上海交通大學(xué)耳鼻咽喉科學(xué)英文版課件 tumor of nasal cavity and paranasal sinuses

TumorofNasalcavityandParanasalsinusesDepartmentofOtolaryngology,AffiliatedNinthPeople’sHospitalofShanghaiJiaotongUniversity,SchoolofMedicine

WangPeihuaTumorofNasalcavityandPar1

BenignTumorofNasalcavityandParanasalsinuses

BenignTumorofNasalcavity2Papilloma（p107)etiologyunknownhumanpapillomavirus,HPVPapilloma（p107)3Pathology:Hardtype

1small,hard,gray,local,single,mulberry-shaped

2usuallylocatedinnasalvestibule,anteriornasalseptum,hardpalate

3squamousepitheliumPathology:4Softtypecomparativelylarge,soft,red,diffusegrowth,withpedicle/widebase.SchneiderianmembraneInvertingpapilloma①recurrenttendency②malignantchange③multiplegrowthandhistoclasiaSofttype5Clinicalmanifestation>40y,male>femaleUnilateralPersistent,progressivenasalobstructionmucopurulentdischarge,sometimeswithbloodHeadacheanddysosmiaRhinosinusitisandnasalpolypsClinicalmanifestation>40y,ma6Examinationwithdifferentsizeandhardness,Polypoid,red-gray,scobinate,easy-bleeding,usuallylocatedinnasalwall.Examination7Treatment

radicalresectionlateralrhinotomy/sublabrumapproach,Maxillectomy+ethmoidotomy(ifnecessary)

EndoscopicSinusSurgery.Treatment8

MalignantTumorofNasalcavityandParanasalsinuses（p109）

MalignantTumorofNasalcavi9Statistics:ENT:20%intotalMalignantTumor.NasalandsinonasalMT:21.74%--49.22%inENTMT.Male:female=3∶1，predilectionage:40～60y.Statistics:10Features:predilectionsiteismaxillarysinus(60～80%),1/3withethmoidsinusMT.

ethmoidsinus>frontalsinus>sphenoidsinus.primarytumor>>metastatictumor.advancedstage>primarystageinvasionofadjacenttissue(orbit,skullbase)Features:11Etiologicalfactor

ImmunocompromiceStimulationofchronicinflammationCancerationofbenigntumorExposuretooncogensEtiologicalfactorImmunocompr12PathologySCC(35%-66%)，other:adenocarcinoma(onlyinparanasalsinuses),lymphoepithelialcarcinoma,transitionalepithelioma,BCC,sarcoma.Carcinoma>Sarcoma(3.5-9.6:1).

Mostofsarcomaismalignantlymphoma(>60%).PathologySCC(35%-66%)，other:a13clinicalmanifestation1．Nasalobstruction2．Epistaxisorhemicsecretionclinicalmanifestation14Carcinomaofmaxillarysinusanterointernal：odonticsymptomsinearlystage,prognosis↑anteroexternal：posterointernal：→orbit/skullbase,prognosis↓↓posteroexternal：→orbit/parszygomatica,prognosis↓Carcinomaofmaxillarysinusan15Carcinomaofmaxillarysinus

Clinicalmanifestation:1.Unilateralnasaldischargewithpusandblood2.Unilateralacheandnumbnessofbuccalregion3.Unilateralprogressivenasalobstruction4.UnilateralOdontalgiaandodontcseisisofsuperiorteethCarcinomaofmaxillarysinusC16Carcinomaofmaxillarysinus1.Oncoidesofbuccalregion2.Eyesymptom3.Oncoidesofhardpalate4.Difficultinopeningmouth5.Basicranialinvasion6.CervicallymphnodemetastasisClinicalmanifestationofadvancedstage:

Carcinomaofmaxillarysinus1.17Carcinomaofethmoidsinusmedialorbitalwall→

proptosis,displacementofglobe→diplopia,hypopsia,swelling/diabrosisofendocanthion/nasalrootUsuallycausedbyCarcinomaofmaxillarysinus,minorityisprimary(epithelioma/sarcoma).Carcinomaofethmoidsinusmedi18

localsorepain,epistaxis,oncoidesofforeheadandsuperior/innerorbitalmargin,displacementofglobeCarcinomaoffrontalsinuslocalsorepain,epista19CarcinomaofsphenoidsinusPrimarysecondaryCarcinomaofsphenoidsinusPri201.Casehistoryandsigns:40y,unilateral2.Anterior-posteriornasalcavityexamination:neoplasm,diabrosis,necrotictissue,bleeding.Posteriorrhinoscopy3.NasalendoscopyDiagnosis1.Casehistoryandsigns:40y214.Imagingdetection:X-ray,CTscan,MRI

andsoon.5.Biopsy6.TNMclassification（UICC,1997)4.Imagingdetection:X-ray,C22Treatmentkeypoint-firsttimetreatment

①chemotherapy/radiotherapy+surgery②surgery+chemotherapy/radiotherapyCombinedmodalitytherapy(basedonsurgery)TreatmentCombinedmodalityth23modusoperandi:1.lateralrhinotomy(Moureincision)2.totalmaxillectomy(Weber-Fergussonincision)3.“T”incisioninnasalroot(Presingerincision)4.externalfrontalsinusotomy(Lynchincision)5.sublabialapproach(Denkerincision)6.binedcraniofacialapproach

modusoperandi:24

Radiotherapy:Simpleradicalradiationtherapy—sarcoma,undifferentiatedcarcinoma

palliativeradiationtherapy—advancedstagePreoperativeradicalradiationtherapy--60Cobalt,linearaccelerator,4-6weeks,50-60Gy.Chemotherapy:

Radiotherapy:25TumorofNasalcavityandParanasalsinusesDepartmentofOtolaryngology,AffiliatedNinthPeople’sHospitalofShanghaiJiaotongUniversity,SchoolofMedicine

WangPeihuaTumorofNasalcavityandPar26

BenignTumorofNasalcavityandParanasalsinuses

BenignTumorofNasalcavity27Papilloma（p107)etiologyunknownhumanpapillomavirus,HPVPapilloma（p107)28Pathology:Hardtype

1small,hard,gray,local,single,mulberry-shaped

2usuallylocatedinnasalvestibule,anteriornasalseptum,hardpalate

3squamousepitheliumPathology:29Softtypecomparativelylarge,soft,red,diffusegrowth,withpedicle/widebase.SchneiderianmembraneInvertingpapilloma①recurrenttendency②malignantchange③multiplegrowthandhistoclasiaSofttype30Clinicalmanifestation>40y,male>femaleUnilateralPersistent,progressivenasalobstructionmucopurulentdischarge,sometimeswithbloodHeadacheanddysosmiaRhinosinusitisandnasalpolypsClinicalmanifestation>40y,ma31Examinationwithdifferentsizeandhardness,Polypoid,red-gray,scobinate,easy-bleeding,usuallylocatedinnasalwall.Examination32Treatment

radicalresectionlateralrhinotomy/sublabrumapproach,Maxillectomy+ethmoidotomy(ifnecessary)

EndoscopicSinusSurgery.Treatment33

MalignantTumorofNasalcavityandParanasalsinuses（p109）

MalignantTumorofNasalcavi34Statistics:ENT:20%intotalMalignantTumor.NasalandsinonasalMT:21.74%--49.22%inENTMT.Male:female=3∶1，predilectionage:40～60y.Statistics:35Features:predilectionsiteismaxillarysinus(60～80%),1/3withethmoidsinusMT.

ethmoidsinus>frontalsinus>sphenoidsinus.primarytumor>>metastatictumor.advancedstage>primarystageinvasionofadjacenttissue(orbit,skullbase)Features:36Etiologicalfactor

ImmunocompromiceStimulationofchronicinflammationCancerationofbenigntumorExposuretooncogensEtiologicalfactorImmunocompr37PathologySCC(35%-66%)，other:adenocarcinoma(onlyinparanasalsinuses),lymphoepithelialcarcinoma,transitionalepithelioma,BCC,sarcoma.Carcinoma>Sarcoma(3.5-9.6:1).

Mostofsarcomaismalignantlymphoma(>60%).PathologySCC(35%-66%)，other:a38clinicalmanifestation1．Nasalobstruction2．Epistaxisorhemicsecretionclinicalmanifestation39Carcinomaofmaxillarysinusanterointernal：odonticsymptomsinearlystage,prognosis↑anteroexternal：posterointernal：→orbit/skullbase,prognosis↓↓posteroexternal：→orbit/parszygomatica,prognosis↓Carcinomaofmaxillarysinusan40Carcinomaofmaxillarysinus

Clinicalmanifestation:1.Unilateralnasaldischargewithpusandblood2.Unilateralacheandnumbnessofbuccalregion3.Unilateralprogressivenasalobstruction4.UnilateralOdontalgiaandodontcseisisofsuperiorteethCarcinomaofmaxillarysinusC41Carcinomaofmaxillarysinus1.Oncoidesofbuccalregion2.Eyesymptom3.Oncoidesofhardpalate4.Difficultinopeningmouth5.Basicranialinvasion6.CervicallymphnodemetastasisClinicalmanifestationofadvancedstage:

Carcinomaofmaxillarysinus1.42Carcinomaofethmoidsinusmedialorbitalwall→

proptosis,displacementofglobe→diplopia,hypopsia,swelling/diabrosisofendocanthion/nasalrootUsuallycausedbyCarcinomaofmaxillarysinus,minorityisprimary(epithelioma/sarcoma).Carcinomaofethmoidsinusmedi43

localsorepain,epistaxis,oncoidesofforeheadandsuperior/innerorbitalmargin,displacementofglobeCarcinomaoffrontalsinuslocalsorepain,epista44CarcinomaofsphenoidsinusPrimarysecondaryCarcinomaofsphenoidsinusPri451.Casehistoryandsigns:40y,unilateral2.Anterior-posteriornasalcavityexamination:neoplasm,diabrosis,necrotictissue,bleeding.Posteriorrhinoscopy3.NasalendoscopyDia