Ethmoido-Orbital Tumors: Our Experience

Iannetti, Giorgio; Valentini, Valentino; Rinna, Claudio; Ventucci, E; Marianetti, Tito Matteo

doi:10.1097/01.scs.0000164332.81428.ba

Cited by 67 publications

(54 citation statements)

References 31 publications

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“…p16 overexpression was seen in all of our cases (luminal nuclear and cytoplasmic reaction; stronger cytoplasmic reaction than in those cases that had associated pleomorphic adenoma), but does not necessarily imply biologically integrated HPV as a potential etiology, as it does with oropharyngeal carcinoma [12]. None of the cases tested contained high-risk HPV (which includes 16,18,31,33,35,39,45,51,52,56,58, and 66) by in situ hybridization, different from a recent series reporting the presence of HPV 33 specifically [141].…”

Section: Immunohistochemical Studiesmentioning

confidence: 58%

Sinonasal Tract and Nasopharyngeal Adenoid Cystic Carcinoma: A Clinicopathologic and Immunophenotypic Study of 86 Cases

Thompson

Penner

Ho³

et al. 2013

Head and Neck Pathol

119

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'Primary sinonasal tract and nasopharyngeal adenoid cystic carcinomas (STACC) are uncommon tumors that are frequently misclassified, resulting in inappropriate clinical management. Eighty-six cases of STACC included 45 females and 41 males, aged 12-91 years (mean 54.4 years). Patients presented most frequently with obstructive symptoms (n = 54), followed by epistaxis (n = 23), auditory symptoms (n = 12), nerve symptoms (n = 11), nasal discharge (n = 11), and/or visual symptoms (n = 10), present for a mean of 18.2 months. The tumors involved the nasal cavity alone (n = 25), nasopharynx alone (n = 13), maxillary sinus alone (n = 4), or a combination of the nasal cavity and paranasal sinuses (n = 44), with a mean size of 3.7 cm. Patients presented equally between low and high stage disease: stage I and II (n = 42) or stage III and IV (n = 44) disease. Histologically, the tumors were invasive (bone: n = 66; neural: n = 47; lymphovascular: n = 33), composed of a variety of growth patterns, including cribriform (n = 33), tubular (n = 16), and solid (n = 9), although frequently a combination of these patterns was seen within a single tumor. Pleomorphism was mild with an intermediate N:C ratio in cells containing hyperchromatic nuclei. Reduplicated basement membrane and glycosaminoglycan material was commonly seen. Necrosis (n = 16) and atypical mitotic figures (n = 11) were infrequently present. Pleomorphic adenoma was present in 9 cases; de-differentiation was seen in two patients. Immunohistochemical studies showed positive reactions for pan-cytokeratin, CK7, CK5/6, CAM5.2, and EMA, with myoepithelial reactivity with SMA, p63, calponin, S100 protein and SMMHC. CD117, CEA, GFAP and p16 were variably present. CK20 and HR HPV were negative. STACC needs to be considered in the differential diagnosis of most sinonasal malignancies, particularly poorly differentiated carcinoma, olfactory neuroblastoma and pleomorphic adenoma. Surgery (n = 82), often accompanied by radiation therapy (n = 36), was generally employed. A majority of patients developed a recurrence (n = 52) 2-144 months after initial presentation. Overall mean follow-up was 19.4 years (range 0.4-37.5 years): 46 patients died with disease (mean 6.4 years); 5 were alive with disease (mean 5.4 years), and 35 patients were either alive or had died of unrelated causes (mean 16.3 years). ACC of the SNT is uncommon. Recurrences are common. The following parameters, when present, suggest an increased incidence of either recurrence or dying with disease: mixed site of involvement, high stage disease (stage IV), skull base involvement, tumor 123Head and Neck ) 8:88-109 DOI 10.1007 recurrence, a solid histology, perineural invasion, bone invasion, and lymphovascular invasion.

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Section: Immunohistochemical Studiesmentioning

confidence: 58%

Sinonasal Tract and Nasopharyngeal Adenoid Cystic Carcinoma: A Clinicopathologic and Immunophenotypic Study of 86 Cases

Thompson

Penner

Ho³

et al. 2013

Head and Neck Pathol

119

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“…In our study, all patients who presented with bone wall erosion and extraconal fat invasion underwent orbital preservation and achieved satisfactory outcomes (Table ). We followed the classification proposed by Iannetti et al in this report. Using this classification, both survival analyses showed that orbital invasion in grade III was associated with the worst survival outcomes.…”

Section: Discussionmentioning

confidence: 99%

Management of orbital invasion in sinonasal squamous cell carcinoma: 15 years’ experience

Tian

Zhu

et al. 2019

Int Forum Allergy Rhinol

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Background This study was intended to review our management strategy for sinonasal squamous cell carcinomas (SNSCCs) with orbital invasion and to explore the role of radiotherapy in orbital preservation. Methods We retrospectively analyzed 93 SNSCC patients with orbital invasion who underwent radiotherapy with or without surgery over the past 15 years. The degree of orbital invasion was classified into 3 grades. Results Eighty‐eight patients presented with T4 tumors and 36 had grade III orbital invasion. Seventy‐two patients received surgery plus radiation and 67 received platinum‐based chemotherapy. The median follow‐up for surviving patients was 60 months. Five‐year overall survival (OS) for the whole group was 57.4%. The patients treated with surgery plus radiation had a 5‐year survival rate of 62.2% and orbital preservation was feasible in 90.3% of cases. Twenty‐one patients with SNSCCs that extended into the extraocular muscles or eye globe also underwent orbital preservation. Five‐year locoregional relapse‐free survival (LRFS) was 69.5% for patients treated with orbital preservation and 57.1% for those treated with orbital exenteration, indicating no statistical difference. Five‐year survival, 5‐year progression‐free survival (PFS), and 5‐year distant metastasis‐free survival (DMFS) were similar between groups. Grade III orbital invasion was independently associated with shorter OS, LRFS, PFS, and DMFS. Conclusion Orbital invasion in grade III was associated with the worst survival outcomes. Invasion of either the extraocular muscles or eye globe is not a contraindication for eye‐sparing surgery. Preoperative chemoradiation continues to offer hope to patients with a strong desire to preserve their eyes.

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“…Iannetti et al [25] staged orbital invasion in three stages: stage I: medial orbital wall erosion and destruction; stage II: tumor invasion of orbital fat; stage III: invasion of medial rectus muscle, optic nerve, ocular bulb or eyelid skin. Histological studies have shown that tumor invasion is limited to the periorbit so orbital exenteration is recommended only in stage III [8].…”

Section: Orbital Preservation In Malignant Tumorsmentioning

confidence: 99%

Endonasal Endoscopic Approach for Primary and Secondary Orbital Lesions

Garcia¹,

Pérez²,

Perdomo³

et al. 2017

J Clin Exp Ophthalmol

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Purpose: To describe the results of endonasal endoscopic resection for primary and secondary orbital lesions.Design: A retrospective cohort study was performed. Subjects:The clinical data of patients with primary and secondary orbital tumors who received treatment with endonasal endoscopic surgery from Agost 2016 to July 2017 in the Department of Head and Neck Surgery of the National Institute of Oncology and Radiobiology (Cuba) were analysed.Intervention: All surgeries were performed by using Karl Storz 00, 450 and 700, 4 mm diameter; 18 cm rod-lens rigid telescopes (Karl Storz and Co, Tuttlingen, Germany). Endonasal endoscopic transethmoidal route was the primary approach, and according to the tumor size, histology and location, a transantral route was aggregate. Main outcome measures:Demographic data, histology nature of the lesions, clinical presentation, surgical route, frozen section margins and complications relative to treatment were obtained. Grade of resection was measured.Results: From total of 12 patients that were interview, 7 were male and 5 female. Age range was 20-70 years and a mean age of 50.2 years. According to nature of the lesions, seven patients have malignant neoplasm and three patients have non-neoplasic disorders. Transethmoidal route was performed in 4 patients and transethmoidal/ transantral in 8 patients. Total resection was achieved in 11 patients (92%). Frozen section margins were negative in all patients. All patients experienced complete resolution of the presenting symptoms with no evidence of optic nerve injury. Two patients presented transient ophtalmoparesis. Conclusion:Endonasal endoscopic surgery is a safe, successful and minimally invasive technique for resecting extra-intraconal primary and secondary orbital tumors; especially those arise posterior to the ocular glove and inferomedially of optic nerve. There are some important key points to take account in order to prevent complications.

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Ethmoido-Orbital Tumors: Our Experience

Cited by 67 publications

References 31 publications

Sinonasal Tract and Nasopharyngeal Adenoid Cystic Carcinoma: A Clinicopathologic and Immunophenotypic Study of 86 Cases

Sinonasal Tract and Nasopharyngeal Adenoid Cystic Carcinoma: A Clinicopathologic and Immunophenotypic Study of 86 Cases

Management of orbital invasion in sinonasal squamous cell carcinoma: 15 years’ experience

Endonasal Endoscopic Approach for Primary and Secondary Orbital Lesions

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