What does nose and sinus cancer look like? Nasal biopsy Possible risk factors

Biopsy of the nasopharynx- taking a small piece of tissue for subsequent examination under a microscope. Biopsy material can be taken from any part of the skin and mucous membranes, incl. and from the mucous membrane of the nasopharynx. This diagnostic intervention is carried out in our clinic under the control of the optical instrument of the endoscope.

Indications for nasopharyngeal biopsy under endoscope control

TO endoscopic biopsy of the nasopharynx we resort to diagnostics of tumor processes, and, above all, nasopharyngeal cancer. Cancers grow from the skin and mucous membranes. Unfortunately, the nasopharyngeal mucosa is no exception in this regard.

The following signs indicate the probable presence of a tumor process in the nasopharynx:

mucous and mucopurulent discharge from the external nasal openings on the side of the lesion, not associated with a cold or runny nose
here is sanious discharge or nosebleeds
difficulty in nasal breathing due to mechanical obstruction, mucosal edema, and displacement of the nasal septum
nasal voice
headache
pain, numbness in certain areas of the face, paralysis of mimic muscles.

In some cases, especially in advanced stages, visual and auditory disorders are possible in the form of a feeling of ear congestion, ringing in the ears, double vision, decreased visual acuity and hearing. However, at first all these symptoms may not be, and the tumor appears only enlargement of the cervical lymph nodes.

In this regard, unreasonably enlarged and painful lymph nodes are a cause for concern. The first thing to think about is their metastatic lesion. However, all the symptoms listed above, incl. and lymph node involvement is not strictly specific for cancer. Perhaps these symptoms are associated with benign tumors of the nasopharynx: fibromas, chondromas, polyps.

The presence of a volumetric tumor formation in the nasopharynx is confirmed by non-invasive (not associated with penetration into the internal environment, and with tissue damage) research methods. These are x-rays, computed tomography and magnetic resonance imaging. Based on the data obtained, we can judge the type of tumor, but only indirectly. The final diagnosis is made only after a biopsy.

Nasopharyngeal biopsy technique

The anatomical features of the initial part of the pharynx, the nasopharynx, are that it is difficult to access for visual inspection and interventions. You can partially examine the pharynx only retrograde, through the oral cavity from the side of the oropharynx using a special mirror.

Endoscopy allows not only to examine the nasopharynx, but also to perform certain types of interventions, incl. and a biopsy. A nasopharyngoscope is a type of endoscope for examining the pharyngeal regions. This is an optical device with a flexible probe, equipped with a light source and a video camera.

The device we have in service is connected to a computer. The image of the mucosal area is captured by a video camera, and fed through optical fibers to the device, and then to the computer. Here the received information is digitized and converted into a multiply enlarged image on the monitor.

Thanks to this, the doctor easily detects the tumor and determines its localization. The nasopharyngoscope is equipped with a special channel for devices with which biopsy material is taken.

The procedure for taking biopsy material is carried out by otolaryngologist in the endoscopic room of our center. The probe is inserted into the oropharynx through the external nasal opening of the corresponding side, and then through the lower nasal passage, the choana (internal nasal opening) into the nasopharynx.

Previously, the nasal cavity is irrigated with sprays of vasoconstrictor and local anesthetic substances to eliminate pain and prevent swelling of the nasal mucosa. To enhance anesthesia, the doctor treats the endoscope probe with a local anesthetic gel. The end of the probe is rounded so as not to injure the mucous membranes.

During the study, the doctor takes a biopsy material and assesses the condition of the mucous membrane, opening into the oropharynx of the mouths of the auditory tubes with tubal tonsils, pharyngeal tonsils. The whole procedure takes about 20 minutes. The conclusion will be available in approximately 7 days. During the first days after the study, short-term pain and nasal congestion are possible.

Contraindications for endoscopic nasopharyngeal biopsy

In many ways, they are similar to those for biopsies of other sites:

colds of the upper respiratory tract
any other acute infections
decompensation, exacerbation of existing chronic diseases
slowing blood clotting
mental disorders
allergy to the drugs used.

All these contraindications are identified during the examination by an otolaryngologist and other specialists of our center.

Biopsy of the nasopharynx - taking a small piece of tissue for subsequent examination under a microscope. Biopsy material can be taken from any part of the skin and mucous membranes, incl. and from the mucous membrane of the nasopharynx. This diagnostic intervention is carried out in our clinic under the control of the optical device of the endoscope.

Indications for nasopharyngeal biopsy under endoscope control

We resort to endoscopic biopsy of the nasopharynx to diagnose tumor processes, and, above all, cancer of the nasopharynx. Cancers grow from the skin and mucous membranes. Unfortunately, the nasopharyngeal mucosa is no exception in this regard.

The following signs indicate the probable presence of a tumor process in the nasopharynx:

mucous and mucopurulent discharge from the external nasal openings on the side of the lesion, not associated with a cold or runny nose
there is sanious discharge or nosebleeds
difficulty in nasal breathing due to mechanical obstruction, mucosal edema, and displacement of the nasal septum
nasal voice
headache
pain, numbness in certain areas of the face, paralysis of mimic muscles.

In some cases, especially in advanced stages, visual and auditory disorders are possible in the form of a feeling of stuffy ear, ringing in the ears, double vision, decreased visual acuity and hearing. However, at first all these symptoms may not be, and the tumor manifests itself only as an increase in the cervical lymph nodes.

Nasopharyngeal biopsy technique

Thanks to this, the doctor easily detects the tumor and determines its localization. The nasopharyngoscope is equipped with a special channel for devices with which biopsy material is taken.

The procedure for taking biopsy material is carried out by an otolaryngologist in the endoscopy room of our center. The probe is inserted into the oropharynx through the external nasal opening of the corresponding side, and then through the lower nasal passage, the choana (internal nasal opening) into the nasopharynx.

Contraindications for endoscopic nasopharyngeal biopsy

In many ways, they are similar to those for biopsies of other sites:

colds of the upper respiratory tract
any other acute infections
decompensation, exacerbation of existing chronic diseases
slowing blood clotting
mental disorders
allergy to the drugs used.

Schneider's papillomas are benign epithelial tumors that are most common in adults and are associated with the human papillomavirus (HPV). Most often localized on one side, but in rare cases can affect several anatomical regions. Three variants of Schneiderian papillomas have been described.

Exophytic papillomas in the vast majority of cases, they are localized on the nasal septum, in the form of leaf-shaped papillary islands with a central fibrovascular core and thickened, non-keratinizing squamous epithelium. Inverted papillomas are the most common form. They affect the lateral wall of the nasal cavity and the paranasal sinuses (most often the maxillary), are characterized by endophytic growth, similar to the growth of non-keratinized squamous epithelium.

Oncocytic papillomas(cylindrical) are less common than all other forms; localization is usually similar to that of inverted papillomas. They consist of stratified columnar epithelial cells with granular eosinophilic cytoplasm. These tumors often recur due to incomplete primary removal. Inverted and oncocytic papillomas degenerate into squamous cell carcinoma in about 11% of cases. Exophytic papillomas are rarely malignant.

Microscopic examination of the tissues of inverted papilloma determines the presence of multiple sections of stratified squamous epithelium,
growing inside its own plate; the integumentary epithelium is thinned, but its structure is not disturbed.

According to WHO classification 2005, there are several forms of nasopharyngeal cancer:
(1) (with typical characteristics of keratinizing squamous cell carcinoma);
(2) non-keratinizing cancer, which can be differentiated (sparing intercellular bridges and clear cell boundaries) and undifferentiated (characterized by syncytial growth and lack of clear cell boundaries);
(3) basaloid squamous cell carcinoma (similar to tumors affecting the larynx). Radiation therapy is the mainstay of treatment.

Squamous cell carcinoma of the nasal cavity and paranasal sinuses is a rare tumor occurring mainly in adults that affects the maxillary sinus (60%), nasal cavity (12%), ethmoid labyrinth (10-15%), nasal vestibule (4%), frontal and sphenoid sinuses (1 each). %). Metastasizes rarely, but is characterized by locally destructive growth.

a - Non-keratinizing cylindric cell carcinoma is characterized by the presence of strands of immature atypical epithelial cells (they lack keratin).
Note the invasion of the mucosal gland.
b - Undifferentiated cancer of the nasal cavity is an extremely aggressive malignant neoplasm with a locally disseminated pathological process,
which in most cases is not associated with the Epstein-Barr virus.
It is characterized by the presence of small groups, trabeculae or layers of undifferentiated epithelial cells with a high ratio of nucleus to cytoplasm,
frequent mitoses and the presence of extensive areas of necrosis.
Even with aggressive treatment, the prognosis is poor.

Most cases diseases It is represented by a simple squamous cell carcinoma with clear cell boundaries, preserved intercellular contacts, deposition of keratin in the intra- and extracellular space. Squamous cell carcinoma can be highly differentiated (characterized by the formation of "epithelial pearls"), poorly differentiated (characterized by the absence of keratin), and moderately differentiated (containing some keratin).

In rare cases squamous cell carcinoma may be non-keratinizing (cylindrical, transitional cell). Verrucous carcinoma, basaloid squamous cell carcinoma, papillary squamous cell carcinoma, spindle cell carcinoma, and glandular squamous cell carcinoma are extremely rare.

Lymphoepithelial cancer is a rare undifferentiated form of cancer with severe lymphoplasmacytic infiltration. Able to affect the nasal cavity and paranasal sinuses. Morphologically similar to lymphoepithelial cancer of the nasopharynx; often associated with the Epstein-Barr virus. Responds well to radiation therapy. Undifferentiated cancer of the oral cavity and paranasal sinuses is a highly malignant neoplasm that is not usually associated with the Epstein-Barr virus.

For intestinal-type adenocarcinoma affecting the paranasal sinuses,
characterized by the presence of malignant invasive epithelium with densely grouped glands of irregular shape,
consisting of columnar epithelial cells and rare goblet cells with hyperchromic nuclei.
The inset shows the result of an immunohistochemical study for the expression of the CDX-2 marker.
Adenocarcinoma of the intestinal type can affect the ethmoid labyrinth (40%), the nasal cavity (27%), and the maxillary sinuses (20%).
Some of these cells histologically resemble normal intestinal structures (Paneth cells, enterochromaffin cells, villi, muscularis mucosa).

Adenocarcinoma of the intestinal type affects the ethmoid labyrinth (40%), nasal cavity (27%), maxillary sinus (20%).

For poorly differentiated adenocarcinoma non-intestinal origin is characterized by a glandular or papillary structure with a single layer of cubic epithelium; characterized by local invasion.

Papillary adenocarcinoma of the nasopharynx may have a similar morphological structure with papillary thyroid cancer, from which it is distinguished by a negative immunohistochemical reaction to thyroglobulin and thyroid transcription factor (TTF-1). Small cell neuroendocrine cancer is a highly differentiated malignant tumor that originates from the upper or posterior parts of the nasal cavity and spreads to the paranasal sinuses and/or nasopharynx.

Small or medium cell size form clusters; they are characterized by a high nucleus-cytoplasm ratio, nuclear hyperchromatosis, nuclear fusion, and high mitotic activity. Immunohistochemically, the tumor is characterized by an increase in the level of neuroendocrine markers (synaptophysin, chromogranin, neurospecific enolase) and cytokeratin. Extremely rare carcinoids of the nose and paranasal sinuses have also been described.

Olfactory neuroblastoma (eisthesioneuroblastoma) is a malignant neuroectodermal tumor,
originating from the olfactory layer of the upper parts of the nasal cavity with spread into the cranial cavity and / or paranasal sinuses.
Usually tumor cells are grouped in the submucosal layer in the form of lobes or nodes, which are separated by a vascularized fibrous stroma.
The cells are characterized by a small amount of cytoplasm and the presence of inclusions of nuclear chromatin (“salt and pepper”).
Rosettes are sometimes formed (pseudo-rosettes of Homer Wright or true Flexner-Wintersteiner rosettes), zones of necrosis.
Tumors are classified according to differentiation, presence of nuclear pleomorphism and necrosis, intensity of mitosis (patients with stage Hyam I-II have a better prognosis than Hyam III-IV).
Neuroendocrine markers are positive, cytokeratin is negative. On the periphery of the tumor nodes, specific supporting cells expressing S-100 are determined.

Ectopic pituitary adenoma consists of polygonal, cytologically normal epithelial cells with clear boundaries; the degree of staining of the cytoplasm may be different.
Ectopic pituitary adenomas originate from embryonic remnants of the adenohypophysis in the nasopharynx or sphenoid sinus.
Polygonal epithelial cells express cytokeratin, neuroendocrine markers, and specific pituitary hormones.

Olfactory neuroblastoma (esthesioneuroblastoma) is a malignant neuroectodermal tumor originating from the olfactory epithelium of the upper nasal cavity that often extends into the cranial cavity and/or paranasal sinuses. Ectopic pituitary adenomas can occur at the site of the embryonic remnant of the adenohypophysis (in the nasopharynx or sphenoid sinus). They may contain polygonal epithelial cells containing cytokeratins, neuroendocrine markers, and specific pituitary hormones.

malignant melanoma of the mucous membranes is a rare tumor of the paranasal sinuses and nasal cavity, which sometimes occurs in elderly patients. Like melanoma of any other localization, it easily mimics and can be represented by a wide variety of cells (epitheloid, fusiform, plasmacytoid, rod-shaped and / or multinucleated. Specific immunohistochemical markers help in the diagnosis (S-100, HMB-45, melan-A, microphthalmia-associated transcription factor).

To other rare neuroectodermal tumors include Ewing's sarcoma, primitive neuroectodermal tumors and paragangliomas. Hemangioma is a benign vascular tumor that can be localized on the nasal septum, turbinates and paranasal sinuses; it consists of proliferating capillaries with inclusions of fibrous stroma.

Angiofibroma of the nasopharynx is characterized by irregularly shaped vascular spaces with thick walls,
the stroma is collagenized, with fusiform and stellate fibroblasts.
Angiofibroma of the nasopharynx occurs exclusively in young males, originates from the posterolateral wall of the nasal cavity or nasopharynx,
characterized by the presence of areas of proliferation of vascular tissue.
The vessels are thin, branching, lined with endothelium, the muscular layer is not always present. The probability of recurrence reaches 20%.

Angiofibroma of the nasopharynx occurs exclusively in young males, localized on the posterolateral wall of the nasal cavity or in the nasopharynx. The risk of local recurrence is quite high.

Glomangiopericytoma (hemangiopericytoma of the paranasal sinuses) affects the paranasal sinuses,
characterized by a perivascular myxoid phenotype, the presence of rounded nuclei and irregularly shaped vessels.
It is a subepithelial non-encapsulated tumor consisting of tightly adherent cells with solid,
fascicular or tortuous growth pattern, collagen fibers and frequent branching vessels.
Positive for muscle actin, vimentin, factor XIIIa; negative for HaCD34, Bcl-2, CD99 (which distinguishes it from soft tissue hemangiopericytoma).

Glomangiopericytoma(hemangiopericytoma of the nasal cavity and paranasal sinuses) is a subepithelial non-encapsulated tumor, consisting of densely adjacent cells growing in solid, umbilical, curled, tortuous types; characterized by a low content of collagen, the presence of branching (“coral”) vessels.

Solitary fibrous tumors in the nasal cavity rare, they consist of intertwined fibroblasts and a dense vasculature. The cells are positive for CD34 and Bcl-2 but do not express smooth muscle actin. Germinogenic tumors of the nasal cavity are rare. Mature teratomas may include mature skin, skin appendages, neuroglial tissues, smooth muscles, bones, salivary glands, respiratory and gastrointestinal epithelium. Elements of the ectoderm, endoderm and mesoderm can occur in any proportion.

Cancer of the nasal cavity and paranasal sinuses is a fairly rare disease. Only about 3% of malignant tumors of the head and neck are localized in the nasal cavity and paranasal sinuses.

The share of the total number of cancers is even less - 0.5%. Men are more prone to this type of disease, and in 80% of cases it affects people over 55 years of age.

Causes of nose cancer

There are a number of factors that increase the risk of this disease:

Exposure to certain chemicals
Human papillomavirus (HPV)
Radiotherapy for hereditary retinoblastoma

Exposure to certain chemicals

Studies show that certain types of industrial work increase the risk of developing this disease. This is due to the effect on the body of certain chemicals.

A number of experts are of the opinion that about a third of cases of this disease are associated with professional activities, including contact with chemicals.

The following reagents may increase the risk of disease:

Wood dust is dangerous for people working in the carpentry industry, including the manufacture of furniture, wood floors and other types of wood products.
Leather dust is dangerous for people working in the shoe industry.
Exposure to chromium used in the manufacture of stainless steel, textiles, plastics and leather can be harmful.
Nickel can also be hazardous and is used in the manufacture of stainless steel.
Formaldehyde is a chemical reagent used to produce other chemical compounds, as well as to make building materials and household products.
Fibers for fabrics pose a threat to people working in the textile industry.
Mineral oils used as lubricants in the production of metal products and in the operation of machinery are potentially hazardous to persons in contact with them.

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There are many strains of this virus, and it can also cause other types of cancer. In more than 20% of cases, cancer of the nose and paranasal sinuses is associated with the presence of HPV in the patient's body. Of all the varieties of this virus, type 16 is the most common in this nasal disease.

This is what HPV looks like on the human body

The risk of the disease of the nose under consideration, as well as the paranasal sinuses, increases with smoking. During smoking, tobacco smoke can pass through the nose on its way to the lungs. The magnitude of the risk is directly proportional to the experience of the smoker and the volume of tobacco products smoked per day. Individuals who quit this bad habit are characterized by a decrease in the likelihood of this form of cancer.

Radiotherapy for hereditary retinoblastoma

The danger of developing cancer of the nose and paranasal sinuses under the influence of this type of radiotherapy has been convincingly shown in the course of conducted and published studies.

Possible risk factors

In addition to the unambiguous risk factors for the occurrence of the disease in question, there are also possible:

Benign neoplasms of the nose
Past non-Hodgkin's lymphoma

Benign neoplasms of the nose

Some studies have shown that there is an increased risk of this type of cancer of the nose and paranasal sinuses in people with a history of benign nasal growths. However, the cause-and-effect relationship is still not fully understood, and further research is required.

Past non-Hodgkin's lymphoma

Symptoms of cancer of the nose and paranasal sinuses

Symptoms of cancer of the nose and paranasal sinuses vary depending on the type, location and stage of the disease. Symptoms characteristic of early types of cancerous lesions are similar to those of respiratory infections of the upper respiratory tract.

The key factor that allows differentiating symptoms of nasal and paranasal sinus cancer from symptoms that develop with respiratory infections is the duration of their presence in the patient.

An upper respiratory tract infection usually resolves within a few weeks with adequate medical treatment, and cancer-related symptoms persist.

In some cases, patients with cancer of the nose and paranasal sinuses do not show any specific symptoms and signs of the disease. The fact is that the types of cancer we are considering are usually diagnosed in the later stages, since the symptoms of this disease are usually not expressed in the early stages. These cancers are often discovered when a patient is being treated for an infectious disease, such as sinusitis.

Since the nasal cavity is bordered by the eyes, ears and mouth, nasal cancer sometimes causes a feeling of pressure and pain in these areas. This can affect vision and the ability to open your mouth. Cancers of the nose can also affect the sense of smell.

Nose related symptoms:

Passage blockage causing permanent blockage on one side of the nose
Nose bleed
Difficulty in smelling
Mucus-like discharge
Mucus-like discharge into the back of the nose and throat

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The most common are the first two symptoms, which prevail in most cases.

Eye related symptoms:

Bulging of one of the eyes
Complete or partial loss of vision
double vision
Pain above and below the eye
Increased lacrimation

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Other symptoms:

Persistent nodular growths on the face, nose, or palate
Persistent pain and numbness in certain parts of the face, especially in the upper cheek
Loss of teeth
Difficulty opening the mouth
Enlargement of the lymph nodes of the neck
Pain or tightness in one ear

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A patient who has noticed the above symptoms and signs should immediately consult a doctor. This is especially important if the symptoms do not stop for several weeks. The doctor is usually interested in the chronology of the development of symptoms, when they appeared and how they developed.

Since many of the above symptoms can be caused by other diseases that are not cancerous, it is important not to neglect regular medical check-ups from specialists. This is especially important if a person uses alcohol or tobacco products. In general, tobacco and alcohol users should have a general medical examination at least once a year, even if they do not have any warning symptoms.

Malignant tumors of the nose and paranasal sinuses

Types of cancer of the nose and paranasal sinuses

Squamous cell carcinoma

This type of cancer is the most common form of cancer affecting the head and neck (more than 60% of the total number of cases). Flat (squamous) cells are similar to skin cells, they are part of the lining of the mouth, nose, larynx and throat.

Adenocarcinoma

Adenocarcinoma is the second most common type of cancer of the nose and paranasal sinuses (about 10% of all cases). Adenocarcinoma begins with adenomatous cells located on the surface of the nasal cavity. These cells produce mucus. The number of adenocarcinomas has increased in the last 20 years in the population, the reasons for this are currently unknown.

adenocystic carcinoma

Adenoid cystic carcinoma is a rare type of glandular cancer. It usually affects the salivary glands, but occasionally it can be localized in the nose and paranasal sinuses.

Lymphoma

Lymphoma usually begins with damage to the lymph nodes. There are many lymph nodes in the neck, and painless swelling of a lymph node is the most obvious indicator of the presence of lymphoma.

plasmacytoma

Plasmacytoma is a tumor composed of plasma cells, they are similar to myeloma.

Melanoma

Melanomas develop from pigment cells that give skin color. Melanomas of the head and neck can be localized anywhere on the skin or inside the nose or mouth.

Esthesioneuroblastoma (olfactory neuroblastoma) and neuroendocrine carcinoma

Neuroendocrine carcinoma and are rare types of tumors characteristic of the nasal cavity.

Neuroblastomas develop on the top of the nasal cavity. Neuroendocrine carcinoma arises from specialized cells that respond to signals from hormone-producing cells.

Sarcoma

Sarcoma develops from cells that form soft tissues.

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Stages of cancer of the nasal cavity and paranasal sinuses

Each type of cancer of the nose and paranasal sinuses is characterized by different symptoms and stages of development, established during the microscopic examination of samples. This type of examination occupies an important place in the diagnosis of these diseases.

Nose cancer diagnosis

Visit doctor

If you are concerned about symptoms that resemble those of the disease in question, you should consult a doctor. A general examination is necessary, as well as a careful examination of the nose, throat, ears and eyes. After the examination, a referral to various types of analyzes is often given. Routine blood tests and a chest x-ray are usually done to check for general health. Then the specialized types of examinations listed below are carried out.

Nasoendoscopy

During this examination, a local anesthetic is often used to minimize painful symptoms. The nasal cavity is examined with a nasoendoscope. If a specialist finds a significant anomaly, then he can send the patient for panendoscopy. With panendoscopy, it is possible to take a biopsy from the area with pathology.

Biopsy

The only guaranteed way to establish this type of disease is to conduct a biopsy of the affected area. Next, a microscopic examination of the sample taken for signs of cancer is carried out.

Needle aspiration

If a specialist can feel the growth, it may need to be aspirated with a needle. Sometimes aspiration is performed in parallel with ultrasound scanning for more accurate analysis. Also, this type of analysis helps to determine whether the cancer has spread to the lymph nodes of the neck. In this case, needle aspiration is done in relation to one of the large nodes in the neck.

Panendoscopy

The doctor may request a panendoscopy if a biopsy is required. This test is performed under general anesthesia. During it, the nasal cavity is examined, as well as the larynx, esophagus and trachea.

If nasal cancer is diagnosed, then do not delay treatment, it will help to familiarize yourself with the methods of successful treatment

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Additional methods of examination

Additional examination methods are usually required to determine the specifics of the upcoming treatment. If the above tests reveal cancer, then it is usually necessary to determine whether it has spread to other parts of the body.

Method for examining nasal cancer

CT scan

This type of analysis may be required for the head, neck, chest, and abdomen. This allows you to identify the size of the tumor and the presence of enlarged lymph nodes in the neck, as well as the possible spread of cancer to other parts of the body.

This type of examination, compared with CT scanning, allows you to better analyze soft tissues. Both types of scans may require the injection of a special dye into the blood for a more accurate analysis.

Positron emission tomography

This type of scan helps to identify areas of active disease. It is also sometimes used to clarify whether the disease has returned after treatment. Sometimes this type of examination is done after surgery to make sure there are no cancer cells left in the scar tissue.