Ocular Lesions in Squamous Cell Carcinoma of the Sinus
Introduction
Introduction to ocular lesions of sinus squamous cell carcinoma Squamous cell carcinoma of the paranasal sinus occurs in all sinuses, but the maxillary sinus is the most common, and the eyelid is almost surrounded by the sinuses. Therefore, the sphenoid sinus tumor often has extraocular muscle paralysis, trigeminal neuralgia and visual function changes. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific people Mode of infection: non-infectious Complications: optic atrophy
Cause
Etiology of ocular lesions in sinus squamous cell carcinoma
Cause:
The sinus mucosa is directly in contact with the outside air and is often affected by adverse factors. It is a good site for malignant tumors and is associated with a variety of tumorigenic factors, such as viral infection, genetics, radiation damage and environmental pollution.
Pathogenesis:
Various carcinogenic factors act on the genetic material of the cell, causing changes in the genetic code, causing mutations or overexpression of certain key cell regulatory genes. These genetic material can be continuously transmitted to the daughter cells according to the genetic law, and some cells are close to the embryo. Naive cells lose their ability to mature and form new organisms in local abnormalities.
Prevention
Prevention of ocular lesions in sinus squamous cell carcinoma
Early without any clinical signs and symptoms, early diagnosis and early treatment are very difficult. When the tumor has invaded the eyelids, eye symptoms and signs appear, or bloody nose and nasal congestion, it is already in the middle and late stage, and the 5-year survival rate does not exceed 25%. In recent years, due to the improvement of treatment methods, the application of high-voltage radiation therapy before or after surgery has increased the 5-year survival rate to 30% to 40%.
Complication
Complications of ocular lesions in sinus squamous cell carcinoma Complications optic atrophy
Cavernous sinus syndrome and optic atrophy.
Symptom
Symptoms of ocular lesions of sinus squamous cell carcinoma Common symptoms Nasal secretions increased tinnitus, nasal congestion, severe headache, nasal bleeding, oculomotor nerve paralysis
Because the sinus has the highest incidence of squamous cell carcinoma, and the clinical manifestations of sinusoidal squamous cell carcinoma are different, the way of invading the eyelid is different, and the signs and symptoms of the secondary tumor of the eyelid are different, so they are introduced separately. Clinical manifestations of sinusoidal squamous cell carcinoma.
Squamous cell carcinoma of the maxillary antrum
Occurred in the sinus mucosal columnar ciliated epithelium, the tumor gradually grows and destroys the sinus bone wall and spreads beyond the sinus. If the sinus wall is destroyed, the tumor invades the lower part of the eyelid, causing the eyeball to protrude and upward (Fig. 1), maxillary sinus The upper inner mass can invade the ethmoid sinus, and the mass invades the posterior sinus and the posterior sacral apex, and the eyeball is displaced outward. The patient has double vision and decreased vision. If the maxillary sinus and the ethmoid sinus are involved at the same time, The eyeball will move up, outside, and forward, the tumor directly invades the eyelid and the bulbar conjunctiva, or the tumor compresses the ocular vein, causing obstruction of the orbital venous return, resulting in swelling of the conjunctiva, swelling of the upper and lower eyelids and making the cleft palate smaller (Fig. 2), tumor compression or Invades the infraorbital nerve, causing ipsilateral squatting, facial sensation diminished or numbness.
Other clinical manifestations such as increased nasal secretions, tumor compression of the nasal wall or invasion of the nasal cavity and nasal obstruction and nosebleed, tumor compression on the alveolar nerve toothache, ipsilateral headache, maxillofacial pain and nasal pain, tumor involving the soft tissue in front The side of the affected area is swollen. In severe cases, the lower eyelids are swollen, and the cleft palate becomes smaller. The wall after the cancer breaks through the wing muscles causes difficulty in opening, and the upper upper teeth loose or fall off, hearing loss or tinnitus. Local transfer to the pre-auricular lymph nodes, submandibular lymph nodes, deep cervical lymph nodes and posterior pharyngeal lymph nodes, distant metastasis to the lungs and the whole body.
2. Squamous cell carcinoma of the sinus sinus sinus squamous cell carcinoma is not as common as the sinusoidal squamous cell carcinoma of the sinus, and the sinus sinus sinus sinus It causes the destruction of the ethmoid cardboard, and the tumor directly invades the eyelids. The tumor can also enter the eyelid along the gap around the inner blood vessels on the inner wall of the iliac crest. The mass is mainly in the inner side of the eyelid, causing the eyeball to shift outward, causing diplopia, and then sieving. The sinus squamous cell carcinoma invades the apex of the sinus. In addition to the eye process, the lumps at the tip of the eyeball can also oppress the optic nerve, the oculomotor nerve and the ocular vein, produce eye movement disorders, freeze the eye, ptosis, vision loss or even blindness. Eyelid conjunctival edema and the like are similar to the performance of the apical syndrome. The tumor invades the lacrimal sac or the nasolacrimal duct, leading to tears. In the advanced stage, the tumor often invades the orbital and upper cervical lymph nodes in addition to invading the eyelids.
Before the tumor invades, the middle cranial concave area causes severe headache. The tumor erodes the anterior wall of the sinus sinus, causing the nasal roots. The sacral bulge enlarges the bottom of the nose, the tumor invades the nasal cavity, produces progressive nasal congestion, or the affected side discharges pus and blood secretion. Things, can be accompanied by stench.
3. Squamous cell carcinoma of the frontal sinus is rare in the sinus of the frontal sinus. Because the bottom of the frontal sinus is the thin wall of the medial condyle, the bottom of the tumor breaks into the eyelid, making the eyeball outward. The lower part is displaced and the protrusion is invaded. The invading trochle causes the superior oblique muscle to be damaged and the double eye is caused. The upper eyelid is edema due to tumor infiltration. Later, the anterior frontal sinus area has a bulging mass. If the anterior wall bone is damaged, it can be affected. In the bone defect area, the mass grows further, causing the skin at the mass to collapse.
Early sinusoidal squamous cell carcinoma has no obvious symptoms. As the disease progresses further, bloody sputum is seen at the front end of the middle nasal passage. Polyps or granulation tissue grows in the middle nasal passage. The advanced tumor involves the anterior cranial fossa, causing headache. The tumor is transferred along the lymphatic vessels to the submandibular, deep cervical lymph nodes.
4. Squamous cell carcinoma of the sphenoidal sinus has a low incidence of sphenoid sinus malignancies, so squamous cell carcinoma should be rare, and there are many important structures around the sphenoid sinus. When the tumor invades these important structures, Caused by various symptoms, the common clinical signs are unilateral nerve palsy, followed by trochlear and oculomotor nerve paralysis, double vision occurs, and then the eye movement is difficult or fixed, the tumor oppresses the optic nerve, the vision is reduced, the visual field is reduced, and even a Side or bilateral eyes are blind.
Squamous epithelial cancer in the initial sphenoid sinus often has no obvious symptoms, followed by bloody snot, and granulation or polypoid tissue can be found in the sinus area of the stencil, invading the middle cranial fossa to produce post-orbital or occipital headache.
Examine
Examination of ocular lesions of sinus squamous cell carcinoma
Histopathological examination: squamous cell carcinoma of the sinus is generally moderately and moderately differentiated. The cancer cells are arranged in the form of cords and lobules. The moderately differentiated squamous cell carcinomas are abundant, and the local cells stained with pink keratinization evidence. The formation of keratinized beads is visible in the center of the tumor, and the columnar epithelium is still visible around the tumor, indicating that the tumor originates from the sinus mucosa rather than the surface epithelium. The poorly differentiated squamous epithelial cancer cells have less cytoplasm, less keratinization, and nuclei. Deep staining, large atypia, mitotic nucleus, sometimes difficult to distinguish from large cell lymphoma, anaplastic cancer and metastatic cancer. Electron microscopy shows special signs of squamous cell carcinoma, intercellular bridging, interstitial tension Silk, other organelles have polysomes, rough endoplasmic reticulum and mitochondria, immunohistochemically positive for Keratin, indicating epithelial-derived tumors.
1. X-ray examination: early maxillary sinus cancer is confined to the sinus cavity. If the mass is small, the X-ray should not be found. When the bone is destroyed, the inferior wall bone defect can be seen, and the inferior temporal hole disappears (Fig. 3). X-ray showed that the sinus airway interval disappeared, the internal wall of the iliac crest was destroyed, and there was a soft tissue mass at the top of the nasal cavity.
2. Ultrasound exploration: When the sinus wall is intact and the nasal cavity contains gas, the ultrasound can not pass through, showing a normal ultrasound image, the bone plate between the sinus and the eyelid is destroyed, and after the tumor extends into the iliac crest, the corresponding part can be found by ultrasound. Occupying lesions, generally in the hypoechoic area, the range of lesions shown in the sonogram exceeds the wall of the eyelid.
3. CT scan: CT can clearly reveal the maxillary sinus cancer eyelid invasion, which is characterized by the middle density of the maxillary sinus, irregular soft tissue mass, bone destruction of the infraorbital wall, and soft tissue mass protruding into the iliac crest, enhancing the visible mass Significantly enhanced, CT can be found in 70% to 80% of cases with bone destruction of the inferior wall (Figure 4), no bone destruction may be due to tumor invasion through the nerve around the sinus, sinus cancer can be seen in the sinus cavity medium density soft tissue The lumps, the inner wall of the iliac crest were destroyed, and the soft tissue mass in the iliac crest was connected to the ethmoid sinus, and the eyeball was obviously compressed.
4.MRI: The location, size and relationship of the tumor to the surrounding structure can be displayed from three locations. T1WI is a medium-low signal, T2WI is a medium-high signal, and MRI shows that the bone wall is not as good as CT, but the maxillary sinus or ethmoid sinus can be seen. The mass is connected to the mass in the orbit, and the signal is consistent. MRI can confirm the relationship between the mass and the surrounding structure, showing that the extraocular muscles and the eyeball are under pressure.
Diagnosis
Diagnosis and diagnosis of ocular lesions in sinus squamous cell carcinoma
The squamous epithelial cancer in the early sinus cavity has no obvious symptoms and signs, and it is difficult to make a diagnosis. The diagnosis of early sphenoid squamous cell carcinoma is more difficult. With the development of the tumor, the tumor collapses and inflammation occurs in the sinus cavity. The tumor invades the nasal cavity and blocks the nasal cavity, causing bloody nose and malodor, or nasal obstruction. The tumor invades the eyelids, causing the anterior process of the eye and the displacement of the different directions. The invasion of the brain nerve causes the eye movement to be restricted. According to the swelling of the different parts of the face, the eyeball moves. The direction of the position and the extent to which the eye movement is limited can be inferred from which sinus cavity the tumor originated.
The sinus is mainly squamous cell carcinoma, but there may be other malignant tumors. Sinus puncture, sinus incision and intraorbital invasion of the tumor are particularly important. It not only establishes the diagnosis, but also the treatment. Estimates of choice and prognosis are very helpful.
The different sinus cavity sources of the tumor can be determined according to the imaging findings of the tumor.
