Imaging of sinonasal tumours

Abstract

More than 70 benign and malignant sinonasal tumours and tumour-like conditions have been described. However, sinonasal tumours are rare, and sinonasal cancers comprise only 3% of all head and neck cancers and 1% of all malignancies, with a peak incidence in the 5th to 7th decades and with a male preponderance. The early symptoms and imaging findings of sinonasal tumours are similar to rhinosinusitis with runny and stuffy nose, lacrimation and epistaxis and therefore neglected both by the patients and doctors. When late symptoms such as anosmia, visual disturbances, cranial neuropathy (Cn II, IV, V, VI) or facial swelling appear, the patient is referred to sinonasal endoscopy or imaging. At the time of correct diagnosis more than half of the tumours have reached an advanced stage with a poor prognostic outcome. Even if imaging is performed in the early stages, a radiologist inexperienced with sinonasal anatomy and tumour features may easily interpret early signs of a malignant tumour as rhinosinusitis or a lesion that does not require follow-up. This article presents the imaging findings in some of the most common benign and malignant sinonasal tumours, and the TNM classification and staging of sinonasal carcinomas.

Early stage adenoid cystic carcinoma of the posterior nasal septum: a rare manifestation

“…Hence, MR imaging with intravenous contrast injection is mandatory, in order to map this perineural spread. On the other hand, the value of [ 18 F] FDG-PET/CT in ACC is limited due to low metabolic activity and therefore low FDG uptake [14].…”

Imaging Appearance ofSMARCB1(INI1)-Deficient Sinonasal Carcinoma: A Newly Described Sinonasal Malignancy

“…The tendency toward avid enhancement, intermediate T2 signal intensity, moderate diffusion restriction, and FDG avidity demonstrated in our series is characteristic for sinonasal undifferentiated carcinoma and squamous cell carcinoma, which, though occurring most commonly in the paranasal sinuses (75%), must still be considered when nasal cavity masses are identified because of the high relative prevalence of this diagnosis. [1][2][3][4]7,12 CT imaging demonstrated associated calcification in close to half of the tumors (6 of 13), though no tumor calcification was reported on histopathologic analysis. In considering this discrepancy, we felt that calcification might reflect retained bone fragments in 2 patients and an aggressive periosteal reaction in 4.…”

“…Though squamous cell carcinoma remains the most common sinonasal malignancy (approximately 60% of cases), there is a diverse and growing array of additional histologies, including tumors of epithelial, neuroectodermal, lymphoproliferatve, and mesenchymal origins. [1][2][3][4] Though imaging features of the various histologies overlap considerably, some tumors demonstrate characteristic findings that support a particular diagnosis, such as T1 shortening in melanoma or chondroid calcification in chondrosarcoma. Other tumors might demonstrate findings that, though not specific to a single diagnosis, suggest their aggressive nature.…”

“…Nevertheless, most sinonasal masses present with very nonspecific clinical findings indistinguishable from rhinosinusitis, and the ability of the radiologist to suggest an underlying malignancy is useful in directing shortterm management, including the need for further imaging and tissue sampling. [3][4][5][6][7][8] SMARCB1 (INI1) is a tumor-suppressor gene that has been implicated in a growing number of malignancies involving multiple anatomic sites, including the kidneys, soft tissues, and CNS.…”

Sinonasal Schwannoma: A Case Report and Updated Review of the Literature

“…These lesions also cause aggressive bony destruction, whereas benign lesions such as meningiomas and angiomatous polyps typically incite benign bone remodeling. Juvenile nasopharyngeal angiofibromas, which are benign vascular lesions, produce broadening of the pterygopalatine fossa from which they arise, with associated enlargement of the sphenopalatine foramen and Vidian canal on CT. On MR imaging, these lesions demonstrate flow voids and intense enhancement given the high vascularity [10].…”