Paranasal Sinus Tumours

The paranasal sinuses are air-filled spaces and comprises of the maxillary sinuses, the ethmoid sinuses, the sphenoid sinuses and the frontal sinuses. As they are air-filled, tumours that arise in the paranasal sinuses often only present when they are large enough to obstruct the sinuses, or when they cause compressive symptoms on neighbouring structures (such as the orbit).

Types of Tumours

Various neoplasms ranging from benign to malignant tumours can arise in the paranasal sinuses. Fortunately, malignant neoplasms of the paranasal sinuses are uncommon and account for <1% of all neoplasms. Several more commonly seen neoplasms are listed in the table here:

The following are some ways in which paranasal sinuses tumours can present in patients:

1. Nasal obstruction
2. Blood-stained nasal discharge or sputum
3. Epistaxis (Nose bleed)
4. Visual disturbances such as diplopia
5. Epiphora (obstruction of lacrimal
6. Facial fullness or pain

Certain environmental agents have been linked to the development of certain paranasal sinus malignancies. Squamous Cell Carcinoma (SCC) has been associated with things like aflatoxin, which is produced by Aspergillus fungi that can colonize and contaminate grain; chromium, nickel, hydrocarbons and other organic chemicals. Adenocarcinoma has been linked with wood dust exposure. Both these malignancies are also linked with exposure to tobacco smoke, salted and smoked foods and heavy metals. Although inverted papillomas are benign, there is a risk of malignant transformation to SCC.

Patients require nasoendoscopic examination and the diagnosis is made with a biopsy. Depending on the location of the tumour, sometimes radiologic investigations such at CT scan or MRI-scan with intra-operative biopsy may be necessary.

Treatment depends on the histology of the tumour. Generally, most tumours of the paranasal sinuses are treated surgically with possible post-surgery radiotherapy +/- chemotherapy for certain malignant tumours. An endoscopic operative approach is often preferable as it avoids any facial incisions and scars but much depends on the size and location of the tumour. Patients will need to have an open discussion with the surgeon on the most appropriate treatment option.