Ching-Zong Lin

Toward a better understanding of sinonasal mucosal melanoma: clinical review of 23 cases.

Background: Primary sinonasal mucosal melanoma is a rare disease, occurring far less often than cutaneous lesions. The objective of this study was to review the records of patients diagnosed with primary sinonasal mucosal melanoma. Methods: We performed a retrospective review of the medical records of 23 patients with sinonasal mucosal melanoma who were treated at Taipei Veterans General Hospital between 1982 and 2002. Results: Sixteen of the 23 patients were male and 7 were female; their mean age was 68.2 years (range, 39‐87 years). At diagnosis, the melanoma was limited to lesions located in the sinonasal area in 20 patients, and had spread in 3 patients. Local recurrence developed in 9 patients, neck metastasis in 5, and distant metastasis in 19. The 5‐year disease‐specific survival and local control rates were 22.26% and 52.30%, respectively. Conclusion: In our experience, primary sinonasal mucosa melanoma is prone to spread from the site of origin. The major obstacle in improving overall survival is achieving systemic control.

Localized Amyloid Deposition in the Nasopharynx and Neck, Mimicking Nasopharyngeal Carcinoma with Neck Metastasis

Amyloidosis results from the deposition of amyloid proteins in organs and tissues. Clinically, it can be classified into systemic and localized forms. Here, we report a case of localized amyloidosis of the nasopharynx and neck. The initial presentation was a nasopharyngeal mass, and bilateral neck masses, mimicking nasopharyngeal carcinoma with neck metastasis. Computed tomographic scans of the neck revealed asymmetry between the bilateral nasopharyngeal walls, and multiple radio-opaque masses in both sides of the neck. A nasopharyngeal biopsy was performed and confirmed amyloid deposition. Subsequent neck-mass excision biopsies confirmed that the neck masses were also amyloid deposits. Further laboratory examinations revealed no systemic involvement. There was no disease progression after local excision. Localized amyloidosis in the head and neck is rare, but can have various manifestations that may sometimes mimic neoplasms.

Locally advanced oncocytic carcinoma of the nasal cavity treated with surgery and intensity-modulated radiotherapy.

Oncocytic carcinomas of the nasal cavity are extremely rare. We report 1 patient whose primary tumor and neck lymphadenopathies were under control nearly 2 years after combined surgery and radiotherapy. An 80-year-old man with a history of nasal oncocytoma had received excision twice previously. Computed tomography demonstrated locally advanced recurrent tumor invading the paranasal sinuses and orbit with lymphadenopathies in the right neck. Skull base surgery was performed. Pathological examination revealed oncocytic carcinoma. Positron emission tomography showed hypermetabolic lesions in the surgical bed and right neck. The patient subsequently received intensity-modulated radiotherapy to the primary site and the whole neck. Follow-up computed tomography 4 months later showed marked shrinkage of the neck lymphadenopathies. There was no progression after nearly 2 years. Although these tumors have historically been regarded as radioresistant, the combined treatment of surgery followed by radiotherapy may offer the best chance for control of locally advanced disease.

Intranasal Glomus Tumor

Glomus tumor is a distinctive benign neoplasm that rarely occurs in the head and neck region, and even less commonly in the nasal cavity. As of 2005, there were only 22 reported cases of sinonasal glomus tumor in the English medical literature. We present here a case of a 58 year-old man presenting with nasal obstruction and intermittent epistaxis. The tumor and its associated symptoms were eliminated by intranasal endoscopic excision. There was no complication or recurrence found during postoperative follow-up. Here we clarify this ambiguous term by reviewing related literature and emphasize the importance of differentiating this tumor from paraganglioma.

Primary Sinonasal Mucosal Melanoma with Unusual Long-Term Survival

The primary sinonasal mucosal melanoma is a rare entity. It has a grave clinical course with a dismal prognosis. A patient with long- term survival is very unusual. We report a 70-year-old male with a primary sinus mucosal melanoma and multiple metachronous disseminations. The patient underwent curative surgery for the primary sinus lesion and multiple salvage therapies for distant failures. A survival period of more than 10 years was achieved. We establish the value of repeated salvage therapies in prolonging survival time for this patient with a primary sinonasal mucosal melanoma.