Sinonasal Undifferentiated Carcinoma with Intracranial Extension

ABSTRACT

Aim: To report our experience in the management of sinonasal undifferentiated carcinoma (SNUC) over a period of 15 years. Study design: A retrospective case review of 13 patients with SNUC treated at the University of California, Davis, Medical Center (UCDMC) Center for Skull Base Surgery, over the past 15 years. Results: Most tumors arose in the ethmoid sinuses. All but 1 patient had a combined intracranial-extracranial resection through the anterior fossa-transcranial route and postoperative irradiation. The 13th patient had a transfacial subcranial approach. There are 6 who have survived free of disease at 14 years' to 8 months' follow-up. The average follow-up was 6 years, 3 months. One patient died of a pulmonary embolism in the first postoperative week, a second died of a bowel infarction 3 months postoperatively. Three patients died of their disease at 20, 18, and 8 months postoperatively: 1 with local recurrence and distant metastasis and the other 2 with local control but distant disease. The 6 survivors are at 8, 20, 28, 62, 84, and 105 months. Conclusion: SNUC is a rare malignancy of the paranasal sinuses with a poor prognosis. Radical surgery and adjunctive therapy can achieve good survival in a significant proportion of patients who would hitherto have seemed incurable.

KEYWORDS

Sinonasal undifferentiated carcinoma - malignancy - skull base surgery

REFERENCES

• 1 Donald P J. Transfacial approach. In: Donald PJ Surgery of the Skull Base. Philadelphia, PA; Lippincott-Raven Pub 1998: 165-194
• 2 Ketcham A S, Wildins R H, Van Buren J M, Smith R R. A combined intracranial facial approach to the paranasal sinuses. In: Donald PJ Surgery of the Skull Base. Philadelphia, PA; Lippincott-Raven Pub 1998: 3-12
• 3 Schramm V L. Anterior craniofacial resection. In: Sekhar LN, Schramm VL Tumors of the Cranial Base. Mount Kisco, NY; Futura 1987: 265-278
• 4 Raveh J, Laedrach K, Iizuka T, Leibinger F. Subcranial extended anterior approach for skull base tumors. In: Donald PJ Surgery of the Skull Base. Philadelphia, PA; Lippincott-Raven Pub 1998: 239-261
• 5 Frierson Jr H F, Mills S E, Fechner R E, Taxy J B, Levine P A. Sinonasal undifferentiated carcinoma. An aggressive neoplasm derived from schneiderian epithelium and distinct from olfactory neuroblastoma.  Am J Surg Pathol. 1986;  10 771-779
• 6 Barnes V L, Brandivein M, Som P M. Disease of the nasal cavity, paranasal sinuses, and nasopharynx. In: Barnes L Surgical Pathology of the Head and Neck. 2nd ed. New York, NY; Marcel Dekker Inc 2001: 509-513
• 7 Houston G D, Gillies E. Sinonasal undifferentiated carcinoma: a distinctive clinicopathologic entity.  Adv Anat Pathol. 1999;  6 317-323
• 8 Franchi A, Moroni M, Massi D, Paglierani M, Santucci M. Sinonasal undifferentiated carcinoma, nasopharyngeal-type undifferentiated carcinoma and keratinizing and nonkeratinizing squamous cell carcinoma express different cytokeratin patterns.  Am J Surg Pathol. 2002;  26 1597-1604
• 9 Lopategui J R, Gaffey M J, Frierson H F et al.. Detection of Epstein-Barr viral RNA in sinonasal undifferentiated carcinoma from Western and Asian patients.  Am J Pathol. 1994;  18 391-398
• 10 Gallo O, DiLollo S, Graziani P, Galliana E, Baroni G. Detection of Epstein-Barr virus genome in sinonasal undifferentiated carcinoma by use of in situ hybridization.  Otolaryngol Head Neck Surg. 1995;  112 659-664
• 11 Jeng Y M, Sung M T, Fang C L et al.. Sinonasal undifferentiated carcinoma and nasopharyngeal-type undifferentiated carcinoma: two clinically, biologically, and histopathologically distinct entities.  Am J Path. 2002;  26 371-376
• 12 Cerilli L A, Holst V A, Brandwein M S, Stoler M H, Mills S E. Sinonasal undifferentiated carcinoma: immunohistochemical profile and lack of EBV association.  Am J Surg Path. 2001;  25 156-163
• 13 Gorelick J, Ross D, Marentette L, Blaivas M. Sinonasal undifferentiated carcinoma: a case series and review of the literature.  Neurosurgery. 2000;  47 750-755
• 14 Righi P D, Francis F, Aron B S, Weitzner S, Wilson K M, Gluckman J. Sinonasal undifferentiated carcinoma: a 10-year experience.  Am J Otolaryngol. 1996;  17 167-171
• 15 Miyamoto R C, Gleich L L, Bidinger P W, Gluckman JL. Esthesioneuroblastoma and sinonasal undifferentiated carcinoma: impact of histological grading and clinical staging on survival and prognosis.  Laryngoscope. 2000;  110 1262-1265
• 16 Kim B S, Vongtama R, Juillard G. Sinonasal undifferentiated carcinoma: case series and literature review.  Am J Otolaryngol. 2004;  25 162-166
• 17 Musy P Y, Reibel J F, Levine P A. Sinonasal undifferentiated carcinoma: the search for a better outcome.  Laryngoscope. 2002;  112 1450-1455