ENT tumors (1).pdf

Otolaryngoloical tumors Dr.Sally A.Elrhman Hassan ENT specialist S.M.S.B M.B.B.S Alzaeem Alazhari University Benign tumors of external nose Rhinmophyma: slow growing tumor hypertrophy of the sebaceous glands of the tip of the nose seen in longstanding case of...

Otolaryngoloical tumors Dr.Sally A.Elrhman Hassan ENT specialist S.M.S.B M.B.B.S Alzaeem Alazhari University Benign tumors of external nose Rhinmophyma: slow growing tumor hypertrophy of the sebaceous glands of the tip of the nose seen in longstanding case of acne rosacea Clinical features: - middle age 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 affecting male and female Affects age group 50-60yrs Common sites are tip and ala Remains confines to the skin for long time Underlying cartilage and bone may involved Nodal mets is rare Treatment : Surgical excision with safety margins and reconstruction of the defect  Basal cell carcinoma  Squamous cell carcinoma The second most malignant tumor Infiltrating nodule or ulcer with rolled out edges Nodal metastasis in 20% Treatment Early lesions treated by radiotherapy Late with nodal mets requires wide surgical excision and neck dissection + plastic repair of the defect  Malignant melanoma The least common variety Clinically: Superficial spreading type Nodular infiltrating type Treatment: Surgical excision Repair of the defect Malignant melanoma  Sinonasal Tumors Benign & malignant Epithelial and non-epithelial tissue+ lymphoreticular tumors Rare tumors, carcinomas accounts for 3% of head and neck carcinomas Male: Female ratio 2:1 5th-7th decades  Benign tumors 1-epithelial : papilloma and adenoma 2-non-epithelial : fibroma, osteoma, neurofibroma and hemangioma Malignant tumors 1- epithelial :Squamous cell carcinoma,Transitional cell carcinoma,Adenocarcinoma,Adenoid cystic carcinoma, Melanoma,Olfactory neuroblastoma,Undifferentiated carcinoma 2- non-epithelial :Rhabdomyosarcoma, Leiomyosarcoma, Fibrosarcoma, Liposarcoma, Angiosarcoma, Myxosarcoma, Hemangiopericytoma, Chondrosarcoma, Osteosarcoma. Lymphoreticular tumors : Lymphoma, Plasmacytoma & Giant cell tumor.  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 S/S unilateral nasal obstruction, epistaxis or non specific symptoms. Primary site is lateral nasal wall followed by maxillary the ethmoid sinuses.  It mimics benign polyp in appearance or lobulated appearance. Investigations include CT scan, MRI in case of intracranial extension, biopsy for histopathology Treatment by complete surgical resection Endoscopic removal for selected patients  Juvenile angiofibroma Rare, vascular benign tumor.05% of all nasal tumors Most commonly affects male of teenage or young adults age. Arise from area superior to sphenopalatine foramen. Histologically, JA consists of 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, it appears as a reddish, smooth polypoid mass. CT scan, MRI Arteriography : feeding vessels and pre-operative embolization(IMA, ascending pharyngeal A) Treatment is by surgical removal 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 (Guangdong). Western of Sudan. Genetic, ethnic, and environmental factors may play a role in the etiology of the disease. The consumption of salted fish (nitrosamine).  Epstein-Barr virus (EBV) has also been considered to play an oncogenic role, because the EBV genome is frequently detected in the biopsy specimens of NPC First-degree relatives of patients with NPC, their incidence of developing this malignancy is six times higher than controls. It occurs in three forms proliferative (mass), ulcerative (epistaxis,blood-stained discharge) or infiltrative ( cranial nerves affection)  WHO classification Type I: those typical keratinizing SCC with intercellular bridges, similar to those found in the rest of the upper aerodigestive tract. Type II: nonkeratinizing epidermoid carcinomas. They show evidence of maturation but without definite squamous differentiation. Type III: undifferentiated or poorly differentiated carcinomas. These cells have indistinct cell margins with hyperchromatic nuclei. Type I and II(II + III)  The most frequent presenting symptom is a painless neck mass (Level V/ II cervical LN) Nasal obstruction and discharge Unilateral deafness (otitis media with effusion) & otolagia. Cranial nerve involvement Symptoms related to distant metastasis are relatively uncommon in NPC.  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 and radiation Role of surgery for debulking or recurrent disease  Oropharyngeal Malignancies Tobacco products and alcohol Precancerous lesions include leukoplakia and erythroplakia Most common is Squamous cell carcinoma (90%) Other include Lymphoma , spindle cell carcinoma and minor salivary gland tumors Base of the tongue and tonsils are the most involved sites. Sore throat ,otalgia& dysphagia, feeling of lump and neck swelling (metastatic node).  On examination either mass or ulcer Cervical Lymph node ( level I/II) Investigations include biopsy- FNA cytology- CT scan neck Treatment depend on the histopatholgy and stage Surgery- Radiation- Chemotherapy  Hypopharyngeal Malignancies Tobacco products, alcohol and acid reflex Plummer-Vinson disease/ postcricoid carcinomas Most common is Squamous cell carcinoma Most frequent involved subside is the pyriform fossa, followed by postcricoid area, and the least frequent is the posterior pharyngeal wall.  Presentation is by dysphagia , otalgia, neck swelling and chronic sore throat May be past history of anaemia 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 Sallow study. Radiation/chemotherapy- surgery.  Laryngeal Tumours Most common bengin tumour is Squamous papillomas Human papillomavirus Recurrent respiratory papillomatosis children Adult-onset papillomas solitary or localized Treated surgically ( laser ).  Most common malignant tumour is Squamous cell cacinoma Male predominance Alcohol, smoking, acid reflex, Human papilloma virus Industrial carcinogens Glottic and supraglottic are the most common subglottic is rare  Presentation : 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