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 natural killer/T-cell lymphoma and its association with type “i”/XhoI loss strain Epstein–Barr virus in Chile

“…Furthermore, the presence of type ''i''/XhoI loss might contribute to explain the intermediate incidence of nasal NK/T-cell lymphoma in Latin America, in between that in Western and in Asian regions. [14][15][16][17][18] The frequency of other genotypes, type 1 and wild-type F at the BamHI-F region in our patients were similar to that of patients with nasal NK/T-cell lymphoma described in Japan. 35 Even early stages have an overall survival rate lower than that in other extranodal or nodal lymphomas.…”

“…3 11-13 Among Latin American countries, previous studies show an incidence in between that in Western and in Asian countries. [14][15][16][17][18] Among the two major types of EBV, type 1 EBV is the predominant strain all over the world, with the exception of Africa, whereas type 2 EBV prevails. [19][20][21][22] Regarding the BamHI-F region, the prototype F has a worldwide distribution, but variant ''f'', featured by the presence of an extra BamHI site, is found only in China, where it is associated with nasopharyngeal carcinoma.…”

Primäre sinunasale Melanome

“…Lebensjahr diagnostiziert werden [19], tritt das primär sinunasale Melanom in einem höheren Lebensalter auf, das Durchschnittsalter liegt zwischen 60 und 70 Jahre [6,8,9,11,15,17,18,26,36,37,39,40,43,44]. Beim primären sinunasalen Melanom berichten zahlreiche Autoren über eine Androtropie [6,14,18,22,26,36,37,39,40], ein Autor stellte keinen Unterschied fest [38], andere Autoren wiederum beobachteten eine Gynäkotropie [8,9,11,33,44].Wir sahen mit 8 von 9 Patienten eine deutliche Prädisposition des männlichen Geschlechtes. Das Durchschnittsalter unserer Patienten war 62 Jahre (39-84 Jahre).…”

“…Als Risikofaktoren für die Entstehung eines sinunasalen Melanoms wurden Formaldehyd, Bestrahlung, Beschäftigung in der Glas, Leder oder Holz verarbeitenden Industrie sowie Umweltverschmutzung, Pestizide, Schwermetalle, Ölstaub und familiäre oder ethnische Einflüsse angeschuldigt, nicht jedoch Nikotin [4,5,8,9,12,16,18,27,28]. Direkte UV-Einwirkung kommt nicht in Betracht, eine allfällige systemische Wirkung einer Sonnenexposition auf das melanozytäre System der Nasen-und Nasennebenhöhlenschleimhaut wird widersprüchlich diskutiert [4,11,32].…”

“…Aus dermatologischer Sicht manifestiert sich das sinunasale Melanom durch unmittelbar sichtbares Vorwachsen im Bereich des Naseneingangs oder durch subkutane Vorwölbung am Nasenrücken [16,36,37,44].Weitere Hauptsymptome sind Nasenbluten und Behinderung der Nasenatmung [6,8,9,15,16,17,18,26,32,36,37,38,39,44].…”