A Clinicopathological study and Treatment of Masses in Sinonasal Cavity

Meenakshi Sundaram, A (2013) A Clinicopathological study and Treatment of Masses in Sinonasal Cavity. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: Sinonasal malignancies, a highly heterogeneous group of cancers, account for less than one percentage of the cancers and less than three percentage of all digeastive system tumors. These lesions may originate from any of the histopathologic components of the sinonasal cavities, including Schneiderian mucosa, minor salivary glands, neural tissue, and lymphatics. 60% of these tumors arise in the maxilla, but twenty percentage come from cavity of nose, five percentage come from sinus of ethimoid, three percentage from the sinus of frontal, sinus of sphenoid. Squamous cell carcinomas are more common within the nasal cavity or maxillary sinus, whereas tumors of the ethmoid sinus and superior nasal vault are usually adenocarcinomas. Mucosal melanoma frequently originates within the nasal cavity, particularly along the lateral nasal side wall and inferior turbinates. Although traditional risk factors for sinonasal cancers have included exposure to nickel, wood dust, and tobacco, no predisposing factors are identified in most patients. Recent reports suggest that HPV promotes the development of some sinonasal squamous cancers. Thus the key to the diagnosis and management of sinonasal malignancies lies in the eliciting of proper history, clinical features and investigation protocol to detect the tumour at the early stage and provide the appropriate treatment for the patient,thereby increasing the survival rate. This study was conducted to assess the importance of detecting the clinical features, detecting the lesion through histopathology and imaging to arrive at the diagnosis at an earlier stage and evaluating the treatment protocol. AIMS OF STUDY In sinonasal tumours, 1. To correlate the symptoms, signs with the clinical staging. 2. To correlate the clinical features with the pathological staging. 3. To study the incidence of age and sex of the tumour. 4. To study the incidence of TNM staging and broder’s staging among the patients. 5. To correlate the histological diagnosis and treatment plan. MATERIALS AND METHODS: The study was done in Government Rajaji Hospital,Madurai medical college, Madurai, from October 2010 to October 2012. Out of the patients who attended the outpatient department during the period, those with symptoms and signs suggestive of sinonasal masses were screened further. After thorough clinical examination, the patients were subjected to Endoscopy into the nasal cavity and computed tomography scan for the sinonasal area were performed. Those with histologically confirmed benign and malignant tumors were selected for the study. The total number of 50 patients were selected for the study and their surgical and non surgical outcomes were noted. CONCLUSION: The work up, management and follow up of sinonasal tumours is complicated by the multiple potential sites and stages of development. Various array of options of management of tumours are radical surgery alone, surgery followed by radiotherapy, chemoradiotherapy and stereotactic gamma knife surgery. This study was performed because of the high incidence of the sinonasal tumours in Government Rajaji Hospital, Madurai. Combined modality approach was entitled for the patients under study which included otolaryngologist, radiotherapist, neurosurgeon, medical oncologist, surgical oncologist, psychiatrist, psychologist, radiologist, pathologist, dentist, nutritionist, social worker. This approach had an advantage of earlier diagnosis of the tumours, accurate delineation of the tumour, precise and appropriate treatment. All these factors improved the prognosis and thus extended the survival rate of the patients. The role of surgery followed by radiotherapy played a pivotal role in the stage I and stage II tumours where a complete cure was almost possible. The role of radiotherapy in stage III and stage IV played a good palliative role in inoperable cases. Complete tumour removal was very much possible both through open and endoscopic methods. The role of chemotherapy combine with radiotherapy was efficient in preventing recurrence and residual tumour rates. Induction chemotherapy followed by maintenance therapy reduced the side effects of chemotherapeutic agents, The goals of treatment can be attained by multidisplinary and multi modality approach.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Treatment of Masses, Sinonasal Cavity, Clinicopathological study.
Subjects: MEDICAL > Otolaryngology
Depositing User: Devi S
Date Deposited: 27 Mar 2020 06:50
Last Modified: 27 Mar 2020 06:50
URI: http://repository-tnmgrmu.ac.in/id/eprint/12483

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