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Malignant tumors of the nose and paranasal sinuses take third place in frequency among other malignant lesions of the upper respiratory tract (larynx and pharynx) and, according to published data, comprise 2 - 3% of malignant tumors of all localizations. Malignant tumors most often develop in the maxillary sinus. In second place in frequency are lattice maze tumors. Much less often they are observed in the nasal cavity (Fig. 2.11.2). Malignant tumors are very rare in the frontal sinus. In the sphenoid sinus, primary tumors are almost not observed, however, they can grow into it from the nasal cavity and other sinuses (Paches A.I., 1983). Among malignant neoplasms of the nose and paranasal sinuses, epithelial tumors predominate, most often squamous cell carcinoma, less often connective tissue tumors (sarcomas).
In the nasal cavity, low-grade tonsillar tumors, such as reticulosarcoma and lymphoepithelioma, as well as rare tumors such as melanoblastoma and estesioneuroblastoma, can also develop. In fig. 2.11.3 presents a CT scan and a photo of a patient with lymphoepithelial nasopharynx extending into the left sphenoid sinus and middle cranial fossa with involvement of the abducent nerve. After a course of radiation therapy (60 Gray), positive clinical dynamics and restoration of abduction nerve function were obtained.
Reticulosarcoma and lymphoepithelium are of tonsillar origin and in most cases are found in the throat (Karpov N.A., 1962). Their development in the nasal cavity is associated with the spread of islets of lymphoid tissue along the entire length of the upper respiratory tract.
Melanoblastoma is characterized by the content of the pigment melanin, is characterized by exceptional polymorphism and a high degree of malignancy. Most often, this tumor occurs in people aged 50-60 years.
Estesioneuroblastoma refers to neuroepithelial tumors and originates from neuroepithelial olfactory cells. It is most often localized in the region of the superior nasal concha and is a soft-tissue polyp, often filling the entire half of the nose. The tumor has a pronounced ability to infiltrate growth and quickly grows in the paranasal sinuses, orbit, and cranial cavity. Metastasizes to the lymph nodes of the neck, mediastinum, pleura, lungs, bones. It occurs in both adults and children.
The direction of growth of cancer of the maxillary sinus is presented in Fig. 2.11.4.
With malignant neoplasms of the nose and paranasal sinuses, metastasis occurs in the corresponding regional lymph nodes. So, in case of damage to the anterior sections of the nasal cavity, metastases of the "first stage" are found in the submandibular region, and when the tumor is localized in the posterior sections, in the lateopharyngeal nodes (Fig. 2.11.5). However, it should be noted that tumors of the nasal cavity are mostly less prone to metastasis compared with the same types of neoplasms of other parts of the upper respiratory tract. Most often and early metastases occur with primary damage to organs and anatomical formations with great active mobility - the tongue, the bottom of the oral cavity (Petrov N.N., 1962). This explains the frequent and early metastasis of cancer of the lower pharynx and vestibular part of the larynx and the rarity of metastases in cancer of the subclavicular space of the larynx. The rarity of metastasis of nasal tumors and paranasal sinuses, obviously, should be explained by the lack of mobility of the walls of the nasal cavity (Karpov N.A., 1962).
Other oncologists also point to a significantly rare metastasis of cancer of the nasal cavity and paranasal sinuses (Paches A.I., 1983; Soldatov IB, 1990; Pogosov BC, Antoniv V.F., 1994).
Of particular interest is metastasis to the nasal cavity and paranasal sinuses of tumors of other locations. So, cases of metastasis in the nasal cavity of an adrenal tumor - hypernephroma are described (Zimont D.I., 1957; Kustner, 1959; Karpov N.A., 1962). If the metastases of tumors in the nasal cavity are casuistic in nature, then the growth of tumors into the nasal cavity and sinuses from neighboring areas is often observed. From the outer integument, skin cancer can sprout into the nasal cavity, destroying first the cartilage and then the bone skeleton of the nose.
From the cranial cavity to the nasal cavity, meningiomas and gliomas can grow. In young children, there are so-called "congenital tumors of the fronto-nasal region" (meningoencephalocele, gliomas, dermoid cysts) resulting from abnormalities in the development of the anterior neuropore. Malignant tumors primarily affecting the hard palate can grow from the oral cavity into the nasal cavity.
The clinical manifestations of tumors of the nose and paranasal sinuses in the early stations often resemble common inflammatory diseases. Patients complain of a unilateral runny nose, difficulty breathing through one half of the nose. Purulent and purulent-bloody discharge, headache and toothache appear later. Therefore, patients are admitted to the hospital after a considerable time after the onset of the disease. During this period, there are already obvious symptoms of a neoplasm of the nose and paranasal sinuses. Such symptoms as swelling of the face, displacement of the eyeball also join the above symptoms. A headache of a different nature is often the first, but not an early sign of a disease, for which patients seek medical attention. Neuralgia is usually seen in tumors that extend into the pterygopalatine fossa. Bleeding from the nose, exophthalmos and lacrimation, the germination of a tumor in the oral cavity, an increase in regional cervical lymph nodes are signs of the prevalence of the tumor process.
In the diagnosis of malignant neoplasms of the nose and paranasal sinuses, an X-ray study carried out in various projections is of great importance. It should be noted that such an important radiological symptom as the destruction of the bone (walls of the nasal cavity and paranasal sinuses) is absent in the early period, and sinus darkening can be observed in various diseases. Diagnostic capabilities are enhanced by computer beam research methods (CT and MRI), as well as radioisotope methods.
The use of modern endoscopes with fiber optics allows you to examine the deep sections of the nasal cavity under magnification and, if necessary, the sinus cavity through small trepanation holes, to make a biopsy of the suspicious area. An important point in the timely diagnosis of neoplasms is oncological alertness.
Differential diagnosis of malignant tumors of the nose and paranasal sinuses should be made with chronic hyperplastic, polypous and purulent sinusitis (usually maxillary sinusitis), with cholestea process and mycotic lesion of the nose, as well as benign tumors. In differential diagnosis, one should remember about infectious granulomas of syphilitic, tuberculosis and scleromic genesis, as well as Wegener's granulomatosis (unilateral monosinitis!) And Stuart granuloma.
The treatment of malignant tumors of the nose and paranasal sinuses should be combined, including surgical, radiation and chemotherapeutic methods. Depending on the biological activity of the tumor, its morphological and clinical characteristics, stage, prevalence and metastasis of the process, these methods can be applied in various combinations (Emelyanov A.A., 1990, Emelyanov A.A., Kryukova S.V., 1993 ) The treatment of malignant tumors in this area is a very difficult task. The anatomical and topographic features of the facial skull and its base do not always allow removal of the tumor within healthy tissues. Radiation therapy is also ineffective not only as a result of the radioresistance of many tumors of the nose and paranasal sinuses, but also due to the location of the tumor in deep areas, irradiation of which is fraught with serious damage to the eyes, brain and spinal cord. These difficulties increase with the spread of the tumor process. Meanwhile, a significant part of patients the correct diagnosis is established with a significant delay. All this makes it possible to classify malignant neoplasms of the nose and paranasal sinuses as malignant tumors with the most unfavorable prognosis (Zimont D.I., 1957, Karpov N.A. et al., 1976) and once again recall the oncological alertness of a doctor during examination of patients with any ENT pathology.
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- TUMOR GROWTH. TUMOR PROGRESSION. TUMOR MORPHOGENESIS. INVASION AND METASTASIS OF MALIGNANT TUMORS. BIOMOLECULAR TUMORS MARKERS. ANTITUMOR IMMUNITY. PARANEOPLASTIC SYNDROMES. BASIC PRINCIPLES OF CLASSIFICATION OF TUMORS. MORPHOLOGICAL FEATURES OF TUMORS FROM EPITELIUM AND TUMORS FROM TISSUES - DERIVATED MESENCHIMES
TUMOR GROWTH. TUMOR PROGRESSION. TUMOR MORPHOGENESIS. INVASION AND METASTASIS OF MALIGNANT TUMORS. BIOMOLECULAR TUMORS MARKERS. ANTITUMOR IMMUNITY. PARANEOPLASTIC SYNDROMES. BASIC PRINCIPLES OF CLASSIFICATION OF TUMORS. MORPHOLOGICAL FEATURES OF TUMORS FROM EPITELIUM AND TUMORS FROM TISSUES - DERIVATIVES
- Malignant tumors
SARCOM is a malignant tumor from the mesenchymal tissue. Unlike sarcoma cancer, the first metastases are hematogenous. Histogenesis sarcomas are divided into a number of varieties. From fibrous tissue. 1. Fibrosarcoma. 2. Swelling dermatofibroma (malignant histiocytoma) - unlike other sarcomas, it is characterized by slow growth and for a long time does not give metastases, although it grows
- Malignant tumors
In the upper respiratory tract, cancer is mainly found in various forms and rarely (about 3% in relation to malignant tumors of the ENT organs)
- Malignant pharyngeal tumors
The comparative incidence of pharyngeal cancers is high; carcinomas, lymphoepitheliomas, cytoblastomas, sarcomas, reticulocytomas, and mixed tumors are found among them. Men get sick more often than women, usually in middle age. K l and n and with to and to kartin and. The early symptoms of pharyngeal malignant tumors are poor and little characteristic. Light sensations may appear.
- Malignant tumors of the nose and paranasal sinuses
Malignant diseases of this localization - cancer and isarcoma, as a rule, are primary. They are relatively rare, more often in middle-aged and elderly men. Most often, the primary malignant process affects the maxillary, then ethmoid, frontal and sphenoid sinuses. Rarely, the source of the malignant tumor is the nasal septum. Malignancy
- Malignant tumors of the ear
Malignant tumors of the ear can be both primary, i.e. developed directly in a particular department of the ear, and arising from the germination of tumors from neighboring organs and tissues. In the outer and middle ear, cancer is more often diagnosed in adults, and sarcoma in children. Of the other species, there may be melanoma. The course of tumors of the outer ear is relatively slow, they look like
- Malignant tumors of the vulva and vagina
Vulvar cancer (RV) is found mainly in elderly women and accounts for 3-5% of all malignant diseases of the genitals. It develops against the background of involutive dystrophic processes. An important role in the occurrence of this pathology is given to metabolic and endocrine disorders and viral infection. Classification of PB by stages • Stage 0 - pre-invasive carcinoma. • Stage I - tumor up to 2
- Malignant Intestinal Tumors
- these are pathological proliferation of atypical cells with an autonomous (not always) progressive irreversible nature of growth, which replace and infiltrate normal tissue. Classification of the Stage of cancer Stage 1 - a tumor of small size, localized in the thickness of the mucosa or submucosal layer, without metastases; Stage 2: a) a large tumor, but no more than a semicircle
- Malignant skin tumors
There are many theories of cancer (embryonic, virogenetic, hereditary, somatic mutations, etc.). Malignant tumors are characterized by infiltrating growth with destruction of the surrounding tissue and metastasis. There are two types of skin cancer: basal cell and squamous. Basal cell carcinoma, or basal cell carcinoma, occurs mainly in the elderly.
- Malignant Epithelial Tumors
They are called cancer, or carcinoma. General characteristics. 1. Meet much more often than all other malignant tumors. 2. Often associated with previous diseases and conditions, which are called precancerous. 3. The development of many carcinomas (morphogenesis) is associated with previous changes in the epithelium - hyperplasia, metaplasia, dysplasia. 4. The only precancerous