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  • Review Article
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Sinonasal carcinoma: clinical, pathological, genetic and therapeutic advances

Nature Reviews Clinical Oncology volume 11, pages 460–472 (2014)Cite this article

Subjects

Key Points

  • A variety of tumour types can develop in the sinonasal cavities; most common are sinonasal squamous-cell carcinoma (SNSCC) and intestinal-type adenocarcinoma (ITAC), which arise in separate sinonasal sublocalizations

  • Patients with sinonasal tumours often present with nonspecific clinical symptoms and with advanced-stage tumours, and therefore, have a poor prognosis

  • Exposure to wood and leather dusts is a strong aetiological factor associated with the development of SNSCC and especially ITAC, possibly through tumorigenic pathways of chronic inflammation

  • SNSCC and ITAC have aneuploid genomes—harbouring multiple genetic aberrations—that are distinct from each other and from histologically similar tumours (head and neck squamous-cell carcinoma and colorectal adenocarcinoma, respectively)

  • Genetic profiling of sinonasal tumours and studies in relevant in vitro cell culture and animal models are laying the foundations for future targeted therapies

  • The clinical management of sinonasal cancer has improved greatly owing to developments in endoscopic surgery and precision radiotherapy

Abstract

The sinonasal cavities represent an anatomical region affected by a variety of tumours with clinical, aetiological, pathological, and genetic features distinct from tumours at the main head and neck cancer localizations. Together, squamous-cell carcinoma and adenocarcinoma account for 80% of all sinonasal tumours, and are aetiologically associated with professional exposure to wood and leather dust particles and other industrial compounds, and therefore, are officially recognized as an occupational disease. Owing to their distinctive characteristics, sinonasal tumours should be considered as separate entities, not to be included in the miscellany of head and neck cancers. Sinonasal tumours are rare, with an annual incidence of approximately 1 case per 100,000 inhabitants worldwide, a fact that has hampered molecular-genetic studies of the tumorigenic pathways and the testing of alternative treatment strategies. Nevertheless, the clinical management of sinonasal cancer has improved owing to advances in imaging techniques, endoscopic surgical approaches, and radiotherapy. Genetic profiling and the development of in vitro cell lines and animal models currently form the basis for future targeted anticancer therapies. We review these advances in our understanding and treatment of sinonasal tumours.

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Figure 1: Schematic view of the sinonasal cavities and distribution of the main sinonasal tumour types.
Figure 2: Imaging approaches for diagnosis of sinonasal tumours.
Figure 3: Histological features of normal, benign metaplastic and various sinonasal tumour tissues.
Figure 4: Microarray CGH analysis demonstrating profiles characteristic of SNSCC and ITAC.
Figure 5: Endoscopic surgery for the treatment of sinonasal tumours.
Figure 6: Precision radiotherapy for the treatment of sinonasal tumours.

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Acknowledgements

The authors thank R. Cabanillas for his assistance with radiotherapy issues and images, B. Vivanco for preparing the pathological images shown herein, and J. Pérez-Escuredo, C. García-Inclán and C. Álvarez-Marcos for their active collaboration.

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  1. Department of Otolaryngology, Instituto Universitario de Oncología del Principado de Asturias (IUOPA), Hospital Universitario Central de Asturias, Celestino Villamil s/n, Oviedo, 33006, Spain

    José Luis Llorente, Fernando López, Carlos Suárez & Mario A. Hermsen

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  1. José Luis Llorente
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  2. Fernando López
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  3. Carlos Suárez
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  4. Mario A. Hermsen
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Contributions

J.L.L., F.L. and M.A.H. contributed to all stages of the preparation of the manuscript. C.S. made substantial contributions to discussion of content and review/editing of the manuscript before submission.

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Correspondence to Mario A. Hermsen.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Video 1

Endoscopic surgery of an ITAC originating in the ethmoid sinus. This video provides an overview of a craniofacial endoscopic approach to resect a bilateral ethmoid ITAC. After tumour debulking and drilling the surrounding bone to reach the margins, the tumour implantation site is identified in the olfactory cleft. Osteotomies and monobloc resection, including the dura mater, are performed around the cribiform plates from the frontal sinuses to the planum sphenoidale. The defect created in the dura mater is repaired by grafting two layers of fascia lata tissue to separate the brain. Ultimately, a clean cavity is left, demarcated by the periorbita of both eyes and a roof formed of the grafted fascia lata tissue. Abbreviations: ITAC, intestinal-type adenocarcinoma. (AVI 16204 kb)

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Llorente, J., López, F., Suárez, C. et al. Sinonasal carcinoma: clinical, pathological, genetic and therapeutic advances. Nat Rev Clin Oncol 11, 460–472 (2014). https://doi.org/10.1038/nrclinonc.2014.97

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