bromochloroacetic-acid and Paranasal-Sinus-Neoplasms

Although the definitions of sinonasal neuroendocrine and neuroectodermal neoplasms did not change substantially in the 5th edition WHO Classification of Head and Neck Tumours, the diagnosis of olfactory neuroblastoma (ONB), small cell neuroendocrine carcinoma, and large cell neuroendocrine carcinoma remains quite challenging in practice. Ambiguities surrounding the amount of keratin expression allowable in ONB and the amount of neuroendocrine differentiation seen in sinonasal undifferentiated carcinoma (SNUC) lead to significant diagnostic discrepancies at the high grade end of this tumor spectrum. Furthermore, a group of problematic neuroepithelial tumors that show overlapping features of ONB and neuroendocrine carcinoma have never been recognized in formal classification schemes. Since publication of the 5th edition WHO, two new tumor entities have been proposed that help resolve these problems. Olfactory carcinoma is defined by high grade keratin-positive neuroectodermal cells with frequent intermixed glands and shows recurrent Wnt pathway, ARID1A, and RUNX1 alterations. IDH2-mutant sinonasal carcinoma is a molecularly-defined category that encompasses tumors with undifferentiated (SNUC), large cell neuroendocrine, and neuroepithelial phenotypes. This review will provide a practical overview of these emerging entities and their application to diagnostic challenges in the post-WHO sinonasal neuroendocrine and neuroectodermal tumor classification.

Topics: Carcinoma, Neuroendocrine; Esthesioneuroblastoma, Olfactory; Humans; Keratins; Maxillary Sinus Neoplasms; Nasal Cavity; New Orleans; Nose Neoplasms; Paranasal Sinus Neoplasms

Although clinical history and morphologic appearance should be the initial considerations when evaluating small round blue cell tumors of the sinonasal tract, the final diagnosis often hinges on immunohistochemical findings. Unfortunately, interpretation of stains in these tumors is fraught with numerous pitfalls and limitations. This article presents an approach to sinonasal small round blue cell tumors based on four common immunohistochemical patterns: cytokeratin positivity, squamous marker positivity, neuroendocrine marker positivity, and cytokeratin negativity.

Topics: Biomarkers, Tumor; Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Diagnosis, Differential; Humans; Keratins; Nasal Cavity; Papillomavirus Infections; Paranasal Sinus Neoplasms

To help the clinician understand the different odontogenic tumors found commonly in the maxillary sinus in terms of clinical and radiographic findings, diagnosis and treatment.. The classification of odontogenic tumors has changed recently with the addition of the odontogenic keratocyst and calcifying odontogenic cyst (Gorlin cyst) from the realm of odontogenic cysts to being classified by the WHO as odontogenic tumors based upon their neoplastic biologic behavior. The odontogenic keratocyst is now called a keratocystic odontogenic tumor. The calcifying odontogenic cyst is now called a calcifying cystic odontogenic tumor.. The diagnosis of odontogenic tumors of the maxillary sinus is difficult and challenging. Surgeons need to work in conjunction with an oral and maxillofacial pathologist to ensure accurate diagnosis for proper surgical planning.

Topics: Ameloblastoma; Calcinosis; Diagnosis, Differential; Fibroma; Humans; Keratins; Maxillary Sinus; Odontogenesis; Odontogenic Cysts; Paranasal Sinus Neoplasms; Tomography, X-Ray Computed

Sinonasal undifferentiated carcinoma is a rare and extremely malignant tumor of the paranasal sinuses. Historically, treatment outcomes have been poor. This review presents recent data on the management of sinonasal undifferentiated carcinoma and examines treatment trends that may result in improved locoregional control and survival.. Patients who receive aggressive multimodality treatments have improved outcomes. In particular, a chemoradiotherapy regimen including concurrent platinum-based chemotherapy given preoperatively or postoperatively to patients with resectable disease seems to result in better disease-free survival. Neoadjuvant chemotherapy, although strongly advocated by some, is currently not offered by many. Although surgery seems to be an important part of the treatment for sinonasal undifferentiated carcinoma, its ideal timing, either upfront or after radiotherapy, remains uncertain.. Overall, outcomes for sinonasal undifferentiated carcinoma are poor. An aggressive approach using surgery, platinum-based chemotherapy, and radiation seems to offer the greatest chance for significant locoregional control and survival.

Topics: Carcinoma; Chemotherapy, Adjuvant; Disease-Free Survival; Humans; Immunohistochemistry; Keratins; Neoplasm Invasiveness; Paranasal Sinus Neoplasms; Prognosis; Radiotherapy, Adjuvant; Risk Factors

A case of true carcinosarcoma primarily arising in the right maxillary sinus is reported in a 60-year-old male. His chief complaints were right nasal obstruction and bleeding. Histological findings of the biopsied primary tumor revealed two components of keratinizing squamous cell carcinoma and osteosarcoma which were intricately intermingled. Despite intensive irradiation and chemotherapy, and total maxillectomy, he finally died of rapid tumor recurrence and widely spreading metastases to lungs, pleurae and brain two months later. At autopsy the recurrent and metastatic tumors consisted entirely of the osteosarcoma component, suggesting the efficiency of the radiotherapy and chemotherapy against the carcinomatous component, but not against the sarcomatous one. As for histogenesis, this case was compatible with a combination tumor judging from histologic, immunohistochemical and electron microscopic findings.

Topics: Carcinosarcoma; Humans; Keratins; Male; Maxillary Sinus Neoplasms; Middle Aged; Paranasal Sinus Neoplasms; S100 Proteins; Vimentin

Topics: Actins; Carcinosarcoma; Craniopharyngioma; Diagnosis, Differential; Esthesioneuroblastoma, Olfactory; Humans; Immunohistochemistry; Keratins; Male; Middle Aged; Mucin-1; Nasal Cavity; Nose Neoplasms; Paranasal Sinus Neoplasms; Pituitary Neoplasms; Teratoma; Vimentin

Sinonasal non-keratinizing squamous cell carcinoma (SCC), previously designated as transitional cell carcinoma or cylindrical cell carcinoma, is an uncommon malignant neoplasm with distinct histopathological features, considered to be a low-grade malignancy that usually occurs in elderly patients. Extensive local invasion is uncommon. Here we report a case of 90-year-old woman whose original presentation was as erythematous nasal skin nodules, biopsy of which showed a dermal tumor with features of sinonasal non-keratinizing SCC. No epidermal dysplasia was present. A subsequent computed tomography scan confirmed the presence of an endophytic tumor on the nasal sidewall. The initial presentation of sinonasal non-keratinizing SCC as a skin lesion is previously unreported to our knowledge. Diagnosis in this context requires accurate evaluation of the histopathology as well as a comprehensive knowledge of pathology specific to this anatomic location.

Topics: Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Humans; Keratins; Neoplasm Invasiveness; Paranasal Sinus Neoplasms; Skin; Skin Neoplasms

Sinonasal teratocarcinosarcoma is an uncommon, aggressive, morphologically heterogenous tumor composed of cells derived from the 3 somatic layers. A histogenetic origin from a multipotential adult somatic stem cell with divergent differentiation has been favored over a germ cell origin. This assumption has been based on the lack of germ cell elements and, until recently, the absence of demonstrable amplification of 12p. We report a case that exhibited foci of yolk sac elements with papillary structures and intracytoplasmic periodic acid-Schiff-positive, diastase-resistant, α-fetoprotein-positive, hyaline globules. An expanded area of undifferentiated cells, likely precursor cells, in the basal layer of the overlying mucosal epithelium transitions into and merges with the immature epithelial, neuroepithelial, and mesenchymal components. These previously unreported histomorphological features support the hypothesis that this tumor is a teratomatous tumor arising from pluripotent embryonic stem cells in the basal layer of the sinonasal epithelium. That notion is further supported by fluorescence in situ hybridization cytogenetic analysis, which showed a distinct subpopulation of the tumor cells with an extra copy of chromosome 12p13.

Topics: 12E7 Antigen; alpha-Fetoproteins; Antigens, CD; Biopsy; Carcinosarcoma; Cell Adhesion Molecules; Chromosome Duplication; Chromosomes, Human, Pair 12; Diagnosis, Differential; Female; Germ Cells; Humans; Hyalin; Immunohistochemistry; In Situ Hybridization, Fluorescence; Isochromosomes; Keratins; Middle Aged; Neoplasm Invasiveness; Paranasal Sinus Neoplasms; Paranasal Sinuses; Periodic Acid-Schiff Reaction; Teratoma; Yolk Sac

This case report describes the clinical, magnetic resonance imaging (MRI)-related, and pathologic features of a nasal acinic cell carcinoma in a cat. A 16-year-old, castrated male, oriental shorthaired cat, weighing 3.8 kg, was presented with history of sneezing, coughing, and nasal discharge persisting several months. Evaluation by MRI revealed an heterogeneous, space-occupying lesion that filled the left nasal cavity and was diagnosed by histopathologic examination as an acinic cell carcinoma arising from a minor salivary gland of the nasal cavity. Acinic cell carcinoma is a rare tumor in veterinary medicine. The tumor is composed mainly of cells resembling serous cells of salivary glands and originates from major or minor salivary glands. Clinicians and pathologists should be aware of the occurrence of acinic cell carcinoma in the sinonasal tract and include the tumor in the differential diagnosis of feline nasal diseases.

Topics: Animals; Carcinoma, Acinar Cell; Cats; Keratins; Magnetic Resonance Imaging; Male; Nasal Cavity; Paranasal Sinus Neoplasms; Salivary Glands, Minor

Topics: Adenocarcinoma; Biomarkers, Tumor; Carcinoma, Squamous Cell; Diagnosis, Differential; Hamartoma; Humans; Inflammation; Keratins; Nasal Mucosa; Nasopharyngeal Neoplasms; Papilloma, Inverted; Paranasal Sinus Neoplasms; Polyps; Teratoma

Salivary duct carcinoma (SDC) is an uncommon malignant tumor, characterized by aggressive behavior and poor prognosis. SDC usually arises from ductal epithelium of the major salivary glands, and it is quite infrequent elsewhere. We present a rare case of a 73-year-old man with SDC, which is possibly originated from the paranasal sinuses or the lacrimal system. Microscopic evaluation revealed that the tumor cells, with pleomorphic nuclei and abundant eosinophilic cytoplasm, formed cell nests and duct-like structure. A cribriform growth pattern was also seen. Immunohistochemical staining was positive for cytokeratins (CAM 5.2 and 34betaE12), gross cystic disease fluid protein 15 (GCDFP-15), and androgen receptor protein, while p63 and involucrin were negative. The patient already had multiple metastasis of the tumor in the lung at diagnosis, and he could not undergo definitive surgical procedures, because of severe restrictive lung disease. Although SDC in the sinonasal tract is quite rare, SDC should be in the differential diagnosis in these regions, due to its aggressive behavior and poor prognosis.

Topics: Aged; Biomarkers; Carcinoma; Diagnosis, Differential; Humans; Immunohistochemistry; Keratins; Male; Neoplasms, Second Primary; Paranasal Sinus Neoplasms; Prognosis; Salivary Ducts; Salivary Gland Neoplasms; Tomography, X-Ray Computed

The pathogenesis of respiratory epithelial adenomatoid hamartoma (REAH) and inverted papilloma (IP) is poorly understood, especially compared with sinonasal adenocarcinoma (SNAC). One feature of malignant glandular lesions is loss of the basal/myoepithelial layer. The immunophenotype of the basal/myoepithelial layer has not been fully examined in benign glandular lesions of the sinonasal tract.. To examine benign and malignant glandular lesions in the sinonasal tract for the immunophenotype of basal/myoepithelial cells, proliferation index, and cytokeratin and intestinal differentiation profiles.. Sinonasal adenocarcinoma (intestinal-type adenocarcinoma [ITAC] and nonintestinal type adenocarcinoma [non-ITAC]), REAH, IP, and chronic sinusitis (CS) were stained for cytokeratin (CK) 7, CK20, 34betaE12, CDX-2, p63, Ki-67, smooth muscle actin (SMA), S100 protein, and calponin.. Basal/myoepithelial cells in CS and REAH were positive for p63 and 34betaE12 but negative for SMA, S100 protein, and calponin. Proliferative activity was localized to the compartment containing p63-positive cells. Inverted papilloma demonstrated broad areas staining for p63 and 34betaE12, with intermediate proliferative activity in these areas. Sinonasal adenocarcinoma had the highest Ki-67 labeling index, and p63-positive SNACs had higher proliferation indices than p63-negative SNACs. REAH, IP, CS, and most SNACs expressed CK7. Only SNAC expressed CK20. Sixty percent of morphologic ITACs expressed CDX-2.. Basal/myoepithelial cells in CS and REAH should be considered basal and not myoepithelial cells. In benign lesions, proliferative activity is limited to the compartments with p63 staining. In SNAC and IP, p63 expression correlates with proliferation index. REAH, IP, and CS share similar immunoprofiles (CK7+, CK20-, and CDX-2-), contrasting with SNAC (CK7+, CK20+/-, CDX-2-/+).

Topics: Actins; Adenocarcinoma; Biomarkers, Tumor; Calcium-Binding Proteins; Calponins; CDX2 Transcription Factor; Cell Proliferation; Chronic Disease; Diagnosis, Differential; Epithelial Cells; Female; Hamartoma; Homeodomain Proteins; Humans; Immunohistochemistry; Immunophenotyping; Keratins; Ki-67 Antigen; Male; Membrane Proteins; Microfilament Proteins; Middle Aged; Papilloma; Paranasal Sinus Neoplasms; S100 Proteins; Sinusitis; Trans-Activators

To study the clinical, radiologic and pathologic features, as well as differential diagnosis of teratocarcinosarcoma in nasal cavity and paranasal sinuses.. Light microscopic examination and immunohistochemical study was performed in 5 cases of sinonasal teratocarcinosarcoma. The clinical, radiologic and pathologic features were analyzed and the literature was reviewed.. All 5 patients were males and their age ranged from 34 to 43 years (mean age = 39 years). The clinical presentation was nasal obstruction, epistaxis and headache. Physical examination often revealed a polypoid mass with contact bleeding. Computed tomography showed a homogeneous nasal mass with obturation of sinuses. Cystic changes, calcification or ossification was not observed. Histologically, the tumor showed a heterogeneous admixture of components from the 3 germ cell layers, exhibiting various degrees of maturation. Squamous epithelium, smooth muscle cells, chondro-osseous tissue, intestinal or respiratory type epithelium, "fetal-type" clear cells and immature neuroepithelium were commonly seen. Immunohistochemical study demonstrated that the epithelial component expressed cytokeratin and epithelial membrane antigen, while the mesenchymal component variably expressed vimentin, smooth muscle actin and S-100 protein. On the other hand, the neuroepithelial component expressed neuron-specific enolase, synaptophysin and chromogranin, and the primitive component expressed CD99. The initial biopsy diagnosis included capillary hemangioma, olfactory neuroblastoma, craniopharyngioma and malignant mixed tumor. Follow-up information was available in all patients. Two of which had local recurrence and 1 had cervical lymph node metastasis.. Sinonasal teratocarcinosarcoma is a rare and highly malignant tumor occurring in sinonasal tract. It manifests mainly in adult males and is characterized by a complex admixture of teratomatous and carcinosarcomatous components. "Fetal-type" clear cells, squamous epithelium and immature neuroepithelium represent important histologic characteristics useful in diagnosis.

Topics: Adult; Carcinosarcoma; Follow-Up Studies; Humans; Keratins; Lymphatic Metastasis; Male; Mucin-1; Nasal Cavity; Neck Dissection; Neoplasm Recurrence, Local; Nose Neoplasms; Paranasal Sinus Neoplasms; Radiography; Teratocarcinoma

Distinction of intestinal-type sinonasal adenocarcinoma (ITAC) from adenocarcinoma of intestinal origin metastatic to the sinonasal cavity may be extremely difficult on histologic grounds alone. We studied the role of cytokeratin (CK) and mucin (MUC) expression in differentiating ITAC, metastatic adenocarcinoma of intestinal origin, and non-intestinal-type sinonasal adenocarcinoma (non-ITAC).. We stained specimens from 5 cases of ITAC and 4 cases of non-ITAC, along with 4 colonic and 3 duodenal adenocarcinoma controls, with CK7 and CK20, MUC2 and MUC5, neuron-specific enolase (NSE), chromogranin (CHR), and carcinoembryonic antigen (CEA) in order to examine the possible combinations of markers that best aid in the diagnosis of these lesions. We also performed a retrospective review of our clinical experience with these rare lesions.. CK7 staining was positive in all ITAC and non-ITAC cases, whereas all cases displaying gastrointestinal-type differentiation (ITAC and metastatic intestinal cases) stained positive for both CK20 and MUC2. Staining for MUC5, NSE, CHR, and CEA was variable.. Tumors with the CK7+, CK20+, MUC2+ immunophenotype are likely primary sinonasal lesions, whereas tumors with the CK7-, CK20+, MUC2+ profile warrant further clinical evaluation to exclude metastatic disease from the gastrointestinal tract. Complete surgical resection of ITAC remains the mainstay of therapy.

Topics: Adenocarcinoma; Adult; Aged; Biomarkers, Tumor; Colonic Neoplasms; Diagnosis, Differential; Duodenal Neoplasms; Female; Humans; Immunohistochemistry; Keratin-20; Keratin-7; Keratins; Male; Middle Aged; Mucin-2; Mucins; Paranasal Sinus Neoplasms; Retrospective Studies

Topics: Actins; Adenocarcinoma, Papillary; Calcium-Binding Proteins; Calponins; Humans; Immunohistochemistry; Keratins; Male; Microfilament Proteins; Middle Aged; Muscle, Smooth; Nose Neoplasms; Paranasal Sinus Neoplasms; Salivary Gland Neoplasms

Because the histopathological features of some primary adenocarcinomas of the sinonasal tract may show considerable overlap, we assessed the diagnostic value of a panel of immunohistochemical markers in the distinction between these malignancies. Paraffin-embedded tumour tissue sections from a series of 39 primary adenocarcinomas of the sinonasal tract, including 25 cases of intestinal-type adenocarcinoma (ITAC), 10 cases of salivary gland-type carcinoma and 4 cases of tubulopapillary low-grade adenocarcinoma were immunostained for CDX-2, cytokeratin 7 and cytokeratin 20. Diffuse nuclear staining for CDX-2 was identified in 80% of ITACs, while all non-ITACs were negative. Staining for cytokeratin 20 was positive in 84% of ITACs, including all cases negative for CDX-2, but negative in all other adenocarcinomas. Cytokeratin 7 was consistently positive in 88% of ITACs and in 100% of non-ITACs. Normal sinonasal epithelia expressed cytokeratin 7, but not CDX-2 and cytokeratin 20. Staining for CDX-2 and cytokeratin 20 has potential use in separating ITACs from other primary malignant glandular neoplasms of the nasal cavities and paranasal sinuses.

Topics: Adenocarcinoma; Biomarkers, Tumor; CDX2 Transcription Factor; Cell Count; Diagnosis, Differential; Homeodomain Proteins; Humans; Immunoenzyme Techniques; Intermediate Filament Proteins; Keratin-20; Keratin-7; Keratins; Paranasal Sinus Neoplasms; Trans-Activators

Topics: Antigens, Neoplasm; Biomarkers; Carcinoembryonic Antigen; Epithelium; Humans; Immunohistochemistry; Keratins; Melanoma; Melanoma-Specific Antigens; Nasal Mucosa; Neoplasm Proteins; Paranasal Sinus Neoplasms; S100 Proteins; Skin Neoplasms

Nonsalivary sinonasal adenocarcinomas can be divided into low-grade and high-grade tumors. The former are often papillary and the latter are usually of intestinal type, morphologically similar to metastatic colonic carcinoma. Antibodies to CDX2, a transcription factor gene highly specific for intestinal adenocarcinomas, MUC2, a mucin gene expressed in adenocarcinomas from various sites, and cytokeratins (CK) 7 and 20 were used to examine the two groups of tumors. Formalin-fixed, paraffin-embedded tissue from 22 sinonasal adenocarcinomas was reclassified into 9 high-grade intestinal-type, 3 high-grade nonintestinal, and 10 low-grade, predominantly papillary adenocarcinomas. Immunohistochemical staining was graded on a 0 to 4+ scale with 5% or greater tumor cell staining considered positive. Of the high-grade intestinal group, 78% demonstrated 4+ CDX2 positivity, with 44% MUC2 positive. Although 89% of this group was CK7 positive, the percent of staining was variable. A majority (67%) of the intestinal cases was 4+ CK20 positive. Almost every nonintestinal adenocarcinoma (90%) (low- and high-grade) was CK7 positive (7 of 9, 4+), without expression of any of the three colonic adenocarcinoma markers. The three high-grade nonintestinal tumors had the expression profile of the low-grade papillary group with the exception of focal MUC2 positivity in 1 case. Intestinal-type adenocarcinomas have an expression profile distinct from nonintestinal sinonasal adenocarcinomas. The former are similar, but not identical, to colonic adenocarcinomas. Immunohistochemical staining for CDX2, MUC2, and differential cytokeratins does not differentiate metastatic colorectal from primary sinonasal intestinal-type adenocarcinoma.

Topics: Adenocarcinoma, Papillary; Adult; Aged; Biomarkers, Tumor; CDX2 Transcription Factor; Female; Homeodomain Proteins; Humans; Immunoenzyme Techniques; Immunophenotyping; Keratins; Male; Middle Aged; Mucin-2; Mucins; Paranasal Sinus Neoplasms; Trans-Activators

To evaluate the clinicopathological profile of 14 cases of nasal and paranasal sinusal adenocarcinoma, and to assess the usefulness of immunohistochemistry in the differential diagnosis of primary and metastatic intestinal-type adenocarcinoma.. Fourteen cases of nasal and paranasal adenocarcinoma, treated at IPOFG, Lisbon, between 1976 and 2002, were studied. Clinical records were reviewed and expression of cytokeratin (CK)7 and CK20 and of neuroendocrine markers was evaluated. The male : female ratio was 3 : 1, and the mean age of the patients was 65.3 years. Ten cases occurred in the paranasal sinuses. There was a history of professional exposure to dust in three patients. Twelve cases were high-grade intestinal type adenocarcinomas (ITAC) and two were low-grade. CK7 was present in 2/9 ITAC cases and CK20 in 8/9 ITAC and in cases of mixed and mucinous histology. All high-grade cases showed neuroendocrine differentiation. Seven of the 12 patients with high-grade adenocarcinoma died of the disease, with a mean follow-up of 47.4 months.. Nasal and paranasal adenocarcinoma mostly occurs in men in the 7th decade. ITAC is the most frequent histological type. The pattern of CK7/CK20 was not useful in the distinction between primary and metastatic intestinal adenocarcinoma. However, in the former, neuroendocrine differentiation proved to be a valuable tool in that distinction.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Chromogranin A; Chromogranins; Female; Follow-Up Studies; Humans; Immunohistochemistry; Intermediate Filament Proteins; Keratin-20; Keratin-7; Keratin-8; Keratins; Male; Middle Aged; Nose Neoplasms; Paranasal Sinus Neoplasms; Synaptophysin

Intestinal-type sinonasal adenocarcinoma (ITAC) is an uncommon neoplasm, which resembles adenocarcinoma of the gastrointestinal tract. ITAC occurs sporadically or in association with occupational exposure to hardwood dust and other agents.. To investigate the phenotype and possible pathogenetic mechanisms of primary sinonasal and nasopharyngeal adenocarcinomas by staining for cytokeratin 7 (CK7), CK20, CDX-2, and villin.. Twelve sporadic sinonasal and nasopharyngeal adenocarcinomas were stained with monoclonal antibodies to CK7, CK20, CDX-2, and villin. The ITACs were classified as papillary, colonic, solid, mixed, or mucinous types.. The diagnosis of ITAC was confirmed in 10 cases: five were colonic type and five were papillary. One was a sinonasal papillary low grade adenocarcinoma, and one a papillary nasopharyngeal adenocarcinoma, and these tumours were CK7 positive, but CK20, CDX-2, and villin negative. All ITACs were positive for CK20, CDX-2, and villin, and six were CK7 positive. One ITAC had a focus of intestinal metaplasia away from the invasive carcinoma.. Sinonasal ITACs have a distinctive phenotype, with all cases expressing CK20, CDX-2, and villin. Most ITACs also express CK7, although a proportion of tumours are CK7 negative. ITAC seems to be preceded by intestinal metaplasia of the respiratory mucosa, which is accompanied by a switch to an intestinal phenotype. Although ITACs are morphologically similar, differences in cytokeratin expression patterns suggest two distinct types. The expression pattern of CK7, CK20, CDX-2, and villin positive may be useful in separating these tumours from other non-ITAC adenocarcinomas of the sinonasal tract and nasopharynx.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Carrier Proteins; CDX2 Transcription Factor; Female; Homeodomain Proteins; Humans; Immunohistochemistry; Industry; Intermediate Filament Proteins; Intestinal Mucosa; Intestinal Neoplasms; Keratin-20; Keratin-7; Keratins; Male; Metaplasia; Microfilament Proteins; Middle Aged; Nose Neoplasms; Occupational Diseases; Paranasal Sinus Neoplasms; Trans-Activators; Wood

Topics: Aged; Carcinosarcoma; Fatal Outcome; Humans; Keratins; Male; Mucin-1; Neoplasm Invasiveness; Nose Neoplasms; Paranasal Sinus Neoplasms; Teratocarcinoma; Vimentin

Paranasal meningioma was diagnosed in a 5-year-old Appaloosa gelding. The mass occupied the right maxillary, frontal, and sphenopalatine sinuses but did not invade the calvarium. The diagnosis was based on histologic evaluation, positive immunohistochemical staining for vimentin and cytokeratin, and ultrastructural features including the presence of interdigitating spindle cells with numerous desmosomes.

Topics: Animals; Horse Diseases; Horses; Immunohistochemistry; Keratins; Male; Meningioma; Paranasal Sinus Neoplasms; Vimentin

Sinonasal undifferentiated carcinoma (SNUC) is a highly aggressive malignant neoplasm that is often difficult to distinguish from other poorly differentiated carcinomas arising in the sinonasal tract. To search for a differential cytokeratin (CK) expression that could be useful for diagnostic purposes, we compared the expression of a large panel of CKs in a series of 6 SNUCs, 10 poorly differentiated squamous cell carcinomas (SCCs), 10 nonkeratinizing squamous cell carcinomas (NKSCCs), and 5 nasopharyngeal-type undifferentiated carcinomas (NPTCs). SCC, NKSCC, and NPTC frequently showed immunoreactivity for CK5/CK6, CK8, CK13, and CK19. In addition, SCC and NKSCC expressed CK14, which was not detected in NPTC, and SCC expressed CK7 (60% of cases) and CK4 (30% of cases), which were absent in NKSCC and NPTC. Three NKSCCs were associated with a Schneiderian papilloma, and the results of the immunostaining were similar in the two components, with the exception of CK4 and CK7, which were expressed by the papilloma and not by the carcinoma. In contrast to other carcinomas, SNUC was characterized by the exclusive expression of CKs of simple epithelia, such as CK8 (100% of cases), CK7 (50% of cases), and CK19 (50% of cases). Thus, there are significant differences in the pattern of CK expression between SNUC, SCC, NKSCC, and NPTC, which could be of diagnostic aid. Moreover, these findings support the hypothesis that SNUC is a separate entity from SCC and NPTC of the sinonasal tract.

Topics: Adult; Biomarkers, Tumor; Carcinoma; Carcinoma, Squamous Cell; Female; Gene Expression Regulation, Neoplastic; Humans; Immunohistochemistry; Keratins; Male; Middle Aged; Nasopharyngeal Neoplasms; Nose Neoplasms; Paranasal Sinus Neoplasms

Cytokeratin (CK) expression was studied in 22 sinonasal inverted papillomas. Columnar (respiratory) epithelium in inverted papillomas abundantly expressed CK7, CK8, CK18, and CK19. Immunoreactivity for CK5/14 and CK17 was found in basal and parabasal/suprabasal cells. Transitional (cuboidal) and squamous epithelium in inverted papillomas comparably expressed CK7, CK8, CK18, and CK19. In addition CK13 was found in subluminal and surface cells. Immunoreactivity for CK5/14 and CK17 involved all layers of the epithelium. In nonpapillomatous nasal mucosa adjacent to inverted papillomas, CK expression in columnar (respiratory) epithelium exactly matched the findings in inverted papillomas. Transitional (cuboidal) and squamous epithelium in nonpaillomatous mucosa were negative for CK7, CK8, CK18, and CK19. CK13 was expressed in subluminal and surface cells. Immunoreactivity for CK5/14 and CK17 was restricted to basal and parabasal/suprabasal cells. Conclusively, transitional (cuboidal) and squamous epithelium in inverted papillomas but not in the adjacent mucosa coexpress CKs typical for columnar and squamous differentiation.

Topics: Adult; Aged; Cell Transformation, Neoplastic; Female; Humans; Immunohistochemistry; Keratins; Male; Middle Aged; Nasal Mucosa; Papilloma, Inverted; Paranasal Sinus Neoplasms

To report three patients with sinonasal undifferentiated carcinoma (SNUC) that invaded the orbit.. Retrospective small case series. The clinical, radiographic, and pathologic features of three patients with SNUC were reviewed.. Three patients with SNUC that invaded the orbit were evaluated. A biopsy was performed on the tumors, which were composed of small, hyperchromatic cells with numerous mitoses and areas of necrosis. Immunohistochemical staining was positive for cytokeratins AE1.3, epithelial membrane antigen, and neuron-specific enolase in all three tumors. Electron microscopic examination showed absence of neurosecretory granules and presence of basement membrane production. Two patients were treated with surgical resection and postoperative chemotherapy and/or radiation. One patient was treated with preoperative radiation and chemotherapy.. Sinonasal undifferentiated carcinoma is a high-grade tumor that arises in the nasal and paranasal sinuses and may invade the orbit. SNUC should be distinguished from other small, round, blue cell tumors, in particular, esthesioneuroblastoma.

Topics: Adult; Biomarkers, Tumor; Carcinoma; Female; Humans; Immunoenzyme Techniques; Keratins; Male; Maxillary Sinus Neoplasms; Middle Aged; Mucin-1; Neoplasm Invasiveness; Orbital Neoplasms; Paranasal Sinus Neoplasms; Phosphopyruvate Hydratase; Radiotherapy, Adjuvant; Retrospective Studies; Tomography, X-Ray Computed

We present 14 patients with primary sinonasal melanomas (SM) identified from 1984-1997 in our archives (11/14 lateral nose, 1/14 nasal septum, 2/14 paranasal sinuses; 8M/6F, mean age 67.7 years, range 39-88 years). Survival was poor (median 9 months) with death related to extensive local disease and/or widespread hematogenous metastases. The following histological subtypes were identified in descending order: amelanotic small blue cell, pleomorphic, epithelioid, spindle cell and myxoid. High mitotic rate and vascular invasion, absence of tumor-infiltrating lymphocytes and regression were features shared by all SM. Negative staining of B- and T-cell markers, LCA, neuroendocrine markers such as NSE, chromogranin and synaptophysin, and CK-negativity excluded olfactory neuroblastoma, small cell undifferentiated carcinoma, and lymphoma. S-100 protein was expressed in all SM, but demonstrated variable staining intensity with areas of complete negativity. HMB45 was strongly and uniformly (>80%) expressed in all undifferentiated small blue cell SM. The pigmented SM were predominantly HMB45-negative. The strong HMB45 staining in amelanotic small blue cell SM is explained by the reaction of HMB45 antibody with an oncofetal antigen found in immature melanosomes. In these poorly differentiated amelanotic malignant melanomas, antibody to HMB45 proved to be a superb diagnostic marker. We therefore strongly advocate the inclusion of HMB45 antibody in the panel of antibodies for initial work-up of undifferentiated mucosal neoplasms, since a negative S-100 stain in small biopsy material may result in incorrect classification of these neoplasms.

Topics: Adult; Aged; Aged, 80 and over; Antigens, Neoplasm; Female; Humans; Immunohistochemistry; Keratins; Male; Melanoma; Melanoma-Specific Antigens; Middle Aged; Neoplasm Proteins; Nose Neoplasms; Paranasal Sinus Neoplasms

Inverted papilloma is a benign sinunasal tumor, characterized by aggressive nature and tendency to recur. This tumor also has a significant malignant potential (10%). In spite of extensive research in the past the origin of inverted papilloma is not known.. A retrospective analysis of the clinical data of 28 patients suffering from inverted papilloma of the nose and paranasal sinuses with regard to symptoms, clinical examination, computed tomography findings, and operative management was performed. Furthermore, immunohistochemical examinations of the cytokeratin profile of 12 specimens were carried out.. The most presenting symptoms were unilateral nasal obstruction (17.61%) and rhinorrhea (7.25%). Polyposis was seen endoscopically in 19 cases (68%), so that in many patients in inverted papilloma became suspicious in the CT scan. The surgical therapy was dictated by the extent of the tumor, so that the tumor was treated by lateral rhinotomy (n = 17), midfacial degloving (n = 5), endonasal endoscopic surgery (n = 5), and craniofacial resection due to an infiltration of the frontal skull base (n = 1). An immunohistochemical analysis of the cytokeratin profile revealed for the first time that the inverted papilloma, when compared to the normal surface epithelium of the nasal cavity and the paranasal sinuses, exhibits increased expression of cytokeratin 5, typical for basal cells, and cytokeratin 13, typical for squamous epithelial cells.. Based on our results we recommend that the endonasal approach is reliable for processes restricted to the middle nasal meatus and the anterior and middle ethmoid cells. Inverted papilloma of the frontal sinus, retrobulbar and supraorbital ethmoid cells, and laterocaudal parts of the maxillary sinus should be resected via lateral rhinotomy or midfacial degloving. The findings of immunohistochemical examinations suggest that inverted papilloma is derived from a cytokeratin 5-immunoreactive cell of the basal layer of the mucosa.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Endoscopy; Female; Humans; Immunoenzyme Techniques; Keratins; Male; Middle Aged; Neoplasm Invasiveness; Nose; Nose Neoplasms; Papilloma, Inverted; Paranasal Sinus Neoplasms; Paranasal Sinuses; Tomography, X-Ray Computed

Undifferentiated carcinoma of the nasopharynx has a well-known association with Epstein-Barr virus (EBV), but only an inconsistent relationship has been identified in undifferentiated carcinomas occurring at other sites. We investigated 22 formalin-fixed, paraffin-embedded cases of sinonasal undifferentiated carcinomas (SNUCs) occurring in Western and Asian patients. A highly sensitive in situ hybridization method was performed using an antisense oligonucleotide probe to the EBER1 gene of EBV. We identified EBV RNA in seven of 11 SNUCs from Asian patients, but in none of the Western SNUC patients (0/11). The EBER1 signal was present in all or virtually all of the tumor cell nuclei in the seven EBV-RNA-positive Asian SNUCs. The latent membrane protein-1 (LMP1) of EBV was not identified in any of the five positive cases tested. Our results suggest that genetic predisposition or environmental/geographical cofactors play an important role in determining the strength of the association of SNUC with EBV.

Topics: Adult; Aged; Aged, 80 and over; Asian People; Carcinoma; Female; Herpesvirus 4, Human; Hong Kong; Humans; Immunohistochemistry; In Situ Hybridization; Keratins; Male; Membrane Glycoproteins; Middle Aged; Mucin-1; Nasal Cavity; Nose Neoplasms; Paranasal Sinus Neoplasms; Phosphopyruvate Hydratase; RNA, Viral; United States; White People

Twenty-one cases of anaplastic carcinoma of the nasal cavity and paranasal sinuses were diagnosed by conventional light microscopy and the use of monoclonal antibodies to epithelial membrane antigen and cytokeratin. Lymphomas and malignant melanomas were excluded by immunohistochemical staining for leukocyte common antigen and S100 protein respectively. The median survival time for these patients was only 1 year despite all forms of treatment. Two patients survived for a longer period and their cases had unusual pathologic features that may have influenced the prognosis.

Topics: Adult; Aged; Antibodies, Monoclonal; Antigens, Surface; Carcinoma; Carcinoma, Squamous Cell; Female; Histocompatibility Antigens; Histocytochemistry; Humans; Immunoenzyme Techniques; Keratins; Leukocyte Common Antigens; Male; Middle Aged; Nose Neoplasms; Paranasal Sinus Neoplasms; Prognosis; S100 Proteins; Staining and Labeling

Eight cases of a highly aggressive undifferentiated carcinoma of the nasal cavity and paranasal sinuses are described. The patients, who ranged in age from 30-77 years, had multiple sinonasal symptoms, and each had involvement of the nasal cavity, maxillary antrum, and ethmoid sinus. Six tumors extended into the orbital bones, and five penetrated the cranial cavity. Five patients died of disease from 1 to 41 months after diagnosis (median: 4 months), and three are alive with tumor less than 1 year following diagnosis. Microscopically, the neoplasms formed nests, trabeculae, and sheets containing medium-sized cells with small to moderate amounts of eosinophilic cytoplasm. A high mitotic rate, tumor necrosis, and prominent vascular permeation were characteristic. Seven neoplasms were immunoreactive for cytokeratin, five for epithelial membrane antigen, and four for neuron-specific enolase. Ultrastructurally, occasional small desmosomes and rare membrane-bound, dense-core granules were observed. Sinonasal undifferentiated carcinoma is a distinctive clinicopathologic entity that must be distinguished from other, less aggressive sinonasal neoplasms.

Topics: Adult; Aged; Carcinoma; Combined Modality Therapy; Ethmoid Sinus; Female; Follow-Up Studies; Humans; Keratins; Male; Maxillary Sinus Neoplasms; Membrane Proteins; Middle Aged; Mucin-1; Nasal Cavity; Neuroectodermal Tumors, Primitive, Peripheral; Nose Neoplasms; Orbital Neoplasms; Paranasal Sinus Neoplasms; Phosphopyruvate Hydratase

Two cases of squamous cell carcinoma with sarcoma-like stroma of the nose and paranasal sinuses are described. To the best of our knowledge, this is the first report of such a localization for this tumour type. Keratin was localized by immunocytochemistry in the epithelial cells, as well as in occasional stromal-like elements. The importance of distinguishing these tumours from morphologically similar neoplasms is emphasized in view of their different therapeutic approach.

Topics: Aged; Carcinoma, Squamous Cell; Histocytochemistry; Humans; Immunochemistry; Keratins; Male; Nose Neoplasms; Paranasal Sinus Neoplasms; Sarcoma

A case of fibromatosis occurring in the maxillary sinus 3 months after enucleation of an odontogenic keratocyst from that sinus is reported. This is believed to be the third reported case of fibromatosis in the maxilla and the first case occurring following the enucleation of an odontogenic keratocyst.

Topics: Adolescent; Fibroma; Humans; Keratins; Male; Maxillary Diseases; Maxillary Sinus; Odontogenic Cysts; Paranasal Sinus Neoplasms

Large cystic lesions of the maxillary sinus may initially manifest with malocclusion, cosmetic deformity, or both. Their origin may be odontogenic or nonodontogenic. Proper diagnosis of these cysts immeasurably aids in adequate (nonmutilating) treatment. A recent case of a calcifying and keratinizing odontogenic cyst that initially manifested as a facial mass exemplifies the need for adequate clinical and histological diagnosis to ensure appropriate treatment. Fewer than 35 cases have been reported since the original description in 1962.

Topics: Adult; Calcinosis; Humans; Keratins; Male; Maxillary Sinus; Odontogenesis; Odontogenic Cysts; Paranasal Sinus Neoplasms

The ultrastructural features of an odontogenic keratocyst are described. The results of the investigation suggest that the basal lamina complex in the odontogenic keratocyst appears to be morphologically normal. The frequently observed splitting of the epithelium from the capsular tissue is marked by the separation of the epithelium and the basal lamina complex from the connective tissue. The morphologic features of the parakeratinized surface zone of the epithelium suggest that the odontogenic keratocyst may be characterized by "incomplete" parakertinization.

Topics: Adult; Collagen; Connective Tissue; Epithelium; Humans; Keratins; Male; Maxillary Neoplasms; Maxillary Sinus; Odontogenic Cysts; Paranasal Sinus Neoplasms

Topics: Adolescent; Adult; Aged; Basement Membrane; Cell Division; Cell Nucleus; Child; Cilia; Cytoplasm; Epithelium; Female; Glycogen; Humans; Inclusion Bodies; Keratins; Male; Middle Aged; Mucus; Nasal Mucosa; Nasal Septum; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Papilloma; Paranasal Sinus Neoplasms; Paranasal Sinuses