomless → no treatment
is required, just follow up.
 Squamous-cell carcinoma: it is the commonest
malignant tumors of the nose and Para nasal
sinuses. It is used to be seen in nickel industries
workers.
 Adenocarcinoma: it arises from gland in the upper
respiratory tract mucous membrane. It is used to
be seen in hardwood dust workers.
 Adenoid cystic carcinoma: it arises from minor
salivary glands in the nose & paranasal sinuses.
 Malignant melanoma: arises from melanocytes.
They appear as dark or pale sessile mass on the
nasal septum or lateral nasal wall.
 Sarcoma e.g. fibrosarcoma, osteosarcoma,
rhabdomyosarcoma.
 Lymphoma e.g. Burkitt's lymphoma.
Sites of malignant tumors:
 80% of malignant Sino-nasal tumors are
squamous cell carcinoma.
 60% of tumors arise in the maxillary sinus.

 30% in the nose

 10% in the ethmoids.

 Tumors of frontal & sphenoid sinuses are rare.

Aetiology
 Smoking

 Nickel exposure (scc)

 Hard wood exposure(adenocarcinoma)

 Human papilloma virus (inverted papilloma)

 Clinical features of malignant sino-nasal
When it gets large
tumours: enough, it becomes
bilateral.
 Nasal tumors → nasal features e.g. unilateral
nasal obstruction, epistaxis, anosmia.
 Frontal sinus tumors → orbital features e.g.
proptosis, diplopia, and blindness
 Sphenoid sinus tumors → neurological
features.
 Ethmoid sinus tumors → nasal and orbital
features
Maxillary sinus tumors:
1- Early features: when the tumor is confined in the
sinus cavity-features of chronic sinusitis.
2- Late features: when the tumors spread outside
the sinus cavity leading to features according
to the site of invasion include:
 Invasion of anterior sinus wall → cheek
swelling, ulceration of cheek skin, involvement
of infra orbital nerve causing facial pain and
paresthesia.
 Invasion of superior wall (orbital floor) →
proptosis, epiphora due to damage to
nasolacrimal duct, blindness due to invasion of
optic nerve, diplopia due to limitation of
movement of the eye ball or external
ophthalmoplegia due to paralysis of extra
ocular muscles.
 Invasion of medial wall → unilateral nasal
obstruction, recurrent epistaxis and anosmia.
O/E there is mass inside the nasal cavity.
 Invasion of the posterior wall → spread to
infratemporal fossa and pterygopalatine fossa
→ trismus (inability to open the mouth due to
invasion of masticatory muscles), facial pain
and parasthesia due to involvement of 5th
cranial nerve.
 Invasion of inferior wall (hard palate)
loosening of teeth, ulceration of the palate
causing oro-antral fistula and dental pain.
 Intracranial spread → headache, vomiting and
other neurological features.
 Submandibular and upper cervical (from retropharyngeal).
The metastasis is small as the lymphatic supply of the nose is limited.

 Lymph node metastasis (10%−15%) → mass in

the neck.
 Systemic metastasis is occasionally seen.
Investigations:
 General blood investigations (CBP, ESR, Renal
function test...etc) (as a preoperative measure
and to detect distant metastasis)
 CT scan & MRI: show the tumor, bone
erosion& extension of the tumor.
 Biopsy:
Treatment:
Usually the treatment of carcinoma is surgery with
chemoradiotherapy . There are three main surgical
options for carcinoma:
 Medial maxillectomy

 Total maxillectomy

 Craniofacial resection: used when there is

involvement of cribriform plate.
In general an orbital exenteration is indicated only
if tumor breaches periosteum to involve orbital fat.
Follow up and after care:
 Monthly → for the 1st postoperative year.

 Bimonthly → for the 2nd postoperative year.

 Every 3 months → for the 3rd postoperative

year.
 Every 6 months → for the 4th & 5th
postoperative year.
 Annually for a further five years.

Prognosis: Overall 5-year survival is 30-50% in

scc and 45-60% in adenocarcinoma.