Adenoid Cystic Carcinoma of the Ethmoid Sinus

Adenoid Cystic Carcinoma of the Ethmoid Sinus

1. Adenoid Cystic Carcinoma of the Ethmoid Sinus Dr. Ferdand Supnet ; Celso V. Ureta MD; Gerardo Cruz MD, Rita Liana Ponce MD PGI DIANE SOSA

2. EMBRYOLOGY Langman’s Medical Embryology 13 h ed

3. ANATOMY PARANASAL SINUSES Snell’s Clinical Anatomy by Region 12 th ed.

4. ANATOMY Probst’s Basic Otorhinolaryngology

5. ANATOMY OSTEOMEATAL UNIT Probst’s Basic Otorhinolaryngology

6. ANATOMY Netter’s Atlas of Human Anatomy 7 th ed. Snell’s Clinical Anatomy by Region 9 th ed.

7. ANATOMY Gray’s Anatomy 41 st ed. Netter’s Atlas of Human Anatomy 7 th ed.

8. ANATOMY Netter’s Atlas of Human Anatomy 7 th ed. Snell’s Clinical Anatomy by Region 9 th ed.

9. ANATOMY Netter’s Essential Histology 1 st ed Probst’s Basic Otorhinolaryngology

10. PHYSIOLOGY Humidification Vocal resonance Mucus production Absorbs shock to the head Regulation of intranasal pressure Reduces the weight of the skull

11. JOURNAL

12. OBJECTIVE To present a rare case of adenoid cystic carcinoma in the ethmoid sinuses.

13. INTRODUCTION commonly found in the minor salivary gland tumor, 6% of all paranasal sinus neoplasms Recurrence Distant metastasis perineural invasion ADENOID CYSTIC CARCINOMA

14. CASE 17 years old Female S tudent CC: mass on the right nasofrontal area

15. CASE 7 months PTC: a pea sized, non tender, slowly growing mass on the right nasofrontal area with no other accompanying symptoms HPI:

16. CASE Unremarkable REVIEW OF SYSTEMS: PAST MEDICAL/ PERSONAL SOCIAL no history of trauma on the facial area Non-smoker known congenital anomaly FAMILY HISTORY Unremarkable

17. CASE a 1x1 cm firm , fixed, non-tender mass on the nasofrontal area no palpable lymphadenopathies Neurologic examination was normal PHYSICAL EXAMINATION

18. CASE mass on the ethmoid labyrinth with destruction of the right medial wall of the orbit with extraconal extension. The mass also extends superiorly to involve the right frontal sinus. CT SCAN:

19. CASE OPERATIVE FINDINGS: firm, non-encapsulated mass that is continuous with its intranasal component. Combined External & Intranasal Ethmoidectomy

20. CASE HISTOPATHOLOGY: microsections of cribriform clusters of glandular neoplasm with hyperchromatic dense nuclei with small to dilated glandular spaces are filled with basophilic mucoid material.

21. CASE W ide resection of the area with possible orbital exenteration OD with postoperative radiotherapy

22. DISCUSSION Carcinomas of the ethmoid sinus h as poor prognosis. The most common findings: unilateral nasal obstruction dull retroorbital headache proptosis diplopia broadening of the nasal dorsum. Some are ASYMPTOMATIC Tumours of nasal cavity & paranasal sinuses https://www.slideshare.net/ibrahimBarakat/sinonasal-tumors-by-dr-ibrahim-habib-md

23. DISCUSSION ADENOID CYSTIC CARCINOMA The most common location : maxillary antrum nasal cavity and adjacent structures nasal cavity

24. DISCUSSION ADENOID CYSTIC CARCINOMA Most commonly, these lesions consists of numerous aggregates of small cells in a cribriform pattern, with a central core of homogenous, cellular material that fills the glandular spaces and stain pink purple with Romanovsky stain.

25. DISCUSSION ADENOID CYSTIC CARCINOMA THREE GRADES: GRADE 1: Cribriform pattern GRADE 2: cribriform mixed with basaloid or anaplastic GRADE 3: predominantly basaloid and anaplastic.

26. DISCUSSION ADENOID CYSTIC CARCINOMA MANAGEMENT: Radiation combined radical resection with post op radiotherapy craniofacial resection standard surgery with irradiation en bloc after 6 weeks

27. REFERENCES: Probst, R., Grevers, G., & Iro , H. (2006). Basic otorhinolaryngology: A step-by-step learning guide. Stuttgart: Thieme . Sadler, T. W. (2012). Langman's Medical Embryology (12th ed.). Philadelphia: Wolters Kluwer. Snell, R. S. (2012). Snell's Clinical Anatomy By Regions (9th ed.). Philadelphia: Wolters Kluwer. Supnet , F; Ureta , C; Cruz, G; Ponce, R. (2005. Adenoid Cystic Carcinoma of the Ethmoid Sinus. Archives, Department of Otorhinolaryngology, Head & Neck Surgery Veterans Memorial Medical Center, 1(1), 87-89.