Objective: To investigate the clinicopathological features and differential diagnosis of olfactory carcinoma (OC). Methods: Twenty-one cases of sinonasal tumors, including those initially diagnosed as olfactory neuroblastoma (ONB) and those with uncertain diagnosis, were collected from the Department of Pathology, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) from January 2016 to August 2022, among which 3 cases were reclassified as OC. The clinicopathological features were investigated, and the remaining 18 cases were used as control. Results: Of the three OC patients, 2 were male and 1 was female, with an average age of 57 years ranging from 35 to 74 years. Microscopically, the tumor cells were arranged in solid, nested or lobulated patterns with occasional palisading around the solid nests. The stroma was highly vascular with focal neurofibrillary areas. There were prominent rosettes or pseudorosettes formation. The tumor cells were mainly ovoid to spindly with scant to moderate amount of cytoplasm, one or several small nucleoli, and fine chromatin content. Brisk mitotic figures were seen. In all 3 cases of OC, there were scanty atypical glands and some were ciliated. Immunohistochemically, at least one epithelial marker and neuroendocrine marker were diffusely expressed in the tumor. Some of the tumor cells were positive for p40 and p63, and the sustentacular cells showed the expression of S-100 protein. All cases tested were negative for NUT, CD99 and desmin, with intact expression of SMARCA4 (BRG1) and SMARCB1 (INI-1). Ki-67 proliferation index varied from 20% to 80%. Follow-up after 16-18 months showed no mortality with tumor recurrence from 1 patient after 16 months. Conclusion: OC is a rare sinonasal tumor with neuroepithelial differentiation, its histomorphology is diverse, and the combination of immunohistochemical markers is essential for appropriate diagnosis.
Humans ; Male ; Female ; Middle Aged ; Paranasal Sinus Neoplasms/chemistry* ; Biomarkers, Tumor/metabolism* ; Carcinoma/chemistry* ; Diagnosis, Differential ; S100 Proteins ; DNA Helicases/metabolism* ; Nuclear Proteins/metabolism* ; Transcription Factors/metabolism*

BACKGROUNDDifferentiating benign from malignant sinonsal lesions is essential for treatment planning as well as determining the patient's prognosis, but the differentiation is often difficult in clinical practice. The study aimed to determine whether the combination of diffusion-weighted (DW) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can improve the performance in differentiating benign from malignant sinonasal tumors.

METHODSThis retrospective study included 197 consecutive patients with sinonasal tumors (116 malignant tumors and 81 benign tumors). All patients underwent both DW and DCE-MRI in a 3-T magnetic resonance scanner. Two different settings of b values (0,700 and 0,1000 s/mm 2 ) and two different strategies of region of interest (ROI) including whole slice (WS) and partial slice (PS) were used to calculate apparent diffusion coefficients (ADCs). A DW parameter with WS ADCs b0,1000 and two DCE-MRI parameters (time intensity curve [TIC] and time to peak enhancement [Tpeak]) were finally combined to use in differentiating the benign from the malignant tumors in this study.

RESULTSThe mean ADCs of malignant sinonasal tumors (WS ADCs b0,1000 = 1.084 × 10-3 mm 2 /s) were significantly lower than those of benign tumors (WS ADCs b0,1000 = 1.617 × 10-3 mm 2 /s, P < 0.001). The accuracy using WS ADCs b0,1000 alone was 83.7% in differentiating the benign from the malignant tumors (85.3% sensitivity, 81.2% specificity, 86.4% positive predictive value [PPV], and 79.5% negative predictive value [NPV]). The accuracy using DCE with Tpeak and TIC alone was 72.1% (69.1% sensitivity, 74.1% specificity, 77.5% PPV, and 65.1% NPV). Using DW-MRI parameter was superior than using DCE parameters in differentiation between benign and malignant sinonasal tumors (P < 0.001). The accuracy was 87.3% (90.5% sensitivity, 82.7% specificity, 88.2% PPV, and 85.9% NPV) using DW-MRI combined with DCE-MRI, which was superior than that using DCE-MRI alone or using DW-MRI alone (both P < 0.001) in differentiating the benign from the malignant tumors.

CONCLUSIONSDiffusion-weighted combined with DCE-MRI can improve imaging performance in differentiating benign from malignant sinonasal tumors, which has the potential to improve diagnostic accuracy and to provide added value in the management for these tumors.

Adult ; Contrast Media ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Paranasal Sinus Neoplasms ; diagnosis ; Retrospective Studies

Female patients, 50 years old, have a recurrent unilateral aggravating headache for 5 years. Without runny nose, sneezing, nasal hemorrhage, smell or vision loss. Prefessional examination: there is a visible hoar neoplasm in the right middle nasal meatus With smooth surface and rich in vascular. The nasopharyngeal MRI shows that there is a occupancy lesion in the right nasal cavity and sinuses, well-demarcated, about 21. 5 mm x 25.5 mm x 37.0 mm. Angiofibroma is the most likely diagnosis. Postoperative pathological section shows that tumor are hypercellular, which contains big nucleus. Cells are spindle or short fusiform shape, there are stripes and nuclear division in some cells. There are vortex structures in partial region. Immunohistochemical examination shows: CD34(++), Ki-67 (< 5%), CD68(-), Des (-), NSE(+), S-100(++), SMA(-), EMA (+). Histopathologic diagnosis: atypical meningioma, some were differentiated to rhabdoid meningioma. The final diagnosis is malignant meningioma in nasal cavity and paranasal sinuses.
Female ; Humans ; Meningeal Neoplasms ; diagnosis ; pathology ; Meningioma ; diagnosis ; pathology ; Middle Aged ; Nasal Cavity ; pathology ; Paranasal Sinus Neoplasms ; diagnosis ; pathology ; Paranasal Sinuses ; pathology

OBJECTIVE: To investigate the clinical prognostic impact factors of adult sinonasal rhabdomyosarcoma (SNRMS). METHOD: The clinical features, treatment methods, and disease outcome were reviewed retrospectively for twenty-three adult SNRMS between 2006 January and 2014 December. The survival analysis was performed by Kaplan-Meier estimate and the comparison between groups by Log-rank test. Multivariate analysis was carried out by Cox proportional hazard model. RESULT: Patients' ages ranged from 18 to 59 years (median, 23.2 years). With a median follow-up of 20 moths (3-47 moths), 14 cases dead and 9 cases alive, the 1-year and 2-year overall survival (OS) rates were 77.1% and 35.0%, respectively. Within the 1-year and 2-year OS rates,early stage group had a higher overall survival rates than advanced diease group (100.0%, 66.7% and 83.3%, 10.5%, P < 0.05); combined therapy group had a higher overall survival rates than single treatment group (86.7%, 50.0% and 50.8%, 0, P < 0.05). In the non-metastasis group (21 cases), 1-year and 2-year distant metastasis rates were 38.1% and 70.5%, respectively. Multivariate analysis showed that radiotherapy, chemotherapy and tumor diameter less than 5 cm were good prognostic factors (P < 0.05), while the lymph node metastasis, meningeal involvement and orbital involvement were poor prognostic factors (P < 0 05). In the 14 cases of dead patients, 92 8% (13/14) died of distant metastasis. CONCLUSION Adult RMS had a high advanced rate with poor prognosis. Distant metastasis is the leading cause of death. Controlling distant metastasis is a key to improve the survival rate.
Adolescent ; Adult ; Humans ; Lymphatic Metastasis ; Middle Aged ; Multivariate Analysis ; Paranasal Sinus Neoplasms ; diagnosis ; mortality ; pathology ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Rhabdomyosarcoma ; diagnosis ; mortality ; pathology ; Survival Analysis ; Survival Rate ; Treatment Outcome ; Young Adult

A 39 years old male patient was admitted with the right of facial abnormalities and gradually protruding in right eye more than 30 years. CT shows high mixed density, clear boundary, and the right eye was crowded to the right. Giant tumor had completely been excised, and the result was fine. The outline figure and function of patients were obviously improved. The pathological examination after resection showed ossifying fibroma.
Adult ; Fibroma, Ossifying ; diagnosis ; Humans ; Male ; Nasal Cavity ; pathology ; Paranasal Sinus Neoplasms ; diagnosis ; Paranasal Sinuses ; pathology

OBJECTIVE: To investigate the clinical features, imaging characteristics, pathological types, the misdiagnosis causes and the early diagnosis method of malignant lymphoma in nasal cavity and paranasal sinuses. METHOD: Clinicopathological data of 34 patients with malignant lymphoma in nasal cavity and paranasal sinuses were retrospectively analyzed. RESULT: Most of patients were middle aged man, the incidence of malignant lymphoma of nasal cavity and paranasal sinuses accounted for 21.7% of nasal malignant tumor over the same period, nasal malignant lymphoma incidence rate was higher than the sinus malignant lymphoma (76.5% VS. 17.6%). The main symptoms were presented as snuffle, epistaxis, purulent nasal discharge, fever and so on. Nasal neoplasm, nasal mucosa hyperemia, erosion, necrosis are the main signs of the disease. CT features were summarized as the lesions located in the anterior-middle area in nasal cavity, homogeneous in density, soft tissue swelling in some cases and less bone destruction. The majority pathological type of nasal malignant lymphoma was NK/T cell lymphoma, but the common pathological type of paranasal sinus malignant lymphoma was B-cell lymphoma. The misdiagnosis rate of malignant lymphoma in nasal cavity and paranasal sinus was 21.2%. CONCLUSION Malignant lymphoma in nasal cavity and paranasal sinuses without specific clinical characteristics, but has some certain CT characteristics. Combined with the clinical, imaging and pathological features, can improve the cognition and diagnosis of the disease.
Diagnostic Errors ; Epistaxis ; Humans ; Lymphoma ; diagnosis ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Male ; Middle Aged ; Nasal Cavity ; pathology ; Necrosis ; Paranasal Sinus Neoplasms ; diagnosis ; Paranasal Sinuses ; pathology ; Retrospective Studies ; Tomography, X-Ray Computed

A patient diagnosed with myoepithelial carcinoma was recently treated in our department. The neoplasm was huge, located in the left maxillofacial region, blocking both eyes, impeding feeding. About one month before admission, the tumor began to bleed frequently, about 100 ml each time, causing headache, dizziness, fatigue, and cold sweats. CT showed the maximum diameter of the tumor was about 23 cm, with uneven density, and maxillofacial bone destruction. MRI revealed internal bleeding and necrosis inside the tumor. After admission, blood routine test showed erythrocyte count 3.64 x 10(12)/L(↓), hemoglobin 106 g/L(↓), hematocrit 0.320 (↓), serum iron 6.2 μmol/L(↓). After surgery, the patient recovered smoothly.
Carcinoma ; diagnosis ; surgery ; Humans ; Magnetic Resonance Imaging ; Myoepithelioma ; diagnosis ; surgery ; Nasal Cavity ; pathology ; Paranasal Sinus Neoplasms ; diagnosis ; surgery ; Paranasal Sinuses ; pathology

BACKGROUNDQuantitative dynamic contrast enhancement MR imaging (DCE-MRI), used to measure properties of tissue microvasculature and tumor angiogenesis, is a promising method for distinguishing benign and malignant tumors and characterizing tumor response to antiangiogenic treatment. The aim of this study was to assess the feasibility of quantitative parameters derived from clinically used DCE-MRI for distinguishing benign from malignant tumors in the sinonasal area, which may be potentially useful for prediction and monitoring of treatment response to chemoradiotherapy of sinonasal tumors.

METHODSOne hundred and forty-three patients with sinonasal tumors, including 78 malignant tumors and 65 benign tumors and tumor-like lesions, underwent clinically used DCE-MRI. Parametric maps were obtained for quantitative parameters including K(trans), kep and ve. Two radiologists reviewed these maps and measured K(trans), kep and ve in the tumor tissue. Data were analyzed using independent T-test or Mann-Whitney U test analysis and receiver operating characteristic curves.

RESULTSK(trans), kep and ve showed significant differences between benign and malignant tumors in the sinonasal area (P = 0.000 1). The accuracy of K(trans), kep and ve in differentiation between benign and malignant sinonasal tumors were 72.0%, 76.2% and 67.1%, respectively. There were significant differences in kep and ve between malignant epithelial sinonasal tumors and lymphomas (P < 0.05). Using a ve value of 0.213 as the threshold value differentiated malignant epithelial tumors from lymphomas with an accuracy of 78.3%, sensitivity of 88.2%, specificity of 68.0%, positive predictive value of 66.7%, and negative predictive value of 90.9%. However, no significant difference in K(trans) and kep was found between malignant epithelial and non-epithelial tumors in the sinonasal area (P > 0.05).

CONCLUSIONSIt is feasible that quantitative parameters of tumors can be derived from clinically used DCE-MRI in the sinonasal region. Preliminary findings suggest an increased value for quantitative DCE-MRI in the evaluation of sinonasal tumors in clinical practice.

Contrast Media ; Female ; Humans ; Image Enhancement ; methods ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Paranasal Sinus Neoplasms ; diagnosis

OBJECTIVE: To analyze and summarize clinical characteristic, treatment scheme and survival rate of primary melanom in nasal cavity and sinus. METHOD: We retrospectively analyzed the 9 patients with primary melanom in nasal cavity and sinus who in data proceed were treated and reviewed the related literature. RESULT: Among the 9 patients, the clinical main symptoms are rhinostegnosis of lateral nasal and intermittent nasal bleeding. Pathologic examination is mainly characterized by tumor cells abnormity and cytoplasm containing pigment or without pigment, and main diagnosis basis is some or all of the positive for HMB45, S-100, melan-A. The survival rate are 88.9% (8/9) of 1-year, 66.7% (6/9) of 3-year and 33.3% (3/9) of 5-year. CONCLUSION The incidence of primary melanom in nasal cavity and sinusis is not frequent in clinic and confirmed by immunohistochemical. The extensive radical excision of focus and combine adjuvant radiotherapy postoperative may improve the survival rate of patients.
Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Male ; Melanoma ; diagnosis ; surgery ; Middle Aged ; Nasal Cavity ; Nose Neoplasms ; diagnosis ; surgery ; Paranasal Sinus Neoplasms ; diagnosis ; surgery ; Retrospective Studies

OBJECTIVE: To improve the accuracy of diagnosis and treatment efficacy of hemangiopericytoma in nasal cavity and paranasal sinuses. METHOD: The clinical and pathological data of 5 cases with hemangiopericytoma in nasal cavity and paranasal sinuses verified by pathology were analyzed retrospectively. RESULT: Computed tomography scan revealed vascular in 5 cases. On CT scan, hemangiopericytoma generally appeared to be a uniform high density mass with obvious enhancement upon injection of contrast material. In pathological examination, there were plentiful capillaries which were like tree branch. The normal endocytes were in the inner wall of the vessel. The round, oval and spear-like pericytes scattered around the vessel. The split phase of the nucleus could be found in the tumor cell. All cases underwent surgical resection and were proved by pathological examination. The clinical data showed that the prognosis of sinonasal hemangiopericytoma was closely related to its histological grade. The recur rate in highly malignant hemangiopericytoma was obviously higher than that in middle and low malignant tumor. The rate of misdiagnosis was 80%. CONCLUSION Hemangiopericytoma is a potentially malignant tumor. Medical imaging can help to demonstrate the site, configuration, and characteristics of the tumors and contribute to the treatment. But there are not characteristic medical features. The final diagnosis must depend on the closely related to its pathological grade. The doctor should pay attention to the description of histological pathology. All the patients must be followed up carefully.
Adult ; Aged ; Female ; Follow-Up Studies ; Hemangiopericytoma ; diagnosis ; pathology ; Humans ; Male ; Middle Aged ; Nasal Cavity ; pathology ; Paranasal Sinus Neoplasms ; diagnosis ; pathology ; Retrospective Studies ; Young Adult