Metastatic behaviour of sinonasal adenocarcinomas of the intestinal type (ITAC)

Abstract

The relative frequency of regional lymphogenic versus distant hematogenic metastases was evaluated in 369 patients with sinonasal adenocarcinoma of the intestinal type (ITAC). We assessed the results of neck dissections for a limited number of patients undergoing this surgical intervention. 117 ITAC patients were followed up for at least 5 years. Neck dissections were performed in 18 cases (15 primary and 3 secondary operations), 4 of which revealed carcinoma-positive lymph nodes. Metastases in lymph nodes were also diagnosed clinically in three other patients adding up to a total of seven individuals (6 % of 117) with lymphogenic metastases. In comparison, distant hematogenic metastases were identified in 15.4 % of these 117 patients. In the second group of 252 patients, the occurrence of distant hematogenic metastases and colorectal adenocarcinomas was registered but no formal follow-up procedure was applied. 50 neck dissections were performed in this group, 46 of which exhibited no histological evidence for metastases in lymph nodes, while in 1 case they were carcinoma-positive. Three additional cases showed clinical signs of metastases in regional lymph nodes. Taken together, our observations indicate that regional lymphogenic metastases are rather rare (about 2 %) in patients with sinonasal adenocarcinoma of the intestinal type. Therefore, the surgery of neck dissection appears not advised as routine intervention in these cases. ITAC patients show a normal prevalence of colorectal adenocarcinomas.

Primary Lingual Colonic-Type Adenocarcinoma: A Rare and Emerging Distinct Entity!

“…Metastatic disease from ITAC is rare [15]. Immunophenotypically, these tumors demonstrate CK7, CDX2 and CK20 positivity [16].…”

Intestinal-type adenocarcinoma of the sinonasal tract: an update

“…Retrolateropharyngeal nodal metastases are likely underestimated, but can be easily detected with MRI or CT. Distant metastases are identified in 1.7% of cases at presentation and 12.8% of cases during follow-up [47]. At PET, ITAC shows a highstandard uptake value, which is second only to sinonasal undifferentiated carcinoma [48].…”

“…In view of the low rate of cervical lymph node metastases at presentation and during follow-up, elective neck treatment is not indicated [47,58].…”

Decreasing recurrence and increasing survival rates in patients of ethmoid or sphenoid intestinal-type adenocarcinomas

“…1 ). Twelve records in 9 studies [ 9 , 11 , 12 , 17 , 19 , 22 , 23 , 34 , 35 ] provided tumor stage. Figure 2 displays the distribution of the 12 records of T3 or T4 stage versus enrollment year.…”

“…[ 2 , 4 , 9 – 11 ] So, a routine neck dissection is not suggested for patients with a clinically negative neck. [ 12 ] Ethmoid ITACs seem to show long-term mortality lower than non-ITAC (e.g., see Meccariello et al [ 13 ] or Fig. 1 of Cantu et al [ 7 ] ).…”