Tumors

of the nose, sinuses

and nasopharynx
 Nasal polyp
• Causes:
– recurrent rhinitis
– allergy
• Gross:
– focal protrusion of
the mucosa
– 3 to 4 cm
• Consequences:
– impaired sinus
drainage
Widened nose due to polyps Gross: left nasal polyp
 Neoplasms of the nose, sinuses and
nasopharynx

1. Nasopharyngeal angiofibroma
2. Sinonasal papillomas
3. Isolated plasmocytoma
4. Olfactory neuroblastoma
(esthesioneuroblastoma)
5. Nasopharyngeal carcinoma
Nasopharyngeal angiofibroma

• Adolescent males
• Bleeds profusely during surgery
 Neoplasms of the nose, sinuses and
nasopharynx

1. Nasopharyngeal angiofibroma
2. Sinonasal papillomas
3. Isolated plasmocytoma
4. Olfactory neuroblastoma
(esthesioneuroblastoma)
5. Nasopharyngeal carcinoma
 Sinonasal papillomas

• SEPTAL
• inverted
• cylindrical
 Inverted papilloma

• Lateral wall of the

nose, paranasal
sinuses
• Locally aggressive
–recurrences
–invasion of the
orbit
  carcinoma
Inverted papilloma
 Neoplasms of the nose, sinuses and
nasopharynx

1. Nasopharyngeal angiofibroma
2. Sinonasal papillomas
3. Isolated plasmocytoma
4. Olfactory neuroblastoma
(esthesioneuroblastoma)
5. Nasopharyngeal carcinoma
Isolated plasmocytoma
 Neoplasms of the nose, sinuses and
nasopharynx

1. Nasopharyngeal angiofibroma
2. Sinonasal papillomas
3. Isolated plasmocytoma
4. Olfactory neuroblastoma
(esthesioneuroblastoma)
5. Nasopharyngeal carcinoma
 Olfactory neuroblastoma
(esthesioneuroblastoma)
• highly malignant
• location:
– nose (superior &
lateral part)
• from
neuroendocrine
cells
• prognosis:
– 5-year  50-70%
ESTHESIONEUROBLASTOMA
ESTHESIONEUROBLASTOMA
ESTHESIONEUROBLASTOMA
 Neoplasms of the nose, sinuses and
nasopharynx

1. Nasopharyngeal angiofibroma
2. Sinonasal papillomas
3. Isolated plasmocytoma
4. Olfactory neuroblastoma
(esthesioneuroblastoma)
5. Nasopharyngeal carcinoma
Nasopharyngeal carcinoma

EBV

Epithelium
 EBV
 nasopharyngeal carcinoma
 Burkitt lymphoma - African form
 B-cell NHL in immunosuppressed
individuals
 some cases of Hodgkin lymphoma
 Nasopharyngeal carcinoma.
Lymphoepithelioma type .

•Etiol. - EBV association

•Epid. – geographic assoc.
•Biol. – radiotherapy-sensitive
•Histol. – Lc infiltration
 Nasopharyngeal carcinoma
(Let). Geographic distribution.

•Africa – CHILDREN ~20%

(Tunisia, Uganda, Kenya,
Nigeria, Sudan)
•China – ADULTS
• HongKong-18%, USA-2% of all
malignant tumors
 Nasopharyngeal carcinoma

• M>F; bimodal distribution (2 & 6 d.)

• Incidence:
–Endemic:
•in Africa – children
•in southern China – adults
–rare in North America (0.25%)
• Site of origin:
–Lateral wall of the nasopharynx
 Nasopharyngeal carcinoma. Let.

•Exophytic (70%)
•Infiltrative
•Ulcerative
•Occult (5%)
 Nasopharyngeal carcinoma

Squamous cell
lymphoepithelioma
carcinoma
Undifferentiated
carcinoma
keratinizing 60%

nonkeratinizing
 Nasopharyngeal carcinoma
malignant

• Large epithelial cells with

indistinct cell borders („syncytial
growth”) and prominent nucleoli
• Mature lymphocytes

lymphoepithelioma
Cytokeratin +
 Nasopharyngeal carcinoma
symptoms
• Asymptomatic cervical neck
mass (posterior cervical LN) in
50 -80%
• Symptoms related to:
–Nose: obstruction, discharge,
epistaxis
–Ear: otalgia, hearing loss
 Nasopharyngeal carcinoma
spread

•Local invasion
•Metastases
LN
distant

5-year survival = 50%

 Nasopharyngeal carcinoma.
Let. Pathogenesis.
• Genetic predisposition (HLA subtypes)
• Environmental factors (vit.&trace metals
deficiency, irradiation, asbestos, Ni
exposition, poor oral cavity hygiene).
• Race - Chinese, Indians, Eskimo
•EBV - EBV DNA in tumor cells
– EBV Ab in serum
 Nasopharyngeal carcinoma.
Diagnosis.

•CT
•MRI
•FNA
•Biopsy
 Nasopharyngeal carcinoma.
Squamous cell carcinoma keratinizing.

• Rather no EBV association

• Tendency for local infiltrative
growth
• Rare below 40
• Poor radiosensitivity

•The worst prognosis

 Nasopharyngeal carcinoma.
Radiotherapy.

•Undifferentiated
– the most sensitive
•Keratinizing – the least
Laryngeal tumors
larynx true vocal cord

false vocal fold (cord)

recess
of the
ventricle

upper trachea

epiglottis

Note the bilateral subglottic erosions

here. These developed in a patient who
had been intubated for several weeks.
Normal larynx

Posterior commissure

Proximal trachea

True vocal cord

False vocal cord

Anterior commissure
 Laryngeal tumors
benign
malignant
1.Vocal cord nodule
(singer’s nodule) 1.Carcinoma of
the larynx
2.Squamous papilloma
(adults)
3.Juvenile laryngeal
papillomatosis
(children; HPV 6, 11)
singer’s nodule
cancer
papilloma on vocal
cord
singer’s nodule
Quiet! This is a laryngeal nodule (laryngeal polyp) that results most often from abuse of the voice
(e.g., a "singer's nodule") or from smoking. Such polypoid lesions are typically found on the true
cord and covered by squamous epithelium. They may impart a hoarse quality to the voice, but they
do not result in malignancy, though larger ones (up to 1 cm) may ulcerate.
Squamous papilloma
Squamous papilloma of the larynx, found on the true vocal fold. Note the long projections of
squamous epithelium over fibrovascular cores. These uncommon lesions are solitary in adults, and
may cause some bleeding.
This papilloma is covered by benign, orderly squamous epithelium. Although rare in children,
papillomas of the larynx tend to be multiple and often recur following resection. With laryngeal
papillomatosis, dozens of lesions may be resected over the years. HPV infection may drive this
process.
 Carcinoma of the larynx

>40 y. (mean 60 y.) M>F (7:1)

Risk factors:
–SMOKING
–ALCOHOL
–Previous radiation exposure
–Asbestos
–HPV (5%)
 Carcinoma of the larynx
localization

Supraglottic
25-40%

Glottic
60-75%
Subglottic
5%
 Carcinoma of the larynx
localization

• Supraglottic
• GLOTTIC
• Subglottic
• Transglottic
–crosses one or more sites so the
site of origin can not be
recognized
 Carcinoma of the larynx
localization

• Supraglottic
• Glottic
• Subglottic
• Transglottic - crosses one or more regions
( site of origin can not be recognized)

• INTRINSIC (within the larynx proper)

• EXTRINSIC (outside the larynx)
 Carcinoma of the larynx
gross

• Exophytic
with/without
ulceration
• Deeply
invasive
without
prominent
surface mass
Subglottic squamous cell carcinoma
after irradiation.
 Carcinoma of the larynx

•Squamous cell
carcinoma (95%)

• Adenocarcinoma
 mild/moderate/severe invasive
normal hyperkeratosis intraepithelial neoplasia carcinoma
Hyperplasia & keratosis
Hyperplasia & keratosis
Severe intraepithelial neoplasia (dysplasia, carcinoma in situ)
Microinvasive squamous cell carcinoma(invades < 2 mm below the BM)
Invasive squamous cell carcinoma
Invasive squamous cell carcinoma
Diagnosis of laryngeal carcinoma

Biopsy with direct laryngoscopy

 Carcinoma of the larynx
symptoms
• Hoarseness (persisting for more than
3 weeks must always be investigated
by a specialist)
• Foreign body sensation in the throat
(globus)
• Mild dysphagia
• Hemoptysis
• Pain
 Carcinoma of the larynx
spread

•Cervical LN
•Distant metastases
–Lungs
–Liver
 Carcinoma of the larynx
prognosis
• Supraglottic tumors
–Rich in lymphatics  30% meta in LN
• Glottic tumors
–Rare lymphatics  <15% meta in LN
• Subglottic tumors
–Advanced disease  40% meta in LN
 Carcinoma of the larynx -
causes of †

Pneumonia
Metastases  Cachexia
 Carcinoma of the larynx.
Treatment.

•Surgery
•Radiation
•S&R