phenylephrine-hydrochloride and Neuroectodermal-Tumors--Primitive--Peripheral

Aesthesioneuroblastoma is an uncommon tumour of the superior nasal cavity, originating from the olfactory mucosa. Usually no specific radiological features indicate the diagnosis; normally these tumours are seen on CT as homogeneous, enhancing, soft tissue masses causing bone remodelling. Typical but quite nonspecific MRI findings include high signal on T2-weighted images and strong enhancement after gadolinium. The extent of tumour in the paranasal sinuses and anterior cranial fossa is best assessed with MRI after intravenous gadolinium, and this is considered as the most accurate method for assessing preoperative resectability. We report an aesthesioneuroblastoma in an atypical location, with extensive calcification.

Topics: Adolescent; Biopsy; Combined Modality Therapy; Ethmoid Sinus; Humans; Magnetic Resonance Imaging; Male; Maxillary Sinus; Maxillary Sinus Neoplasms; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Tomography, X-Ray Computed

Forty-nine patients with esthesioneuroblastoma were treated at the Mayo Clinic between 1951 and 1990. Their clinical manifestations and treatment results were reviewed to identify possible prognostic factors. The 5-year survival rate for all patients was 69%. Tumor progression occurred in 25 patients (51%; no local control in 6 and local recurrence in 19). Metastasis was found in 15 patients (31%; regional in 10 and distant in 9). Nineteen patients died directly from metastatic or intracranial tumor extension. The pathological grade of the tumor was the most significant prognostic factor identified. The 5-year survival rate was 80% for the low-grade tumors and 40% for the high-grade tumors (P = 0.0001). Surgical treatment alone is effective for low-grade tumors if tumor-free margins can be obtained. Radiation is used for low-grade tumors when margins are close, for residual or recurrent disease, and for all high-grade cancers. The poor prognosis associated with high-grade tumors may also mandate the addition of chemotherapy. Recurrent tumor and regional metastasis should be treated aggressively because this approach has been shown to be worthwhile. A craniofacial resection is now the surgical procedure performed in all cases. Because recurrence can occur after 5 or even 10 years, long-term follow-up is mandatory.

Topics: Adolescent; Adult; Aged; Brain; Brain Neoplasms; Chemotherapy, Adjuvant; Child; Child, Preschool; Combined Modality Therapy; Cranial Irradiation; Craniotomy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Prognosis; Radiotherapy Dosage

Midfacial degloving can be characterized as an alternative surgical approach for exposing the bony structures of the midface. In combination with transient partial osteotomies the nasal cavities, the paranasal sinuses, the pterygopalatine fossa and the posterior parts of the anterior skull base are easily accessible. Using an intercartilaginous, a transseptal and a circumvestibular incision in the nose and a vestibular incision in the oral cavity the soft tissues of the upper face are mobilized and transposed cranially up to the infraorbital rim, the nasion and the lacrimal sac. Thus one can avoid scar formations in the face. In comparison with the common visible incisions in the face a bilateral exposure of midline structures is possible. The resected bone can be easily replaced and fixed with titanium miniplates for osteosynthesis. The soft tissue glove is replaced. A correct suture technique for readaptation especially in the nasal cavity is most important to avoid a circular stenosis of the nasal aperture. Between 1986 and 1991, 40 patients with various tumors (juvenile angiofibroma, inverted papilloma, esthesioneuroblastoma, squamous cell carcinoma of the maxillary sinus, benign tumors of the pterygopalatine fossa, clivus chordoma) underwent this procedure. Neoplasms and fractures of the anterior frontal skull base, the frontal sinus, the orbital cavity and the zygoma were less accessible due to the unsatisfactory exposure of these regions. Complications and side effects were rare. In five cases, a transient paresthesia of the infraorbital nerve and a facial edema were observed. In one case, a circular stenosis of the nasal aperture required a second plastic procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenoma; Carcinoma; Fibroma; Hemangioma; Humans; Melanoma; Neoplasm Staging; Neurilemmoma; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Paranasal Sinuses; Plasmacytoma; Postoperative Complications; Precancerous Conditions

Topics: Animals; Biomarkers, Tumor; Dog Diseases; Dogs; Male; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms

Ethmoid sinus neoplasms have traditionally been associated with a poor prognosis. Their advanced stage at presentation and proximity to vital structures have made them difficult to treat. Bilateral ethmoidal tumors impinging on or actively infiltrating the cribriform plate have been particularly resistant to cure. We have used the superior rhinotomy in conjunction with a bifrontal craniotomy in three patients to effect an en bloc resection of both ethmoid labyrinths and cribriform plate in an oncologically acceptable fashion.

Topics: Adenocarcinoma; Craniotomy; Ethmoid Bone; Ethmoid Sinus; Humans; Male; Methods; Middle Aged; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Paranasal Sinus Neoplasms; Postoperative Complications

Malignant tumours of the nasal cavity and paranasal sinuses are uncommon amounting to 0.3-1% of all tumours and 3%-5% of carcinomas of the upper respiratory tract. Modern diagnostic techniques include endoscopy and computer tomography. Prognosis and therapy depend on the histological type, site of origin and extent of the tumour. The variety of possible treatment modalities demands individual therapy planning. A combined surgical and radiotherapeutic approach, possibly supplemented by small volume intracavitary brachytherapy or polychemotherapy in some defined histological tumour types, has been generally accepted, enabling a five year survival rate of 35%-45% to be achieved. The causes for failure are firstly local persistence of tumour (18%) or a local recurrence (37%). The cumulative recurrence rate after one and two years was 76% and 95% respectively. Late recurrences occur in 2.5% of cases. The complication rate with combined-modality therapy reaches 27% with minor complications occurring in 12% and major complications in 15% especially affecting the irradiated homolateral eye. The present statistical results show a number of weak points that cast doubt on their validity. We recommend a controlled, prospective, randomised, multi-centre and multi-disciplinary study to define the prognostic parameters for tumours of the paranasal sinuses and to choose the most effective, individually tailored therapy.

Topics: Adenocarcinoma; Carcinoma, Squamous Cell; Combined Modality Therapy; Endoscopy; Humans; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Paranasal Sinuses; Prognosis; Tomography, X-Ray Computed

Topics: Adult; Female; Humans; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms

Topics: Adult; Bleomycin; Cobalt Radioisotopes; Humans; Male; Nasal Cavity; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Radioisotope Teletherapy; Radiotherapy, High-Energy

Topics: Adolescent; Angiography; Follow-Up Studies; Humans; Male; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Radiotherapy Dosage

Topics: Carcinoma, Squamous Cell; Cystadenoma; Epithelial Cells; Epithelium; Humans; Melanocytes; Melanoma; Nasopharyngeal Neoplasms; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Papilloma

Topics: Adolescent; Biopsy; Blepharoptosis; Blood Transfusion; Female; Humans; Maxillary Sinus; Neoplasm Metastasis; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Palate; Radiography; Skull

Topics: Animals; Biological Evolution; Brain Neoplasms; Cats; Central Nervous System Diseases; Cerebral Arteries; Cerebral Cortex; Craniocerebral Trauma; Diagnosis, Differential; Electroencephalography; Encephalocele; Endocrine System Diseases; Female; Genital Diseases, Female; Genital Diseases, Male; Haplorhini; Humans; Hypothalamus; Limbic System; Lymphatic Metastasis; Male; Manometry; Neoplasm Metastasis; Neural Conduction; Neuroectodermal Tumors, Primitive, Peripheral; Neurons; Nose; Nose Neoplasms; Olfaction Disorders; Olfactory Mucosa; Olfactory Nerve; Rabbits; Sensory Receptor Cells; Smell

Topics: Animals; Brain Neoplasms; Carcinoma, Squamous Cell; Epithelium; Ethers; Hydrocarbons, Halogenated; Lung; Lung Neoplasms; Neoplasm Metastasis; Neoplasms, Experimental; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Occupational Diseases; Paranasal Sinus Neoplasms; Rats; Respiratory Tract Neoplasms

Topics: Adult; Female; Humans; Male; Middle Aged; Neuroectodermal Tumors, Primitive, Peripheral; Nose; Nose Neoplasms; Staining and Labeling