[Nose neoplasms and paranasal sinus neoplasms].
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Undifferentiated neoplasms of nose and nasal sinuses are very rare. They are very difficult to diagnose by both light and electron microscopies. Twelve cases of undifferentiated neoplasms of nose and nasal sinuses were collected and the morphological features under light and electron microscopes compared histologically. The results showed that correct diagnoses were only obtained in six cases by light microscopy. The other six cases were diagnosed by electron microscopy as malignant melanomas in two cases, leiomyosarcoma in one case, olfactory neuroblastomas in two cases and malignant fibrous histiocytoma in one case. It showed that a correct diagnosis for undifferentiated neoplasm of nose and nasal sinuses was impossible to obtain by light microscopy only. Poorly differentiated olfactory neuroblastoma was also difficult to diagnose under electron microscope because the neurosecretory cytoplasmic granules were not easy to find and several hours would be required to search for them under electron microscope.
International incidence and mortality data for ICD rubric 160 (nose and nasal cavities, middle ear and accessory sinuses) are reviewed, the relative frequency data for cancer for each of the constituent anatomical locations presented and the histological types of neoplasms encountered tabulated to determine if geographical differences exist which might be worth further investigation. Relatively high rates for this generally rare disease were found in Asian and African populations, the highest age-adjusted rates, between 2.6 and 2.5 per 100,000 per annum, occurring in Japanese males. Independent of the higher rates, the extremely low proportion of cancers of the nose and nasal cavities together with the very high proportion of cancer of the maxillary sinus in Japan are in contrast with a much higher relative frequency of nose and nasal cavity cancer in other countries. These findings seem to justify further studies of these tumours in this country, particularly as none of the known aetiological factors reviewed in this paper explain the high rates for this cancer in Japan.
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A review of 250 patients with malignant disease of the nose and paranasal sinuses treated over a 20 year period is presented. Treatment could be divided broadly into three groups consisting of subradical surgery plus radiotherapy; a drainage procedure plus radiotherapy and radiotherapy alone. Three and 5 year survival rates are presented for each mode of treatment for tumours originating in four anatomical sites. In tumours of the maxillary antrum the 5 year survival was significantly higher in patients who underwent a partial maxillectomy or palatal fenestration before radiotherapy. In the other anatomical sites the survival rates were not significantly different. Although this is an uncontrolled retrospective review, it does add further data to that already published on this uncommon but difficult management problem.
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The author analyzes and discusses characteristic features of the results of combined treatment in 260 patients with malignant tumours of the superior maxilla, nose and accessory sinuses. The majority of patients were from 40 to 60 years old (81.5%). These were 158 men and 102 women. Epithelial tumours were diagnosed in 91.5%, sarcomas in 8.5% cases. The flattened-cell form of cancer with or without keratosis was diagnosed in 82.7%; other forms of cancer-in 17.3% cases. Sarcoma in women was diagnosed 3.5 times as often as in men. Tumours of the I stage were found in 12, of the II stage in 34. of the III stage in 146, of the IV stage in 73 patients. All patients were subjected to combined treatment-telegammatherapy and resection of the tumour with an electroknife. Patients with cancer of the I stage were first operated on with the electroknife and then subjected to radiotherapy with a focal dose of 3000-4000 rad. The 34 patients with cancer of the II stage underwent preoperative radiotherapy with a focal dose of 4500 to 5000 rad, then surgical intervention followed in 2-5 weeks. Preoperative radiotherapy was practiced in the 146 patients with cancer of the III stage, the total dose per focus being 5000-6000 rad, surgical intervention followed in 3-5 weeks. The 73 patients with cancer of the IV stage were operated on after radiotherapy with a focal dose of 6500-700 rad. Early and remote results of combined treatment in 260 patients were favourable. The length of life was up to 3 years in 119 (45.77%), up to 5 years in 74 (28.46%), up to 10 years in 48 (18.5%), over 10 years in 22 (8.5%) patients.
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