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Questions and Answers
What is the most common site of Basal cell carcinoma?
What is the most common site of Basal cell carcinoma?
What is the treatment for Rhinophyma?
What is the treatment for Rhinophyma?
What is the percentage of nodal metastasis in Squamous cell carcinoma?
What is the percentage of nodal metastasis in Squamous cell carcinoma?
What is the most common type of skin tumor?
What is the most common type of skin tumor?
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What is the age group most commonly affected by Basal cell carcinoma?
What is the age group most commonly affected by Basal cell carcinoma?
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What is the male to female ratio of Sinonasal tumors?
What is the male to female ratio of Sinonasal tumors?
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What is the percentage of head and neck carcinomas that are Sinonasal tumors?
What is the percentage of head and neck carcinomas that are Sinonasal tumors?
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What is the treatment for early lesions of Squamous cell carcinoma?
What is the treatment for early lesions of Squamous cell carcinoma?
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What is the percentage of sinonasal tumors that are lymphoreticular tumors?
What is the percentage of sinonasal tumors that are lymphoreticular tumors?
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Which of the following is a common symptom of inverted papilloma?
Which of the following is a common symptom of inverted papilloma?
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What is the primary site of inverted papilloma?
What is the primary site of inverted papilloma?
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What is the most common age group affected by juvenile angiofibroma?
What is the most common age group affected by juvenile angiofibroma?
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What is the appearance of juvenile angiofibroma on examination?
What is the appearance of juvenile angiofibroma on examination?
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What is the most common type of nasopharyngeal carcinoma?
What is the most common type of nasopharyngeal carcinoma?
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Which of the following is a risk factor for nasopharyngeal carcinoma?
Which of the following is a risk factor for nasopharyngeal carcinoma?
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Which of the following arteries is involved in the embolization of juvenile angiofibroma?
Which of the following arteries is involved in the embolization of juvenile angiofibroma?
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What is the most common malignant tumour in laryngeal tumours?
What is the most common malignant tumour in laryngeal tumours?
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What is the most common involved subsite in hypopharyngeal malignancies?
What is the most common involved subsite in hypopharyngeal malignancies?
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What is the cause of recurrent respiratory papillomatosis in children?
What is the cause of recurrent respiratory papillomatosis in children?
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What is the presentation of hypopharyngeal malignancies?
What is the presentation of hypopharyngeal malignancies?
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What is the treatment of adult-onset papillomas?
What is the treatment of adult-onset papillomas?
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What is the risk factor for laryngeal tumours?
What is the risk factor for laryngeal tumours?
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What is the investigation of choice for hypopharyngeal malignancies?
What is the investigation of choice for hypopharyngeal malignancies?
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What is the common site of cervical lymph node metastasis in laryngeal tumours?
What is the common site of cervical lymph node metastasis in laryngeal tumours?
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What is the frequency of developing nasopharyngeal carcinoma (NPC) in first-degree relatives of patients with NPC compared to controls?
What is the frequency of developing nasopharyngeal carcinoma (NPC) in first-degree relatives of patients with NPC compared to controls?
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What is the most frequent presenting symptom of nasopharyngeal carcinoma (NPC)?
What is the most frequent presenting symptom of nasopharyngeal carcinoma (NPC)?
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What is the role of surgery in the treatment of nasopharyngeal carcinoma (NPC)?
What is the role of surgery in the treatment of nasopharyngeal carcinoma (NPC)?
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What is the most common type of oropharyngeal malignancy?
What is the most common type of oropharyngeal malignancy?
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What is the typical location of oropharyngeal malignancies?
What is the typical location of oropharyngeal malignancies?
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What is the type of nasopharyngeal carcinoma (NPC) that shows evidence of maturation but without definite squamous differentiation?
What is the type of nasopharyngeal carcinoma (NPC) that shows evidence of maturation but without definite squamous differentiation?
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What is the diagnostic test that involves taking a biopsy from the nasopharynx?
What is the diagnostic test that involves taking a biopsy from the nasopharynx?
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What is the suspected oncogenic virus in nasopharyngeal carcinoma (NPC)?
What is the suspected oncogenic virus in nasopharyngeal carcinoma (NPC)?
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Study Notes
Benign Tumors of the External Nose
- Rhinophyma: a slow-growing tumor characterized by hypertrophy of the sebaceous glands of the tip of the nose, often seen in longstanding cases of acne rosacea
- Clinical features: middle-aged men, pink lobulated mass over the tip of the nose with superficial vascular dilatation, nasal obstruction
- Treatment: tumor debulking and grafting the defect
Malignant Tumors of the External Nose
- Basal cell carcinoma (Rodent ulcer):
- Most common skin tumor
- Equally affects male and female
- Affects age group 50-60 years
- Common sites are the tip and ala
- Remains confined to the skin for a long time, may involve underlying cartilage and bone, with rare nodal metastasis
- Treatment: surgical excision with safety margins and reconstruction of the defect
- Squamous cell carcinoma:
- Second most malignant tumor
- Infiltrating nodule or ulcer with rolled out edges
- Nodal metastasis in 20%
- Treatment: early lesions treated by radiotherapy, late lesions with nodal metastasis require wide surgical excision and neck dissection + plastic repair of the defect
- Malignant melanoma:
- Least common variety
- Clinically: superficial spreading type, nodular infiltrating type
- Treatment: surgical excision, repair of the defect
Sinonasal Tumors
- Rare tumors, carcinomas account for 3% of head and neck carcinomas
- Male: Female ratio 2:1
- 5th-7th decades
- Benign tumors:
- Epithelial: papilloma, adenoma
- Non-epithelial: fibroma, osteoma, neurofibroma, hemangioma
- Malignant tumors:
- Epithelial:
- Squamous cell carcinoma
- Transitional cell carcinoma
- Adenocarcinoma
- Adenoid cystic carcinoma
- Melanoma
- Olfactory neuroblastoma
- Undifferentiated carcinoma
- Non-epithelial:
- Rhabdomyosarcoma
- Leiomyosarcoma
- Fibrosarcoma
- Liposarcoma
- Angiosarcoma
- Myxosarcoma
- Hemangiopericytoma
- Chondrosarcoma
- Osteosarcoma
- Lymphoreticular tumors: Lymphoma, Plasmacytoma, Giant cell tumor
- Epithelial:
Inverted Papilloma
- 5-4% of all sinonasal tumors
- Human papilloma virus
- 5th-6th decade, more common in male, usually unilateral
- High tendency for recurrence
- Presenting symptoms: unilateral nasal obstruction, epistaxis, or non-specific symptoms
- Primary site: lateral nasal wall, followed by maxillary and ethmoid sinuses
- Investigations: CT scan, MRI in case of intracranial extension, biopsy for histopathology
- Treatment: complete surgical resection, endoscopic removal for selected patients
Juvenile Angiofibroma
- Rare, vascular benign tumor, 0.5% of all nasal tumors
- Most commonly affects male of teenage or young adults
- Arises from area superior to sphenopalatine foramen
- Histologically: multiple vascular channels surrounded by fibrous connective tissue
- Unilateral epistaxis, nasal obstruction, or both
- Unilateral middle ear effusion, proptosis, diplopia, cheek swelling with or without pain
- On examination: reddish, smooth polypoid mass
- Investigations: CT scan, MRI, arteriography, feeding vessels, and pre-operative embolization
- Treatment: surgical removal by external or endoscopic approach, irradiation, and chemotherapy for poor surgical candidates
Nasopharyngeal Carcinoma
- Squamous cell carcinoma (SCC) arising from the epithelial lining of the nasopharynx
- Fossa of Rosenmuller, ethnic Chinese in the southern part of China, and Western Sudan
- Genetic, ethnic, and environmental factors may play a role in the etiology of the disease
- The consumption of salted fish (nitrosamine) and Epstein-Barr virus (EBV) may play a role in the etiology
- First-degree relatives of patients with NPC have a higher incidence of developing this malignancy
- Three forms: proliferative (mass), ulcerative (epistaxis, blood-stained discharge), and infiltrative (cranial nerves affection)
- WHO classification:
- Type I: typical keratinizing SCC with intercellular bridges
- Type II: non-keratinizing epidermoid carcinomas
- Type III: undifferentiated or poorly differentiated carcinomas
- Presenting symptoms: painless neck mass (Level V/II cervical LN), nasal obstruction, discharge, unilateral deafness, otalgia, cranial nerve involvement, and symptoms related to distant metastasis
- Diagnosis: clinical picture, estimation of antibody levels against EBV, imaging studies, endoscopic examination of the nasopharynx, and taking a biopsy, FNA cytology from the involved cervical lymph node/s
- Treatment: chemotherapy, radiation, and role of surgery for debulking or recurrent disease
Oropharyngeal Malignancies
- Tobacco products, alcohol, and genetic factors
- Precancerous lesions: leukoplakia and erythroplakia
- Most common: Squamous cell carcinoma (90%)
- Other: Lymphoma, spindle cell carcinoma, and minor salivary gland tumors
- Base of the tongue and tonsils are the most involved sites
- Presenting symptoms: sore throat, otalgia, dysphagia, feeling of lump, and neck swelling
- On examination: mass or ulcer, cervical lymph node (level I/II)
- Investigations: biopsy, FNA cytology, CT scan neck
- Treatment depends on the histopathology and stage: surgery, radiation, and chemotherapy
Hypopharyngeal Malignancies
- Tobacco products, alcohol, acid reflux, and Plummer-Vinson disease/ postcricoid carcinomas
- Most common: Squamous cell carcinoma
- Most frequent involved subsite: pyriform fossa, followed by postcricoid area, and least frequent is the posterior pharyngeal wall
- Presenting symptoms: dysphagia, otalgia, neck swelling, and chronic sore throat
- May be past history of anemia and web
- On examination: mass, immobile vocal cord, pooling of saliva in the pyriform fossa
- Cervical lymph nodes (level II/III)
- Investigations: biopsy, FNA cytology from lymph node, CT scan, and Barium Swallow study
- Treatment: radiation/chemotherapy, surgery
Laryngeal Tumors
- Most common benign tumor: Squamous papillomas
- Human papillomavirus
- Recurrent respiratory papillomatosis: children
- Adult-onset papillomas: solitary or localized
- Treatment: surgical (laser)
- Most common malignant tumor: Squamous cell carcinoma
- Male predominance
- Alcohol, smoking, acid reflux, Human papilloma virus, and industrial carcinogens
- Glottic and supraglottic are the most common subsites, subglottic is rare
- Presenting symptoms: hoarseness of voice, stridor, dysphagia (supraglottic)
- Cervical lymph node metastasis incidence is more in supraglottic
- Examination: mass, vocal cord mobility
- Biopsy, CT scan neck
- Chemoradiation/surgery
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Description
This quiz covers the features and treatment of benign tumors of the external nose, including Rhinophyma. It's a crucial topic for ENT specialists and medical students.
