Malignant neoplasms of the nasal cavity and paranasal sinuses: A series of 256 patients in Mexico City and Monterrey. Is air pollution the missing link?☆☆☆

Abstract

Air pollution is a serious health problem in major cities in Mexico. The concentrations of monitored criteria pollutants have been above the US National Ambient Air Quality Standards for the last decade. To determine whether the number of primary malignant nasal and paranasal neoplasms has increased, we surveyed 256 such cases admitted to a major adult oncology hospital located in metropolitan Mexico City (MMC) for the period from 1976-1997 and to a tertiary hospital in Monterrey, an industrial city, for the period from 1993-1998. The clinical histories and histopathologic material were reviewed, and a brief clinical summary was written for each case. In the MMC hospital the number of newly diagnosed nasal and paranasal neoplasms per year for the period from 1976-1986 averaged 5.1, whereas for the next 11 years it increased to 12.5. The maximal increase was observed in 1995-1997, with an average of 20.3 new cases per year (P = 0.0006). The predominant neoplasms in these series were non-Hodgkin's lymphoma, squamous cell carcinoma, melanoma, adenocarcinoma, Schneiderian carcinoma, and nasopharyngeal carcinoma. In the Monterrey hospital a 2-fold increase in the numbers of newly diagnosed nasal and paranasal neoplasms was recorded between 1993 and 1998. The predominant MMC neoplasm in this series, namely nasal T-cell/natural killer cell non-Hodgkin's lymphoma, is potentially Epstein-Barr virus related. Nasal and paranasal malignant neoplasms are generally rare. Environmental causative factors include exposure in industries such as nickel refining, leather, and wood furniture manufacturing. Although epidemiologic studies have not addressed the relationship between outdoor air pollution and sinonasal malignant neoplasms, there is strong evidence for the nasal and paranasal carcinogenic effect of occupational aerosol complex chemical mixtures. General practitioners and ear, nose, and throat physicians working in highly polluted cities should be aware of the clinical presentations of these patients. Identification of this apparent increase in sinonasal malignant neoplasms in two urban Mexican polluted cities warrants further mechanistic and epidemiologic studies.

Nasal Biopsies of Children Exposed to Air Pollutants

“…Therefore, air pollutants are also affecting the paranasal sinuses in children. A concept that should be kept in mind in this highly exposed population as we are seeing an apparent increase in nasal and paranasal malignancies in Mexico City adult residents (13).…”

“…Their nasal biopsies exhibit basal cell hyperplasia, squamous metaplasia, and mild dysplasias in addition to ultrastructural alterations including abnormal cilia and the presence of PM in heterolysosomal bodies in epithelial cells (14). Adults with signi cant outdoor daily exposures living in SWMMC show dysplastic nasal lesions with nuclear accumulation of p53 protein (10), and there is an apparent increase in nasal squamous cell carcinomas (SCC) in Mexico City adults (13). The principal objective of this study was to determine if children in SWMMC have nasal biopsies exhibiting nuclear accumulation of p53 protein by immunohistochemistry (IHC).…”

Management of Sinonasal Tumors: Prognostic Factors and Outcomes: A 10 Year Experience at a Tertiary Care Hospital

“…These tumors remain quite challenging to manage and, therefore, a multidisciplinary approach cannot be over-emphasized. Loco-regional treatment requires radiation along with surgery [21][22][23]. Also presence of an advanced T classification, bone or neural invasion, intracranial extension, dural or brain involvement, or positive margins require adjuvant radiation as part of a treatment modality [24].…”

Prevalence of occupational hazards in patients with different types of epithelial sinonasal cancers

“…It is very important to locate the primary site of the tumours properly, since the frequency of various anatomical sites of onset differs considerably between the various types of sinonasal cancer: the most common histotype in the maxillary sinus is The nasal cavity is the most common portal of entry and a wellknown target site for a wide range of pollutants and chemically induced carcinogenicity (8) . Occupational factors are responsible for a huge proportion of epithelial SNC besides other established congenital or acquired risk factors such as previous radiotherapy in the region and tobacco smoking (9) , chromosomal and genetically determined alterations (10,11) , inverted papilloma (12) .…”