Pathology

The sinonasal region offers a great histological diversity of tumours. Of these, squamous cell carcinoma remains the commonest. Late presentation may make it difficult to define the exact site of origin. Generally, the maxillary sinus is regarded as the usual site, though lesions frequently arise in the lateral wall of the nasal cavity and eth-moids. The primary malignant tumours of the frontal and sphenoid sinuses are extremely rare.

The nasal cavity and sinuses are intimately related to the orbit and skull base (anterior and middle cranial fossae)—areas into which the tumours may spread early and covertly. In addition, anterior spread into the soft tissues of the face, posterior involvement of the pterygoid region and nasopharynx, and inferior spread to the oral cavity may all be encountered, generally along the routes of least resistance. Distant lymphatic and haematogenous spread are rare in the early stages of the disease and patients more often die of local disease before secondary spread is apparent.

Table 24.3 Sinonasal malignancy

Epithelial

Malignancy

Epidermoid/squamous

Carcinoma (spindle cell, verrucous, transitional)

Non-epidermoid

Adenoid cycstic carcinoma

Adenocarcinoma

Mucoepidermoid carcinoma

Acinic cell carcinoma

Metastases

Neuroectodermal

Malignant melanoma

Olfactory neuroblastoma

Mesenchymal

Vascular

Angiosarcoma

Kaposi's carcoma

Haemangiopericytoma

Muscular

Leiomyosarcoma

Rhabdomyosarcoma

Cartilaginous

Chondrosarcoma (mesenchymal)

Osseous

Osteogenic sarcoma

Lymphoreticular

Burkitt's lymphoma

Non-Hodgkin's lymphoma

Extra-medullary plasmacytoma

Midline destructive lesions

Miscellaneous

Fibrosarcoma

Liposarcoma

Malignant fibrous histiocytoma

Ewing's sarcoma

Alveolar soft part sarcoma

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