Sphenoid sinus malignancy
Introduction
Introduction to sphenoid sinus malignant tumor Sphenoid sinus malignant tumors are rare in clinical practice. According to Godtfiedson (1947), 218 cases of sinus malignant tumors were analyzed, which occurred in the maxillary sinus, accounting for 86.7%, ethmoid sinus, 43.6%, and sphenoid sinus, 2.3%. The sphenoid sinus malignant tumor is divided into primary and secondary. There are pre-cleft adenocarcinoma, myeloma, thyroid cancer, thyroid cancer, lung cancer, liver cancer, breast cancer and kidney cancer secondary to distant organ metastasis. Invaders from adjacent organ tumors, mainly sinus, nasopharyngeal and sella tumors in the nasal cavity. Barrs (1974) believes that sphenoid sinus metastasis, distant metastasis more than adjacent organ metastasis. basic knowledge The proportion of illness: 1% Susceptible people: no specific people Mode of infection: non-infectious Complications: eyeballs, diabetes insipidus
Cause
Etiology of sphenoid sinus malignancies
Long-term chronic inflammatory irritation (30%):
Clinically, the incidence of sinusitis in each group is similar to the incidence of sinus malignant tumors. The maxillary sinus is the most common, followed by the ethmoid sinus, and the frontal sinus is again, and the sphenoid sinus is rare.
Benign tumor malignancy (20%):
Nasal polyps or inverted papilloma are recurrent, and there is a risk of malignant transformation after multiple operations. Another nasal induration, small parotid mixed tumor, schwannomas, fibroids, etc., may be malignant.
Radioactive material (15%):
Those who undergo radiotherapy due to benign lesions of the nose and sinus may induce malignant tumors several years later.
Trauma (10%):
Patients with sarcoma often have a history of trauma.
Carcinogens (20%):
Long-term inhalation of certain irritating or chemical substances such as nickel, arsenic, chromium and its compounds, hardwood chips, cork dust, etc.
Prevention
Sphenoid sinus malignancy prevention
1. Supply protein foods that are easily digested and absorbed, such as milk, eggs, fish, soy products, etc., can improve the body's ability to fight cancer. Among them, milk and eggs can improve the disorder of protein after radiotherapy.
2, eat more anti-cancer foods, such as turtle, mushrooms, black fungus, garlic, seaweed, mustard and royal jelly and other foods.
Complication
Sphenoid sinus malignant tumor complications Complications, eyeballs, diabetes insipidus
Ocular symptoms can gradually develop from one side to both sides, often accompanied by eyeball protrusions. For example, invading the sella, there may be symptoms of hypopituitarism, or diabetes insipidus. In addition to the above symptoms and signs, sphenoid sinus metastasis Symptoms and signs of distant primary cancer can often be found in the whole physical examination.
Symptom
Symptoms of sphenoid sinus malignant tumors Common symptoms Double eyelid ptosis intraocular oblique cranial nerve palsy Urinary squamous cell carcinoma Eyeball protruding Sella deformation Sella vacuole
According to Alexander (1963), malignant tumors originating from the sphenoid sinus have squamous cell carcinoma, lymphoid epithelial cancer, undifferentiated carcinoma, cylindrical cell carcinoma, adenocarcinoma, giant cell tumor, ameloblastoma, malignant inversion. Papilloma, etc., because the sphenoid sinus bone is thin and easy to be destroyed by the tumor, the earliest symptoms and signs are caused by the invasion of adjacent organs of the sphenoid sinus. The metastatic cancer is faster than the primary cancer. There are few cervical lymphatic metastases. Wyllie (1973) reported that only 6 cases of 6 cases of sphenoid sinus tumors found cervical lymph node metastasis.
Most of the sphenoid sinus malignant tumors occur in adulthood. There is no gender difference. Primary sphenoid sinus malignant tumors may have progressive headache with tumor enlargement and compression. The headache is often located in the deep or posterior iliac crest, deep in the neck or amount. Deep in the top, sometimes in the occiput, and spread to the back of the neck, there are also headaches are not significant, then the most easily misdiagnosed, the tumor develops to the side wall, the first abductor nerve paralysis, intraocular oblique, double vision, rear trochle Nerve and oculomotor nerves are also paralyzed, clinical manifestations of fixed eyeballs, ptosis, dilated pupils, optic nerve compression can occur vision loss or blindness, ocular symptoms can gradually develop from unilateral to bilateral, and often accompanied by eyeballs If the saddle is invaded, symptoms of hypopituitarism may occur, or diabetes insipidus may be present. In addition to the above symptoms and signs, sphenoid sinus metastasis may often reveal symptoms and signs of distant primary cancer in the whole physical examination. Clinicians should pay special attention to systemic examination of space-occupying lesions of the sphenoid sinus to avoid misdiagnosis caused by local attention.
Examine
Examination of sphenoid sinus malignancies
Due to the low incidence of sphenoid sinus malignant tumors, the anatomical site is concealed, the early symptoms are not obvious, and it is easy to be misdiagnosed. Therefore, for patients with deep headache, followed by VI, IV, III, V cranial nerve palsy, the sphenoid sinus should be considered first. Diseases, such as the above symptoms progress faster, should suspect sphenoid sinus malignant tumors, at this time to conduct a comprehensive examination of the patient, including all organs, nasal, nasopharyngeal cavity, ophthalmology, neurology and other examinations, more important need to take the head positive Lateral radiograph, skull base, optic nerve, carotid angiography, head CT or MRI, to show the size and extent of tumor, the diagnosis of sphenoid sinus tumor needs to be puncture or transsphenoidal sphenoid sinus surgery for living tissue Pathological examination.
Diagnosis
Diagnosis and differentiation of sphenoid sinus malignant tumor
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
The disease needs to be differentiated from nasopharyngeal carcinoma, sphenoid sinus mucinous cyst, saddle and parasagittal tumor.
Nasopharyngeal carcinoma is a malignant tumor that originates in the epithelium of the nasopharyngeal mucosa. It is one of the common malignant tumors in China. The malignant frequency is high, and the average survival time is 18.7 months. The onset is concealed and it is difficult to be discovered in the early stage.
