Clinical management of emerging sinonasal malignancies

Abstract

Several emerging sinonasal malignancies have recently been described in the pathology literature. Although not all distinctly classified by the World Health Organization, these rare tumors present a management challenge to surgeons and oncologists. While prior studies have summarized histologic details, a clinically focused review is currently lacking in the literature. This review describes the presentation, histopathology, imaging, treatment, and prognosis of newly described or recently evolving sinonasal malignancies while highlighting the distinguishing features of these entities. It includes teratocarcinosarcoma, human papillomavirus‐related multiphenotypic carcinoma, biphenotypic sinonasal sarcoma, sinonasal renal cell‐like adenocarcinoma, NUT‐midline carcinoma, squamous cell carcinoma associated with inverted papilloma, sinonasal undifferentiated carcinoma, and INI‐1‐deficient sinonasal carcinoma. By describing the diagnosis, treatment, and prognosis of these recently defined entities, this clinical review aims to help guide oncologists in the clinical management of these patients.

Need for long‐term follow‐up in sinonasal inverted papilloma: A Single‐institution experience

“…Possibly, frontal sinus SNIPs are rather a result of invading disease or a displacement of tumor cells after incomplete initial surgery. Additionally, studies reporting “true frontal sinus SNIPS” are biased by a significant rate of revision surgery up to 51% 13,37 . In line with this hypothesis, 3 of 10 recurrences in our study were located in the frontal sinus along with extended ethmoidal disease.…”

“…In contrast to their findings, we observed a lower rate of 2 of 102 (2%) synchronous and no metachronous malignancies. Similar to the carcinogenesis for other malignancies, a continuous epithelial transformation from dysplasia towards invasive, SNIP‐associated SCC is assumed 13 . This transformation may be additionally driven by smoking, HPV infections and epidermal growth factor receptor (EGFR) mutations 13 .…”

“…Similar to the carcinogenesis for other malignancies, a continuous epithelial transformation from dysplasia towards invasive, SNIP‐associated SCC is assumed 13 . This transformation may be additionally driven by smoking, HPV infections and epidermal growth factor receptor (EGFR) mutations 13 . Typically, SNIP‐associated SCC is diagnosed only after surgical excision and seen at an advanced stage (T3 or T4 classification).…”

“…Additionally, it was shown that SNIPs classified as stage T3 tumors revealed a 51% higher likelihood of recurrence 5 . While confirmed negative margins are associated with increased recurrence free survival (RFS), frontal sinus involvement, incomplete resection, presence of dysplasia, multifocal attachment and pertinent human papilloma virus (HPV) infection have been implicated as risk factors 7‐14 . Overall, reported recurrence rates (RRs) in the literature vary from 5% to 45% 4,7,15‐17 .…”

Hybrid positron emission tomography imaging for initial staging of sinonasal tumors: Total lesion glycolysis as prognosticator of treatment response

“…9,27 Similar to other series, sinonasal melanoma and SCC were among the most frequent tumor entities. 9,22,28,29 Initial radiological staging of sinonasal tumors requires detailed information on local tumor extent, especially with regard to infiltration of the orbit and skull base. As represented in the AJCC cancer staging system, this information determines the T category and serves as a strong predictor of the 5-year diseasespecific survival.…”