Imaging Characteristics of Malignant Sinonasal Tumors

Abstract

Malignancies of the nasal cavity and paranasal sinuses account for 1% of all malignancies and 3% of malignancies of the upper aerodigestive tract. In the sinonasal tract, nearly half of all malignancies arise in the nasal cavity, whereas most of the remaining malignancies arise in the maxillary or ethmoid sinus. Squamous cell carcinoma is the most common histological subtype of malignant tumors occurring in this area, followed by other epithelial carcinomas, lymphomas, and malignant soft tissue tumors. Although many of these tumors present with nonspecific symptoms, each tumor exhibits characteristic imaging features. Although complex anatomy and various normal variants of the sinonasal tract cause difficulty in identifying the origin and extension of large sinonasal tumors, the invasion of vital structures such as the brain, optic nerves, and internal carotid artery affects patients’ prognosis. Thus, diagnostic imaging plays a key role in predicting the histological subtype and in evaluating a tumor extension into adjacent structures. This article describes the computed tomography and magnetic resonance imaging findings for malignant sinonasal tumors.

Advantages of the open approach in sinonasal tract tumors with midfacial and suprastructure invasion

“…The majority of the patients suffer from chronic crusting rhinitis, epiphora and sensory loss in the ophthalmic or infraorbital territories after rhinotomies. Following the French Society of ENT (Société Française d'Oto-Rhino-Laryngologie -SFORL) 2008 guidelines, the follow-up must consist in clinical examination every two months for the first year, every three months for the second year, then every six months for life; MRI every three months after treatment, then determined by clinical examination, and chest X-ray at 6 months followed by once a year [14][15][16] .…”

Renal cell carcinoma presenting as epistaxis from a nasal cavity metastasis

“…The differential diagnosis for masses in this region includes angiofibroma, inverted papilloma, squamous cell carcinoma, adenocarcinoma, or metastasis. Malignant features include tumor expansion, erosion, remodeling, expansion of the sphenopalatine foramen, and pterygopalatine fossa [1] , [3] , [4] , [5] , [6] , [7] . Olfactory neuroblastomas arise from neuroepithelial cells of the olfactory mucosa with possibility for lymph node metastasis and distant metastasis.…”

“…Traditionally, contrast-enhanced CT is the imaging test of choice to delineate vascularity, extent, invasion, and skull base involvement [7] . Characteristic findings in metastatic RCC include avid enhancement without calcification due to high tumor vascularity.…”

“…Characteristic findings in metastatic RCC include avid enhancement without calcification due to high tumor vascularity. Intralesional calcifications are more often seen in adenocarcinoma, olfactory neuroblastoma, inverted papilloma, fibrous dysplasia, osteomas, osteosarcomas, and cartilaginous tumors [1] , [2] , [3] , [4] , [5] , [6] , [7] . Further, high-grade malignancies tend to show extensive bony destruction.…”

“…Further, high-grade malignancies tend to show extensive bony destruction. MRI provides greater soft tissue resolution compared to CT. Malignant tumors are usually characterized by T2-weighted high signal with variable T1-weighted signal intensity [7] . Low Apparent Diffusion Coefficient (ADC) indicates hypercellularity, hemorrhage, or necrosis.…”