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Objective: The objective of the study was to investigate the postoperative tumor incidence on routine histopathologic examination of surgical specimens in patients who underwent endoscopic sinus surgery with the preoperative diagnosis of unilateral or bilateral nasal polyposis., Methods: Patients who underwent endoscopic sinus surgery with the preoperative diagnosis of unilateral or bilateral nasal polyposis between 2000 and 2009 were included in the study as the 2 separate groups. In both groups, tumor incidence that had been noticed on routine postoperative histopathologic examination was recorded retrospectively. Patients who had a preoperative diagnosis other than nasal polyposis, determined on biopsy, were excluded., Results: Of 251 patients included, 197 had the preoperative diagnosis of bilateral nasal polyposis, and 54 had unilateral nasal polyposis. No tumor was diagnosed on postoperative histopathologic examinations in patients with preoperative bilateral nasal polyposis. Seven patients (12.96%) with the preoperative diagnosis of unilateral nasal polyposis had tumors on postoperative histopathologic examinations. Two of these 7 patients had malignant tumors that were reported preoperatively by intranasal biopsy as inflammatory polyps., Conclusions: Diagnosis of a neoplasia is an extremely rare situation, unless there are special findings of tumor in patients with preoperative diagnosis of bilateral nasal polyposis. On the other hand, histopathologic examinations should be carried out in every case operated with preoperative diagnosis of unilateral nasal polyposis, as the tumor incidence is higher.

Nasal NK/T-cell lymphoma (NKTCL) frequently presents with necrotic, granulomatous lesions in the upper respiratory tract, and usually shows a highly aggressive clinical course. Thus, it was initially included in the clinical condition of lethal midline granuloma. Recently, the disease has been recognized as a neoplastic proliferation of NK/T cells. The disease is much more frequent in Asian and Latin American countries than in Western countries, and is universally associated with Epstein-Barr virus (EBV) infection. Analyses of gene mutations, especially p53 and c-kit, revealed the different frequencies by district. Abnormalities of other genes have also been reported. Case-control studies showed that the exposure to pesticides and chemical solvents could be causative of NKTCL. Further studies including HLA antigen typing of patients is necessary to further clarify the disease mechanism.

We conducted a retrospective case-series review to identify the various diagnoses of neoplasms of the nasal cavity and paranasal sinuses in a pediatric population. Our study group was made up of 54 children-23 boys and 31 girls, aged 8 months to 16 years (mean: 9 yr). All patients had been diagnosed with a tumor of the nasal cavity or paranasal sinuses between Jan. 1, 1955, and Dec. 31, 1999, at one of four university-based, tertiary care referral centers. We compiled data on tumoral characteristics (location, size, and histopathology), morbidity and mortality, and rates of recurrence. Lesions included adnexal neoplasm, ameloblastic fibro-odontoma, basal cell carcinoma, benign fibrous histiocytoma, blue nevus, chondrosarcoma, compound nevus, epithelioma adenoides cysticum, esthesioneuroblastoma, Ewing sarcoma, fibrosarcoma, giant cell granuloma, granulocytic sarcoma, hemangioma, hemangiopericytoma, Langerhans cell histiocytosis, lymphangioma, lymphoma, melanoma, neuroblastoma, neurofibroma, ossifying osteofibroma, osteochondroma, osteosarcoma, port wine stain, rhabdomyosarcoma, Spitz nevus, and xanthogranuloma. To the best of our knowledge, this is the largest such study of its kind to date. We believe that the large size of this study and the data on disease incidence will allow clinicians to be better informed of the differential diagnosis of neoplasms of the nasal cavity and paranasal sinuses in the pediatric population.

Several naphthalene Unit Risk Factors (URFs) were proposed by the US Environmental Protection Agency in 2004 using data on the development of olfactory epithelial neuroblastomas and nasal respiratory epithelial adenomas in rats, but these URFs may be inappropriate and unnecessarily conservative for estimating human cancer risks. The purpose of the present exercise was to perform a screening-level population risk assessment of the US population to compare the observed number of naphthalene-induced nasal tumors in the US to the number that would be predicted if the URFs for naphthalene were as proposed. Nine scenarios were evaluated to represent the range of exposures individuals have typically experienced. Results indicate that the total predicted burden of naphthalene-induced nasal tumors per year in the US (65,905 rare nasal tumors, of which 29,121 are olfactory epithelial neuroblastomas) is much greater than the number of these tumors actually observed per year (910 total nasal tumors, of which 66 are olfactory neuroblastomas) over the period 1973-2006. This suggests that using rat nasal tumor data to derive a naphthalene URF for humans should be re-evaluated., (Copyright 2010 Elsevier Inc. All rights reserved.)

Context: Primary cutaneous lymphoma is an uncommon, extranodal lymphoma, and it is usually more indolent with a better prognosis than its histologically similar systemic counterpart is., Objectives: To illustrate the clinicopathologic features of cutaneous lymphomas in Taiwan and to compare the relative frequencies of subtypes of cutaneous lymphoma among different geographic areas., Design: A total of 56 patients with cutaneous lymphomas were retrospectively collected and were reclassified according to the 2005 World Health Organization and the European Organization for Research and Treatment of Cancer and the 2008 World Health Organization classifications. The data were compared with those from other studies for different geographic areas., Results: Thirty-one (55%) tumors were primary cutaneous lymphomas, and twenty-five (45%) tumors were secondary or concurrent cutaneous lymphomas. Among primary cutaneous lymphomas, 23 cases (74%) were T-cell or natural killer-cell lymphomas, and 8 cases (26%) were B-cell lymphomas. The most common types were extranodal natural killer/T-cell lymphoma, nasal type, and primary cutaneous peripheral T-cell lymphoma, unspecified (5 cases each; 16%). In contrast with other primary cutaneous B-cell and T-cell lymphomas, either primary or secondary extranodal cutaneous natural killer/T-cell lymphomas, nasal type, had extremely poor prognoses (1-year overall survival, 0%)., Conclusions: This study showed that the frequency of subtypes of primary cutaneous lymphoma varied in different geographic areas. Compared with the Western countries, there was a higher frequency of extranodal natural killer/T-cell lymphoma, nasal type, and a lower frequency of mycosis fungoides in Taiwan. Extranodal natural killer/T-cell lymphoma, nasal type, also had an extremely poor prognosis compared with other lymphomas.

Tumours affecting the nose, paranasal sinuses and adjacent skull base are fortunately rare. However, they pose significant problems of management due their late presentation and juxtaposition to important anatomical structures such eye and brain. The increasing application of endonasal endoscopic techniques to their excision offers potentially similar scales of resection but with reduced morbidity. The present document is intended to be a state-of-the art review for any specialist with an interest in this area 1. to update their knowledge of neoplasia affecting the nose, paranasal sinuses and adjacent skull base; 2. to provide an evidence-based review of the diagnostic methods; 3. to provide an evidence-based review of endoscopic techniques in the context of other available treatments; 4. to propose algorithms for the management of the disease; 5. to propose guidance for outcome measurements for research and encourage prospective collection of data. The importance of a multidisciplinary approach, adherence to oncologic principles with intent to cure and need for long-term follow-up is emphasised.

Objective: To evaluate the treatment outcome for sino-nasal carcinomas in Denmark from 1995-2004 and compare the results to the previous Danish survey covering 1982-1991., Design: Retrospective follow-up., Materials and Methods: In the five Danish head and neck oncology centres, charts of all consecutive patients with sino-nasal carcinomas were reviewed and data extracted to a common database. Altogether 242 patients from the period 1995-2004 were identified. Of these 162 (67%) were male and 80 (33%) female. Histologies included squamous cell carcinoma (55%), adenocarcinoma (28.5%), adenoid-cystic carcinoma (5.0%), undifferentiated carcinoma (4.5%), transitiocellular carcinoma (1.7%), mucoepidermoid carcinoma (0.8%), neuroendocrine carcinoma (2.5%), small cell carcinomas (1.2%) and carcinomas not otherwise specified (0.8%). Treatments included radiotherapy alone 79 (33%), surgery alone 29 (12%), combined surgery and radiotherapy 96 (40%), palliative/no treatment 38 (16%). A total of 204 (86%) patients were treated with curative intent., Results: Of the 204 patients treated with curative intent, 94 (46%) relapsed. Most failures were in T-site (63, 30%). N-site failures were 10 (5%) and M-site failures six (3%). Failure occurring in T+N-site, T+M-site, N+M-site and T+N+M-site were seven (3%), two (1%), one (0.5%) and five (3%) respectively. The 5-year actuarial local, nodal and loco-regional control rates were 55 + or - 4%, 86 + or - 3%, 49 + or - 4%, respectively. The overall 5-year actuarial survival rate for the entire cohort was 47 + or - 3%, and the corresponding cancer-specific 5-year actuarial survival rate was 57 + or - 3%. Female gender, nasal cavity tumour, adenocarcinoma and low clinical stage were significant positive prognostic factors in univariate analysis. A Cox multivariate analysis showed that only tumour site and clinical stage were independent significant prognostic factors., Conclusion: The current series has confirmed stage and tumour site as independent prognostic factors. Compared to the previous Danish survey covering the period 1982-1991, the overall survival and cancer-specific survival rates have improved significantly.

Background: Sinonasal cancer (SNC) includes uncommon tumours that are characterized by a high occupational etiologic component. For this reason they are an easy target for systematic surveillance by setting up a specific disease registry. The National Registry of these tumours is located at the Italian Institute for Occupational Safety and Prevention (ISPESL) and is based on data from Regional Operating Centres (ROCs). In the Lombardy Region a ROC was established in 2008 at the Clinica del Lavoro "Luigi Devoto" in Milan aimed at making surveillance systematic and thus provide adequate support for scientific research and prevention measures in the high risk work sectors., Objectives: To estimate the incidence of SNC, to define different sources of occupational exposure both known (wood, leather, nickel, chromium) and unknown., Methods: The Registry collects all the new incident cases of epithelial SNC occurring among residents ofthe Lombardy Region. The Regional Registry is managed in accordance with the specific National Guidelines and uses the experience already acquired with the organizational and operational management of the Regional Mesothelioma Registry., Results: During the first period of activity (1.1.2008-30.9.2009) 556 cases of suspected SNC were reported to the Registry; only 62 (11.2%) of these actually complied with the inclusion criteria of the Registry and were mainly adenocarcinoma and squamous carcinoma. Occupational exposure to wood or leather dust was ascertained in 50% of cases., Conclusion: Data collected up to now confirm that occupational exposure to wood and leather dusts are the most significant risk factors for SNC. The study of occupational sectors and job tasks in cases with as yet undefined exposure might suggest new etiologic hypotheses.

Background: The etiology of sinonasal inverted papilloma (IP) is unknown. This study was designed to evaluate the possible risk factors associated with IP Methods: This is a case-control epidemiology study in a tertiary referral center. Fifty patients with IP and 150 matched controls were interviewed using a questionnaire on suspected risk factors. Univariate analysis of the risk factors and calculation of the matched odds ratios, the corresponding 95% CIs, and p values was performed. Significant risk factors were further studied using conditional logistic regression analysis., Results: Outdoor and industrial occupations were associated with IP. Tobacco smoking, drinking alcohol, history of allergic rhinitis, sinusitis, nasal polyp, non-sinonasal papilloma and non-sinonasal malignancy were not significant factors., Conclusion: Outdoor and industrial occupations were associated with IP and may be potential risk factors. Future studies are warranted to further evaluate the individual type of occupation and chemical involved.

Objective: The rationale of this study is to analyze the demographic distribution and clearance of excision margin in basal cell carcinoma among patients diagnosed at AFIP Rawalpindi., Materials and Methods: Records of a total of 235 cases diagnosed from January 2005 to December 2007 were retrieved from our tumour registry. The following variables were recorded for each patient: age, gender, site of biopsy, type of biopsy (incisional vs excisional) and status of clearance of surgical margins. The data was analyzed using SPSS version 17.0., Results: Among the total of 235 cases, 125 (53.2%) were males and 110 (46.8%) were females (1.2:1). The ages ranged from 32 to 90 years with mean age of 60.0 + 11.7, with a general age-dependent increase. The nose was the most frequent site (28.9%), followed by the eye, including the orbit (24.7%), and the cheek (20.4%). Among the type of biopsies, 140 (59.6%) were excisional and 95 (40.4%) were incisional. With the former, the excision margins were reported as clear in 82 (34.9%) cases and involved in 55 (23.4%) cases., Conclusion: Basal cell carcinoma (BCC) appears to be on the rise in our part of world. Careful clinical assessment, and complete excision with the help of frozen sections can avoid recurrence.

Chronic nasal disease is a common problem in dogs. To determine the aetiology, a retrospective study in 75 dogs with persistent and chronic nasal disease was done. All dogs were evaluated by means of survey nasal radiographs, antegrade and retrograde rhinoscopy, bacterial and fungal cultures, and histopathology. A definitive diagnosis was made in 74/75 cases (98.6%). Nasal neoplasia was the most common diagnosis (46.7%), median age 108 months, followed by lympho-plasmacytic rhinitis (20%), median age 112 months, and fungal rhinitis (10.7%), median age 53.5 months. Other diagnoses included nasal foreign body (5.3%), median age 51 months, and primary bacterial rhinitis (6.7%), median age 116.5 months. Rare aetiologies identified were nasal polyps, granulomatous rhinitis, oro-nasal fistula and naso-pharyngeal stenosis. This study showed that by using a structured combination of survey radiography, rhinoscopy, cultures and histopathology, a diagnosis could be made in dogs with chronic nasal disease.

Statement of Problem: Sinonasal inverted papilloma is a benign, epithelial neoplasm, which has a propensity for malignant transformation and recurrence. The evolution of endoscopic trans-nasal surgery has facilitated less destructive and, more functionally and cosmetically acceptable approaches to this tumour. Recurrence rates have been shown to be more favourable than after traditional external approaches. Precise surgery is enhanced by pre-operative localisation of the site of tumour attachment. The aim of this study was to examine, in a prospective fashion, the predictive value of osteitis on the pre-operative CT scan of the paranasal sinuses at correctly identifying the site of attachment of sinonasal inverted papilloma., Method of Study: Pre-operative CT scans of the paranasal sinuses in 24 patients with histology-proven sinonasal inverted papilloma were examined for osteitis, allowing a prediction of the site of attachment. Coronal reformats of thin-cut (1mm) axial CT scans were evaluated. Intra-operatively, the actual site of tumour attachment was established. A correlation between the predicted and actual site of tumour attachment was calculated., Main Result: The predictive value of the osteitis sign was 95%., Principal Conclusion: Pre-operative identification of osteitis can be used in 95% of cases to accurately predict the intra-operative site of attachment of sinonasal inverted papilloma.

Objective: The aim of this study is to analyze occupational cancer claims compensated in the industrial sector in Italy between 1994 and 2006., Methods: A descriptive analysis of compensated occupational cancers based on the Italian Workers' Compensation Authority (INAIL) data was performed. Summary statistics were compiled by sex and age of worker, cancer type, workplace agent and economic sector. The temporal trend in the period 1994-2006 was investigated for the most frequently compensated cancers (mesothelioma and lung cancer from asbestos; nasal cavities cancer from wood and leather dust)., Results: Between 1994 and 2006, 6,243 cancer claims were compensated by INAIL due to occupational exposure in the industrial sector. Most (5,288, or 85%) of these compensated claims occurred in the period 2000-2006, when the annual mean of the most compensated cancers increased approximately four times compared to the period 1994-1999., Conclusions: There is an increasing trend in compensation for work-related cancers in Italy in recent years, even if occupational cancers are still widely underreported., ((c) 2009 Wiley-Liss, Inc.)

Background: Tumours of the nose and paranasal sinuses in sub-Saharan Africa are generally characterised by late presentation posing management challenges to the otorhinolaryngologists in the sub-region., Objectives: To appraise surgical considerations in the management of tumours of the nose and paranasal sinuses in a developing nation from the experiences of an Ear, Nose, and Throat Department of a Nigerian Teaching Hospital., Methods: This was a chart review of patients with tumours of the nose and paranasal sinuses who underwent various surgical operations over a period of four and a half years.The patients were referred by other physicians or health care workers. They were assessed clinically, backed by laboratory and radiological investigations., Results: A total number of 55 patients underwent 64 surgical operations. There were 31 (56.4%) males and 24 (43.6%) females, giving a male to female ratio of 1.3:1. They were aged between four years and 70 years. In 46(83.6%) patients the tumours had extended beyond the nasal cavity or one sinus cavity to contiguous structures. The surgical operations carried out were lateral rhinotomy in 37(57.8%), intranasal clearance and intranasal antrostomy in 16(25%), total maxillectomy in seven(11%), and anterior craniofacial resection in two (3.1%) patients.The histological examination showed that 43 (78.2%) cases were benign, while 12 (21.8%) cases were malignant. These malignant cases needed radiotherapy and chemotherapy., Conclusion: Majority of the cases were characterised by late presentation, requiring surgical approaches such as lateral rhinotomy, total maxillectomy or craniofacial resection depending on the extent of the tumour. Poverty, ignorance, inadequate funding and administration challenges of health resources are factors militating against proper clinical management of tumours of the nose and paranasal sinuses in developing nations. Provision of free medical care and modern facilities for early diagnosis, treatment, and health education are needed to reverse the trend.

Introduction: Inverted papillomas are benign sinonasal lesions that arise primarily from the lateral nasal wall which are characterized by their tendency to recur and propensity to be associated with malignancy. The aim of this work is to analyze our experience in the treatment of these lesions, especially through the endoscopic approach., Material and Method: We present 61 cases of sinonasal inverted papillomas that were treated at our hospital since 1983. The patients were studied by age, gender, site of presentation of the tumor, symptoms, radiologic studies, surgical treatment and evolution. The mean follow-up was 51 months (range 6-228 months)., Results: Thirty eight of the patients (62%) were males and 23 females (38%). The average age was 58 years (range 22-80). The most common symptom was unilateral nasal obstruction in 91% of the cases, followed by rhinorrhea in 46%. The most frequent location was the ethmoid region in 51% of cases, followed by the maxillary sinus in 28% and the lateral nasal wall in 21% of the cases. 78% of cases had associated sinusitis and the 43% polyposis. Tumours were classified with the Krouse staging system as follows: 35% stage I, 37% stage II, 18% stage III and 8% stage IV. 37% of the patients had bony erosion in the CT scan. Six of the 42 patients treated by endoscopic procedures presented recurrence (14%), compared with 6 of the 9 patients (67%) who were treated by open approaches. The average time to the recurrence was 41 months. 17% of the patients had malignant inverted papillomas, nine of them diagnosed from the beginning as malignant neoplasies and one which became malignant during follow up., Discussion and Conclusions: The endoscopic approach is the method of choice for the treatment of the majority of inverted papillomas. The close follow up of the patient for a large period of time is necessary for the early detection of recurrence and to allow for surgical salvage.

Objective: Head and neck chondrosarcomas are rare, accounting for less than 12% of all chondrosarcomas. Few studies with larger series approach the clinicopathological characteristics of these tumours. The aim of this study was describe clinical findings, management and outcome of 16 cases of head and neck chondrosarcoma from a single institution., Study Design: The files of the Cancer Hospital A.C. Camargo were reviewed, and data from patients with head and neck chondrosarcoma were collected., Results: Mean age was 36 years, with slight male predilection. The most common site affected was maxilla (43%). Surgery was the main modality treatment performed in 10 patients. Overall 5-year survival rate was 56.4%. Although it was not statistically significant, the most important factor affecting overall survival was tumour size., Conclusion: Early diagnosis and adequate surgical resection are important to get better survival rates.

Human papillomavirus (HPV) is one of the most common causes of sexually transmitted infection in the world. France and Belgium present one of the highest incidence of head and neck squamous cell carcinomas (HNSCC) worldwide. Besides, considering only the male population, HNSCCs represent the fourth most frequent cancer after prostate, lung and colon cancers. Although the causal link between high-risk HPVs and cervical carcinoma is well established, the implication of this viral infection in HNSCC remains debatable. Here, we discuss current knowledge concerning the HPV implication in HNSCCs. Based on our literature review, 20 to 25% of HNSCCs could be associated with oncogenic HPVs, in particular HPV type 16. The oropharynx--more precisely the tonsil--is the head and neck location presenting the highest incidence of HPV infection. Moreover, a clear increase of tonsillar carcinoma incidence has been described. As observed in cervical carcinomas, HPV positive HNSCCs are sexually transmitted and characterized by alterations of p53 and pRb signalling pathways. Several studies have shown that HPV positive subgroup presented better prognosis particularly if these patients overexpressed p16INK4. New studies regarding HPV status in HNSCCs are warranted to provide a rationale for large scale HPV vaccination in young male populations.

The aim of presented work is analysis of the inverted papilloma cases treated by endoscopic surgery between years 2006 and 2008. Within this period there were 180 surgeries, out of which 11 patients were diagnosed with papilloma inversum in the histopatological test of irradiated tissue. Symptoms reported by the patients, tumor loci, scope of the surgery and its efficiency are described and analyzed. The arguments supporting endoscopic surgery as a treatment modality for inverted papilloma are presented.

Introduction: Nasal reconstruction after tumor extirpation is a necessity. The aim of the current study was to present the Greek experience in this field for a long period., Materials and Methods: Charts of patients who underwent nasal reconstruction, from 1985 to 2006, were reviewed retrospectively. They were analyzed in relation to their age, sex, location of the defect, histologic diagnosis of the lesion, type of reconstruction, recurrence of the tumor, and final outcome., Results: A total of 1585 patients underwent nasal reconstruction by the senior author (O.P.) during a period of 21 years in our department. A clear male preponderance was shown (845 or 53.3% vs 740 or 46.7%). Their age ranged from 13 to 97 years with a mean of 65.9 years. One thousand five hundred ninety-three different tumors had been resected during the studied period (some patients had >1 lesion). Basal cell carcinoma was the most common type, affecting 1399 patients (87.8%), followed by squamous cell carcinoma, which was identified in 109 patients (6.8%). Cutaneous melanoma was not a frequent diagnosis. Excision and primary closure represented the most frequent type of reconstruction, followed by flap reconstruction and any type of graft. Sidewalls were the usual location in the whole population. Recurrence rate was 3.4%., Conclusions: Nasal reconstruction remains a challenge for every plastic surgeon. Efficient diagnosis and appropriate reconstruction are prerequisites for the final desired outcome.

Cancer is regarded as abnormal cellular multiplication; it is not controlled by the organism, and its cells present a differentiated DNA. Initially, the disease does not show clinical signs, but it can be diagnosed by laboratory examinations. When tumors are present in the maxillofacial area, the carrier can lose structures in this area, resulting to the carrier's social environment exclusion. This article aims to show incidences and causes of malignant neoplasias in the maxillofacial area.

Among 1153 new adult cases of peripheral/T-cell lymphoma from 1990-2002 at 22 centers in 13 countries, 136 cases (11.8%) of extranodal natural killer (NK)/T-cell lymphoma were identified (nasal 68%, extranasal 26%, aggressive/unclassifiable 6%). The disease frequency was higher in Asian than in Western countries and in Continental Asia than in Japan. There were no differences in age, sex, ethnicity, or immunophenotypic profile between the nasal and extranasal cases, but the latter had more adverse clinical features. The median overall survival (OS) was better in nasal compared with the extranasal cases in early- (2.96 vs 0.36 years, P < .001) and late-stage disease (0.8 vs 0.28 years, P = .031). The addition of radiotherapy for early-stage nasal cases yielded survival benefit (P = .045). Among nasal cases, both the International Prognostic Index (P = .006) and Korean NK/T-cell Prognostic Index (P < .001) were prognostic. In addition, Ki67 proliferation greater than 50%, transformed tumor cells greater than 40%, elevated C-reactive protein level (CRP), anemia (< 11 g/dL) and thrombocytopenia (< 150 x 10(9)/L) predicts poorer OS for nasal disease. No histologic or clinical feature was predictive in extranasal disease. We conclude that the clinical features and treatment response of extranasal NK/T-cell lymphoma are different from of those of nasal lymphoma. However, the underlying features responsible for these differences remain to be defined.

Background: To analyze the incidence of the metastatic tumors within sinonasal tract in Taiwan and review the data in the English literature., Methods: Retrospective reviewed of patients from 1990 to 2005 with a histologically proven diagnosis of metastatic malignancies in the sinonasal tract., Results: Among seventeen enrolled patients, 9 were men and 8 were women, with ages ranging from 24 to 76 years old, with a mean of 50.8 years. In order of frequency, sinonasal metastatic tumors originated from the gastrointestinal tract (30%), liver (18%), kidney (18%), breast (18%), thyroid gland (12%) and lung (6%)., Conclusion: The incidence and characteristics of metastatic neoplasms in Taiwanese patients are comparable to other countries in East Asia, except for Japan. However, our data are very different when compared with European and North American reports. Different incidences of malignant neoplasms in the primary site may explain the result of different incidences of sinonasal metastatic tumor.

Objectives: To examine the risk of wood dust and chemical exposures for adenocarcinoma of the nasal cavity and paranasal sinuses (ADCN) among German wood workers., Methods: An industry-based case-control study with 86 male ADCN cases and 204 controls was conducted in the German wood-working industries. Cumulative and average wood-dust exposure was quantified with a job-exposure matrix based on wood-dust measurements at recent and historical workplaces. Probabilities of exposure to wood preservatives, stains, varnishes, and formaldehyde were semi-quantitatively rated. Odds ratios and 95% confidence intervals were calculated with logistic regression analysis conditional on age and adjusted for smoking and other factors. For estimating the risks of either wood dust or chemical additives, the authors additionally adjusted for the corresponding co-exposure., Results: ADCN occurred relatively more frequently among wood workers that had ever worked as cabinet makers or joiners (OR 2.96, 95% CI 1.46 to 6.01) than as saw millers (OR 0.15, 95% CI 0.03 to 0.68). Average exposure to inhalable wood dust >/=5 mg/m(3) was associated with a high risk (OR 48.47, 95% CI 13.30 to 176.63) compared to levels below 3.5 mg/m(3). Assuming 40 years of exposure under these concentrations, the corresponding OR was 4.20 (95% CI 1.69 to 10.43). Exposure between 3.5 and 5 mg/m(3) was also found to pose a risk (OR 10.54, 95% CI 3.34 to 33.27). Exposure to pigment stains before 1970 was associated with an increased risk (OR 3.03; 95% CI 1.11 to 8.26). No significant associations were estimated for wood preservatives, varnishes, and formaldehyde., Conclusions: The authors found an elevated ADCN risk for exposure to inhalable wood dust above 3.5 mg/m(3). The rareness of the disease does not allow the exclusion of risk below that concentration. For pigment stains, there is evidence for an association of historical exposure with the development of ADCN in German wood workers.

Nasal NK/T-cell lymphoma (NKTCL) is an uncommon disease, but usually shows a highly aggressive clinical course. The disease is much more frequent in Asian and Latin American countries than in Western countries, and is universally associated with Epstein-Barr virus (EBV) infection. Analyses of gene mutations, especially p53 and c-KIT, revealed the different frequencies by district. Epidemiological studies revealed the changes of the disease frequency in Korea during the period from 1977-1989 to 1990-1996. Case-control study showed that the exposure to pesticides and chemical solvents could be causative of NKTCL. Further studies including HLA antigen typing of patients is necessary to further clarify the disease mechanism.

Introduction: Cancers of nasal cavities and paranasal sinuses are not very frequent; they attract attention by their histological varieties. The aims of this study were to describe the epidemiologic and diagnostic characteristics of cancers of the cavities naso-sinusiennes in the service of ORL of the CHU of Treichville; and to evaluate their treatment., Patients and Methods: Were concerned 8 patients (6 men and 2 women) operated for cancer of the cavities naso-sinusiennes during the period from January 1996 to May 2007., Results: They mean aged 51 years; extremes from 28 to 75 years old. No significant factor supporting was raised. The diagnosis was late in the majority of the cases (T > 2: n=5). The way of rhinotomy paralateronasale was used for the tumoral excision associated a ganglionic clearing out in a case. The operational continuations were marked by neurological and ocular disorders. Three patients repeated. The operational follow-up post not having exceeded three months, the long-term evolution and mortality could not be evaluated., Conclusion: In our unit the epidemiologic and histological characteristics of cancers of nasal cavities and paranasal sinuses are common with those of the literature. Surgery was the main treatment witch was late and disappointing.

Endoscopic sinus surgery is a gold standard in chronic sinusitis since middle '80. More and more attention is put on endosnasal tumor removal with the endoscopic technique. Two major pathologies are present in the literature, the inverted papilloma and the angiofibroma. Other tumors are rare. In the ENT Department of Poznań Medical University, endoscopic removal of tumors of the nose and paranasal sinuses is done with the four hands technique. Since November 2006 to July 2007 12 cases were operated in our institution. Fully endoscopic removal was performed in 7 cases. In 2 cases an endoscopic assisted surgery was performed. In 3 cases a convertion to open surgery was necessary. Endoscopic approach to nonmalignant tumor of the nose and parana sal sinuses is an alternative to open surgery of tumor of the nose and paranasal sinuses. The four hands technique is very helpful and leads to extend limits of this surgery. Performing an endoscopic surgery of tumor one has to be prepared to make an intraoperative convertion to open surgery.

Introduction: Sinonasal malignances (SNM) usually present as a difficult diagnostic and therapeutic problem. In the paper presented, the epidemiological and clinical characteristics of SNM, diagnosed in Holy Cross Cancer Center in Kielce (Dept. of Otolaryngology, Head and Neck Surgery), from 2001 to 2007, as well as a calculated survival rates are discussed., Material and Methods: From the hospital data and current clinical observations of 87 patients with SNM the age, sex, localization, stage of the disease, pathology and treatment applied, was taken for analysis. In cases with at least 3 year observation, the Kaplan-Meier survival curves were calculated. Results. In the analyzed group of 87 cases, ranging from 8 to 82 years of age (average 62.3 years), there was 48 male, and 39 female patients (M:F = 1.2:1). 59.8% of all group was in the age above 60 years, with the most common age group 71-80 years (33.3%). The most common defined localization was a maxillary sinus (33.3%), but due to very advanced stage at time of diagnosis in 37.9% of cases, the precise localization within the region was not possible to define. The primary epithelial tumors were diagnosed in 52.9% (n=46), of all SNM, the non epithelial malignant tumors in 42.5% (n=37), and metastatic tumors to the nose and paranasal sinuses in 4.6% (n=4). In the group of epithelial SNM the Squamous cell carcinoma dominated (26/46-56.5%), and in the non epithelial SNM the most common group was a malignant lymphoma (10/37-27.0%). At time of diagnosis the majority of patients with epithelial SNM (80.4%) presented with advanced local stage of the disease (T3+T4a+T4b). The combined modality treatment was applied in the most of patients in the analyzed group (79.3%). The probability of 3 years disease free survival, calculated with Kaplan-Meier method was 64.0%, and 5-years survival--45.0%., Conclusions: (1) The SNM present as a very heterogeneous group of tumors. (2) The most common SNM are a Squamous cell carcinoma, and malignant lymphoma. (3) The majority of SNM are diagnosed at then advanced stage of local disease. (4) The calculated probability of 3-years survival was 64.0%, and 5-years survival 45.0%. (5) The diagnostic, as well as therapeutic approach to SNM requires a multidisciplinary cooperation.

Objective: The purpose of this work was to investigate the clinical manifestations and diagnostic range of malignant entities presenting as a nasal mass in the pediatric population., Patients and Methods: A retrospective cohort analysis was conducted at a specialty hospital and a tertiary care university hospital. Patients aged between birth and 18 years and diagnosed with a malignancy that arose within the nasal cavity between the years 1991 and 2006 were included. This institution-specific patient group was compared with a similar cohort of patients extracted from the national Surveillance Epidemiology and End Results database. The main outcome measures were the incidence, presentation, and diagnoses of nasal cancer presenting in this population., Results: Sixteen patients with nasal malignancies presented institutionally in the defined pediatric age group. Patient age at the time of diagnosis ranged from 7 months to 17 years, with a slight male predominance. The main presenting symptoms were unilateral nasal congestion and ophthalmologic complaints. The median time from presentation to diagnosis was 7 weeks; patients who presented with nonspecific complaints, such as nasal obstruction, headache, and fatigue, were given a diagnosis, on average, later than those who presented with focal manifestations. Nationwide, 47 patients were identified from the Surveillance Epidemiology and End Results database. In both subject groups, the most common diagnoses were rhabdomyosarcoma (37.5% institutionally and 23% in the Surveillance Epidemiology and End Results group) and esthesioneuroblastoma (25% institutionally and 28% Surveillance Epidemiology and End Results). In the Surveillance Epidemiology and End Results cohort, the overall mean survival rate was 188 months., Conclusions: Nasal cancer in the pediatric population often presents with nonspecific signs and symptoms, and a high index of suspicion is necessary for a timely diagnosis. Soft tissue sarcomas are expectedly common. The relative high frequency of esthesioneuroblastoma is particularly noteworthy.

Introduction: The mucosal malignant melanoma (MM), represent a rare group of tumors (0.2%--8% of all MM), with predominant localization on the mucosal surface of head and neck region, where the localization on the mucosa of nasal cavity, paranasal sinuses and oral cavity are the most common. The mucosal MM within the nose and paranasal sinuses represent approximately 4% of all malignant tumors in these localizations, affecting predominantly the age group over 60-es, equally in both sexes. The treatment of choice in mucosal MM is surgery followed by Rtg-therapy in cases of small or doubtful margins of resection. The prognosis of mucosal MM is poor with 8% to 30% of 5-years survival., Materials and Methods: 6 cases of mucosal MM, selected from 72 of all MM in the head and neck region, diagnosed and treated from 2001 to 2007 in Dept. of ORL H&N Surgery, Holy Cross Cancer Center in Kielce., Results: In group of mucosal MM which was taken to analysis there was 5 female and 1 male patient, with range of age from 55 to 80 (mean--69.4) with following localization: nasal septum--2 cases; lateral wall of nasal cavity--2; and paranasal sinuses--2. In 1 case an extremely rare pathologic form of amelanotic MM was diagnosed. The surgical resection of tumor followed by Rtg-therapy was performer in 4 cases. In 1 case, the radical surgery was the only method of treatment, and in 1 case the palliative Rtg-therapy was only applied. Within the observation period (4-96 months) 3 patients died, all due to the fatal progression of the MM., Conclusions: (1) Mucosal MM localized in the nasal cavity and paranasal sinuses, present a very rare, but highly diversified group of malignant tumors. (2) The surgery, followed by Rtg-therapy is still the treatment method of choice. (3) The prognosis of mucosal MM in the nose and paranasal sinuses is bad.

Objective: To determine prevalence, clinical features, and causes of epistaxis in dogs., Design: Retrospective case series., Animals: 176 dogs with epistaxis., Procedures: Medical records were reviewed for information related to signalment, clinical features, diagnosis, and outcome., Results: 132 (75%) dogs were initially examined by the hospital's emergency service; prevalence of epistaxis was 0.3%. Dogs with epistaxis were more likely to be old (> or = 6 years), male, and large (> or = 26 kg [58.5 lb]) than were dogs in a reference population. In 109 (62%) dogs with epistaxis, an underlying cause was identified; 115 underlying disorders were identified, with 90 classified as local and 25 classified as systemic. Local causes of epistaxis included nasal neoplasia (n = 35), trauma (33), idiopathic rhinitis (20), and periapical abscess (2). Systemic causes included thrombocytopenia (12), thrombocytopathia (7), coagulopathy (3), hypertension (2), and vasculitis (1). Dogs with local causes were more likely to have unilateral than bilateral epistaxis, but 11 of 21 (52%) dogs with systemic disorders also had unilateral epistaxis. Dogs with systemic disorders were more likely to have clinical signs of systemic disease. Duration of epistaxis (acute vs chronic), severity, and duration of hospitalization were similar for dogs with local versus systemic disorders., Conclusions and Clinical Relevance: Results suggested that epistaxis was a common disorder in dogs and frequently regarded as an emergency. Local causes of epistaxis were predominant, but clinical features traditionally thought to be helpful in distinguishing local versus systemic causes could not be reliably used for this purpose.

The antrochoanal polyp (Killian polyp) is an infrequent, benign neoplasm, which arises from the maxillary sinus to reach the ipsilateral choana. The treatment of this disease is essentially surgical, by means of a wide antrostomy. The aim of the study was to compare the results obtained on 23 consecutive cases of antrochoanal polyps endoscopically treated between February 1997 and January 2000 with those reported in the literature, with particular regard to the surgical technique adopted, the histological features, the patterns of its development and the clinical outcomes. The histology revealed in most of the cases a cystic aspect surrounded by edematous stroma. In all cases the polyp emerged from the middle meatus, mostly starting from the upper-lateral (zygomatic) wall of the antrum. All patients were endoscopically followed-up for an average period of 39 months (17-61). We observed two recurrences, both in pediatric cases who evidently underwent an incomplete surgical removal of antral mucosa at its inferior aspect, probably due to the fear of damaging the teeth buds. We did not observe any postsurgical complication. Our data indicate the endoscopic middle meatal antrostomy as the optimal approach, also for the revision cases and in children.

Small cell carcinoma (SCC) has become recognized as a distinct, though relatively infrequent, clinical pathology that occurs in multiple sites throughout the head and neck. Excluding cases that are considered to arise from skin, SCC in the head and neck has been found to develop in nearly all structures associated with the upper aerodigestive tract. Among the head and neck sites, the frequency of SCC is greatest in the larynx, with salivary glands and the sinonasal region comprising the other principle areas of origin. Controversy exist as to whether SCC can develop as a distinct entity in the thyroid, with most tumors that previously would have been considered as SCC now found to be lymphomas or variant forms of other types of thyroid malignancy. While there seems to be some differences among tumors arising from the various subsites, in general all SCC that originate in the head and neck have a tendency for aggressive local invasion and a strong propensity for both regional and distant metastasis. Treatment may include surgical resection, radiotherapy, chemotherapy, or some combination of these modalities. Due to the infrequency of these tumors, it is very unlikely that any large, controlled study will ever be done. For this reason, recommendations for treatment of SCC arising in the head and neck are based primarily on retrospective data from various small case series and on comparative data for treatment of SCC of bronchogenic and other extrapulmonary origin. Although patients with truly limited local disease may enjoy some prolonged survival, most patients with this tumor do poorly despite all current attempts at treatment.

Cases of nasal NK/T-cell lymphoma (NKTCL) occur occasionally in Asian and Latin American countries but rarely in Western countries. The etiological role of life-style and environmental factors in nasal NKTCL was investigated. Five university hospitals in Japan and one each in Korea and China participated in this study; a total of 88 cases and 305 hospital controls were accrued during 2000-2005. The odds ratio (OR) of NKTCL obtained after adjustments of age, sex and country was 4.15 (95% confidence interval (CI), 1.74-9.87) for farmers, 2.81 (CI, 1.49-5.29) for producers of crops, 4.01 (CI, 1.99-8.09) for pesticide users, 11.65 (CI, 1.17-115.82) for residents near garbage burning plants, 2.95 (CI, 1.25-6.95) for former drinkers, and 0.49 (CI, 0.23-1.04) for current smokers. The ORs for crop producers, who minimized their exposure to pesticides by using gloves and glasses, and sprinkling downwind at the time of pesticide use, were 3.30 (95% CI, 1.28-8.54), 1.18 (95% CI, 0.11-12.13) and 2.20 (95% CI, 0.88-5.53), respectively, which were lower than those for producers who did not take these precautions. Exposure to pesticides and chemical solvents could be causative of NKTCL. Taken together, life-style and environmental factors might be risk factors for NKTCL., ((c) 2006 Wiley-Liss, Inc.)

Unlabelled: The aim of this study was retrospective analysis of evidence concerning to malignant tumors of the nasal cavity and the paranasal sinuses diagnosed in Otolaryngology Clinic of the Military Institute of the Health Service 1971-2005. The methods of therapy were also discussed., Material and Methods: Material comprised 113 patients (35 females and 78 males) with diagnosis of malignant tumors of the nose and paranasal sinuses. The clinical aspects, sex, age, TNM classification and therapy methods (surgery, radiotherapy, chemotherapy) were analysed., Results: There were 31% females and 69% males (ratio 1 : 2.23). Each year on average 3.23 cases occurred. The highest morbidity was observed in 1997 and 2001 (6 cases each). In 89 subjects (23 females and 66 males) the neoplasm of epithelial origin were diagnosed. The age range of patients was 14-74 years (mean 68.2 years). The most numerous were groups of 60-69 (50 patients) and 70-79 (44 patients). In 82 cases (over 72%) tumors in advanced stages (T3, T4) were revealed. Two subjects (T1) were opera tem on and others 88 (T2, T3, T4) were treated surgically with subsequent radiotherapy. Three of patients did not agree for therapy., Conclusions: The most frequent of malignant tumors of the nose and paranasal sinuses was cancer. The clinical symptoms of tumor were disclosed most often in age of 60-80 years. The method of choice in treatment is surgery combined with postoperative radiation.

Objective: The aim of this study is to define the epidemiological aspects of carcinoma of the nasal cavity and paranasal sinuses., Material and Methods: We performed a retrospective study of 72 carcinomas of the nasal cavity and paranasal sinuses. Various sites, age and sex distribution, drug consumption, TNM stage grouping and treatment were reported., Results: The average age was 63. Seventy- five percent of patients (54/72) were male and 25% (18/72) female. The site of origin was paranasal sinuses in 46 patients (64%), 30 in ethmoid sinus, 15 in maxillary sinus and 1 in sphenoid sinus. Twenty-six patients (36%) were located in nasal cavity. Squamous cell carcinoma was the most frequent histological type in both localizations. The 5-year adjusted survival rate for all patients was 60% (IC: 54-66), 36% (IC: 28-44) for paranasal sinus carcinoma and 86% (IC: 79-93) for nasal cavity carcinoma. The 5-year adjusted survival rate according to the T distribution in 46 carcinomas paranasal sinus was 80% T2, 71% T3, 19% T4a and 6% T4b.(p = 0.0002)., Conclusions: Carcinoma of nasal cavity and paranasal sinuses represent a group of tumors that differ from the rest of carcinomas of the head and neck.

Objective: To evaluate the clinicopathological profile of sinonasal inverted papilloma in a tertiary referral center in eastern part of Nepal., Methods: A prospective study consisting of total 28 histologically proven cases of sinonasal inverted papilloma was conducted in the ENT department of the center. The study period was from April 2002 to November 2005., Result: Out of 28 cases studied, 21 were males and 7 were females with male to female ratio of 3:1. The highest incidence was seen in the 5th and 6th decades of life. The duration of symptoms varied from 5 months to 20 years with mean duration of 3.9 years. The lateral nasal wall and nasal cavity involvement was seen in all 28 cases. Maxillary sinus was involved in 27(96.4%) subjects followed by ethmoid (20), sphenoid (10) and the frontal sinus (7). The principle presenting symptom was nasal obstruction seen in 96.4% of the patients. Twenty two cases were treated by lateral rhinotomy with medial maxillectomy while, orbital exenteration was done in two cases. Associated carcinoma was noticed in 10.15% of all the subjects studied., Conclusion: Sinonasal papilloma mostly presented in fifth to six decades of life mainly affecting the male patients. Majority of the patients were treated by lateral Rhinotomy with medial maxillectomy surgery. Early presentation would have given chances for endoscopic surgery.

Background: Cancer rates of the head and neck are traditionally linked to public health issues., Objective: To describe the epidemiology of head and neck cancer in the United States., Design and Setting: National Cancer Institute's Surveillance Epidemiology and End Results (SEER) program., Results: A total of 75,000 cases of head and neck cancer were diagnosed in 2001. Incidence is rising in thyroid (up 52%), bone (43%) soft tissues (20%), salivary (20%), tongue (16%), tonsil (12%), and nose (12%). Incidence is falling in lip (down 58%), hypopharynx (35%), cervical esophagus (32%), oropharyngeal mucosa (26%), and larynx (26%). There were 30,000 deaths from head and neck cancer in 2001. Mortality has decreased to some degree at all sites except thyroid where it was stable., Conclusion: Many head and neck cancers have changing incidence and mortality rates contrary to expected changes given trends in public health issues. Further investigation of risk factors, diagnostic practices, and management strategies is warranted., Ebm Rating: 2C.

Extramedullary plasmacytomas are uncommon tumors, with a worldwide annual incidence of 3 per 100,000 population. They account for 1% of all tumors of the head and neck and 4% of all nonepithelial tumors of the nasal tract. A variety of treatment options has been suggested. These treatments vary according to the site of presentation, the presence of locoregional spread, and the histologic picture. Radiotherapy has been widely used as a treatment modality, but little has been written about surgery as a single management modality. However, such an option assumes importance in a developing nation, where patient follow-up is erratic and treatment costs must be kept low. We discuss the feasibility of surgery in such a circumstance, and we describe our surgical treatment of a case of extramedullary plasmacytoma in an elderly woman who presented to our hospital in India.

Objective: To report the epidemiological and clinical features of nasal and paranasal sinus cancers collected during a period of 35 years at the Salah Azaiez Institute of Tunis., Material and Methods: This retrospective study concerned patients with histologically confirmed nasal and paranasal sinus cancers treated at our institute from 1969 to 2004. We collected the following data: age, sex, residence (rural or urban), site, occupation and professional exposure, histological type and tumor extension., Results: We identified 265 cases (163 M; 102 F; Sex-ratio=1.65) with a mean age of 60 years (3 months - 91 years). Epidermoid carcinoma (47%) and adenocarcinoma (16%) predominated followed by sarcoma (14%) and melanoma (6%). We observed only 2 cases (0.7%) of ethmoidal adenocarcinoma., Conclusion: Nasal and paranasal cancers in Tunisia are linked more to chronic rhino-sinusal inflammation than professional exposition (wood).

Dogs and cats of our society have outgrown their status as merely pets and are now considered our close companions and even family members. This shift in their roles has led to pet owners seeking improved preventative medicine for their four-legged friends. Subsequently, dogs and cats are living longer lives than ever before and developing more old-age-related diseases. One of the most devastating diseases of older animals is cancer. Once a veterinarian has detected cancer in a pet, pet owners seek advice on their next course of action. This article is intended to provide concise information regarding the diagnosis and treatment of intranasal tumors of the dog and cat. This article outlines the forms of nasal tumors that are the most common, the recommended imaging and biopsy techniques to diagnose the tumor, and the most appropriate treatments of them.

In Japan, EBV positive rate in immunocompetent patients with nodal lymphomas is less than 10% in B-cell and 20-50% in T cell lymphoma. Among extranodal lymphomas, EBV positive rate is higher in pyothorax-associated lymphoma (PAL), nasal NK/T-cell lymphoma, and adrenal lymphoma. PAL is non-Hodgkin's lymphoma that develops from chronic pyothorax resulted from artificial pneumothorax for the treatment of lung tuberculosis or tuberculous pleuritis. This disease was originally described by Dr. Aozasa as a distinctive clinicopathologic entity in 1987, and now listed as the disease entity in the WHO classification of Tumours, Pathology & Genetics, Tumours of the Lung, Pleura, Thymus and Heart (2004).

SUMMARY Clinicopathological and electron microscopical findings of eight cases of enzootic nasal adenocarcinoma of sheep, diagnosed solely in one big flock in Slovenia between years 2001 and 2003 are described. All affected sheep were female, their mean age was 4.5 +/- 1.5 years and they either belonged to the Istrian pramenka breed (five sheep) or were crossbreeds (three sheep). Tumours that arose from the ethmoid area of the nasal cavity were unilateral in six cases (75%) and bilateral in two cases (25%). All tumours were classified as adenocarcinomas by histopathological examination and they displayed either a combination of tubular and papillary growth or less often solely tubular proliferation. No metastases were detected in regional lymph nodes, brain or other organs. Electron microscopical studies performed on the reprocessed paraffin-embedded tissues revealed the presence of the virus-like particles with an average diameter between 70 and 90 nm.

Unlabelled: Osteoma (0.01-0.4%) and inverted papilloma (0.5-4%) are the most common benign tumours of the nose and paranasal sinuses, whereas heamangioma occurs very rare. Orbital and ocular symptoms are uncommon in these types of neoplasmas., Aim of the Study: Analysis of symtoms, diagnostic procedures and treatment options in 10 patients with diagnosed orbital and ocular complications of benign tumours of the nose and paranasal sinuses., Material and Methods: There are 4 cases of inverted papilloma, 3 cases of osteoma and 3 cases haemangioma. All patients had laryngological, ophtalmological examination, radiografic evaluation by plain film--4 cases, CT--9 patients and angiography in 1 case. Presenting orbital and ocular symptoms occured in 7 patients and in 3 left person orbital involvement was presented only radiographically and intraoperatively. In 5 cases there were correlation between orbital symptoms and radiologic findings. The most common presenting feature--orbital pain (6 patients) and proptosis (5 patients) were observed in papilloma and haemangioma. In 8 cases there were signs of bone destruction in CT, what was intraoperatively confirmed in 4 cases., Results: Nine of the patients were operated: 4--lateral rhinotomies, 2--Denker's operations, 2--operations of sinus frontalis and/or ethmoidalis by external approach and in 1 case resection of maxilllary sinus's tumor were performed. In 2 patients with inverted papilloma there were recurrences 3 years followed operation. The rest of patients stay without recurrences of tumor., Conclusion: Orbital and ocular symptoms in benign tumors of nose and paranasal sinuses do not always correlate with radiologic and intraoperative findings.

On the base of retrospective analysis of 927 cases of malignant neoplasms of the nose and paranasal sinuses, diagnosed and treated in 10 clinical centers in Poland from 1992-2001, the assessment of basic epidemiological data, including the localization of tumor, and stage of local and clinical advancement of the disease at the time of diagnosis has been conducted. In analyzed period of 10 years the trends to change the mentioned above parameters has been examined. The index of morbidity in this period was constant and compareable with figures published earlier. In the analyzed material there is a predominance of males and the sex ratio was 1.45. The majority of cases were between 50-69 years (55%). The most common histopathological diagnosis was carcinoma (58%). The majority of cases of malignant tumors of the nose and paranasal sinuses was diagnosed in the advanced stage T3-T4 (72.3%) with the highest percentage in the middle region. 90% of all cases were treated surgically, but in about 30% it was the only treatment (also in cases of stage T2-T4). In 56% of all patients the surgical procedure was completed by radiotherapy. This data suggest that indications for additional irradiation should be extended.

Unlabelled: Malignant neoplasms of the nose and paranasal sinuses occur rarely but due to late diagnosis and poor treatment effects still remain a serious problem. The aim of the study was the analysis of all nose and paranasal sinus neoplasms treated at Lower Silesia in the years 1992-2001., Material and Methods: In the years 1992-2001 in Lower Silesia region there were 182 patients treated for malignant nose and paranasal sinus tumors. Males outnumbered females significantly with male : female ratio was 1.9:1. Principal management was combined therapy--surgery with radiotherapy in 84% of the cases. Radiotherapy alone was performed in 8.8% and chemotherapy as palliative treatment in 7.1%. Fifteen patients (8.2%) underwent radical neck dissection followed by radiotherapy., Results: The analysed group constituted 79.6% patients with epithelial tumors and 20.4% with nonepithelial tumors. Cases T3-T4 predominated in the material in amount of 77.9% (113). There were 15 T2 cases (10.4%) and none of T1. Most of the tumors (57%) arose from middle segment of ethmomaxillary sinuses. Upper segment tumors constituted 18.6% of cases and lower segment--10.4%. Enlarged lymph nodes were diagnosed in 8.2%. Survival rate analysis in patient treated in the years 1992-2001 revealed 37.9% (69) of 3-year survival and 30.2% (55) of 5-year survival., Conclusions: Unsatisfactory results of treatment are an effect of a high advanced stage of the tumor while diagnosed. Its direct causes are: asymptomatic course of the disease, localization in complex anatomical structure, not enough experience among medical staff dealing with the disease very rarely.

The sino-nasal inverted papilloma is a rare benign tumour with certain aggressive features because of frequent relapses and the high probability of malignant degeneration. For these reasons, several studies have been made to evaluate the efficacy of the different courses of treatment, but only afew studies have been carried out to establish the etiology of this tumour, which is still uncertain. Although it is believed that viral infection, chronic inflammation and cigarette smoking can play an important etiological role, it has recently been suggested that occupational risk factors, such as those involved in malignant epithelial sino-nasal cancer (SNC), can also be involved in causing sino-nasal inverted papilloma. A group of 70 patients was examined who have been diagnosed with inverted papilloma from 1991 to 2003; the occupational history, collected via the standardized questionnaire, showed that risk factors like wood and leather dusts, chromium and nickel vapours or fumes and formaldehyde were associated with only 5% of all cases. This proportion is much lower than that established for SNC in several epidemiological studies. Although occupational environmental pollution can be a source of chronic sino-nasal mucosa irritation, on the basis of our results we believe that a causal relationship between exposure to occupational risk factors and inverted papilloma is not likely, differently from the suggestions made in other studies. Consequently, an epidemiological surveillance of inverted papilloma as a "sentinel" tumour, as has been proposed in Italy for SNC, is not considered necessary. Among the possible non-occupational risk factors we observed that 75% of the male patients were smokers and 40% of all patients suffered from chronic sinusitis and sino-nasal polyps. Lastly, among the 70 cases of inverted papilloma, we observed 5 with malignant degeneration.

Objectives: There is controversy about whether all nasal polyps removed at operation should be sent for histopathologic examination. The primary aim of this study was to assess the incidence of unsuspected clinically relevant diagnoses in a large series of patients undergoing nasal polypectomy. A review of the literature on the frequency of this event was also performed., Study Design: Retrospective study and review., Methods: Data from patients undergoing nasal polypectomy over a 14 year period were reviewed. All adult patients undergoing first surgical removal of bilateral nasal polyps were included. Monolaterality and presence of suspicious looking lesions were exclusion criteria., Results: A total of 2,147 patients were recruited. Eight cases of clinically relevant unexpected diagnoses were identified, corresponding to a frequency of 0.37% (95% confidence interval 0.16-0.73%). Inverted papilloma occurred in seven cases, neoplasia in one case. Affected patients tended to be older. Four previous smaller studies on this topic were identified. The reported incidence of unsuspected clinically relevant diagnoses varied between 0.00% and 0.92%., Conclusions: Although rare, unexpected clinically relevant findings may be identified during routine histologic examination of nasal polyps specimens. Future cost effectiveness analyses are required to clarify whether routine histology is a cost effective strategy.