Malignant Neoplasms: General Remarks 9.1.1


Malignant neoplasms of the sinonasal tract are quite rare, since they account for only 1% of all malignancies (Tüfano et al. 1999; Rinaldo et al. 2002b), with an annual incidence of 0.5-1 new cases/100,000 inhabitants. Although infrequent, sinonasal neoplasms include a variety of histotypes, a distinctive feature which reflects the peculiar density in this area of different anatomic structures.

Sinonasal tract malignancies account for 2-3% of all head and neck cancers; up to 80% of cases are maxillary sinus carcinomas (Le et al. 1999; Tiwari et al. 2000). Of the remaining tumors, most arise from the ethmoid sinus (Wax et al. 1995; CANtu et al. 1999a). More rarely the nasal fossa is the site of origin of malignancies. Malignant tumors originating within the sphenoid or the frontal sinus are exceedingly rare.

In the maxillary sinus, the most frequent histotype is squamous cell carcinoma, which accounts for up to 73% of all malignancies (Tiwari et al. 2000). Other histotypes, such as adenocarcinoma, adenoid cystic carcinoma, mucoepidermoid carcinoma are less frequently observed.

As far as ethmoid malignancies are concerned, ad-enocarcinoma, squamous cell carcinoma, and olfactory neuroblastoma are the most common histotypes. However, the prevalence of the different malignant tumors in the literature is extremely variable (Wax et al. 1995; Shah et al. 1997; Lund et al. 1998; CANtu et al. 1999a; Bridger et al. 2000; BHAttACHARYYA 2002).

The carcinogenic effect of some factors like exposure to wood and leather dust in the development of ethmoid adenocarcinoma is well recognized (CANtu et al. 1999a). Other etiological factors, such as nickel and chrome refining processes, have been linked to the development of squamous cell and anaplastic carcinoma (Goldenberg et al. 2001). In contrast, tobacco and alcohol, do not seem to be associated with an increased risk for sinonasal tract malignancies (Goldenberg et al. 2001).

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