ENT TUMORS

NASAL CAVITY MASS

1. NASAL POLYP: benign semitransparent of nasal lesion that arise from the mucosa of the
nasal cavity of from paranasales sinuses.
High in male
Usually > 20 years (more common>40 yo)
ETIOLOGY
 Chronic inflammation
 Allergy
 Vasomotor imbalance
 Autonomic nerve system dysfunction
 Genetic predisposition

MULTIPLE POLYPS SOLITARY POLYPS

- occur in children Usually from maxillary sinus- ostia
Ususally from ethmoidal Chaone and nasopharynx (chonal polyp/ auto
cellulae. choanal polyp)
Associated with: Anterior rhinoscopy
 Chronic sinusitis Posterior rhinoscopy: choanal polyp
 Allergic sinusitis X-ray with water’s position
 Cystic fibrosis
 Allergy fungal sinusitis
Examine with anterior
rhinoscopy
GOLD STANDARD: HISTOPATHOLOGICAL EXAMINATION
DDX:
- encephalocele
- papilloma
- juvenile nasopharyngeal angiofibrima
- inverting papilloma
TREATMENT:
-corticosteroid topical & oral
- surgery

MICROSCOPIC:
1. Pseudostratified ciliated columnar epitehlium with thickening of epithelial basement
membrane.
2. Stroma; edematous, poorly vascularization, lacks of innervations (except at base)
3. Hyperplasia serousmucous gland cause cystically dilated and degenerated gland s
containing inspissated mucous
4. Infiltrate of eosinophil, neutrophil, degranulated mast cell, plasma cells, lymphocytes
and myofibroblast.

SYMPTOMS:
 nasal airway obstruction
 Postnasal drainage
 Dull headaches
 Snoring/ rhinorrhea
 Hyposmia or anoosmia
 Frog face deformity

2. NASOPHARYNGEAL CARCINOMA: malignant epithelial tumor airising in the

nasopharyngeal mucosa, including keratinizing squamous cell carcinoma and non-
keratinizing squamous cell carcinoma. (differentiare and undifferentiate)
 >chiniese southeast asians
 >males commonly
 >30 yo (peak 40-50 yo)

ETIOLOGY:
 Genetic
 Infection Epstein- Barr Virus (EBV)
 Environmental factors (dietary/nondietary)
- bahan nitrosamine yang mudah menguap dalam preserved food
- salted fish
- cigarette smoking
- occupational exposure to smoke
- chemical fumes and dust
- formaldehyde exposure
- radiation exposure

Localised at the lateral wall of

Nasopharynx esp rossenmuller
Fossa and superior post wall

ENDOPHYTIC EXOPHYTIC

HISTOPATHOLOGY
KERATINIZING NON-KERATINIZING
- show clearcut evidence of keratinization - don not show evidence of keratinization
- less marked association with EBV - most common type
-older age group Subdivided:
- differentiated
- stratified/ tiled arrangement
- well defined cell margins
- undifferentiated
- syncytial appearance
- indistinct cell margins
- some tumor cells may be spindle
shaped

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Tumor spread:
 Loco-regional infiltration
 Regional (cervical) node
 Hematogenous dissection

SYMPTOMS
 Painless enlargement of upper cervical lymph
 Complain nasal symptoms, blood stained post nasal drip
 Eustachian tube obstruction ( serous otitis media)
 Advanced stage: headache and related with cranial nerve involvement (N.X),
 Ophthalmic (double vision, squint (juling), blindness)
 Speech and swallowing problems _ weight loss

SIGNS
 Enlarged neck nodes
 Bilateral nodes
 Neck node extend to supraclavicular fossa
 Cranial nerve palsy
 Deafness & dermatomyositis

STAGE 1: T1 & N0
STAGE 2: T2 &N0
STAGE 3: T3; N0@1/ T2&N1/ T1&N1
STAGE 4: T4; N1@N0 or ANY T&N1-4

DDX:
 Malignant lymphoma
 Olfactory neuroblasma: ada ggn halusinasi bauan pada bubus olfactory
 Nasopharyngeal angiofibroma

TREATTMENT
Radiation therapy:
 Treatment of choice
 Complete remission dari segi pathology
 Or combine with chemotherapy

3. LARYNGEAL CARCINOMA: arise from laryngeal epithelium (glottis, supraglottis,

subglottis)
90% laryngeal carcinoma are squamous cell carcinoma
> MALE
> Black than white race
Peak at middle-older aged

ETIOLOGY
 Smoking !!
 Alcohol
 Others: metal dust/ cement dust/ varnish/ lacquer (syellek kayu) / polycyclic aromatic
hydrocarbon

MORPHOLOGY
 GROSS: protruding pink to gray mass, often ulcerated
 MICROS: squamous cell carcinoma/ well/moderately/ poorly differentiated

SPREADING :
 Direct extension to adjacent structures
 Lymphatic spread to regional lymph nodes (cervical)
 Hematogenous spread: lung,liver, bone

SYMPTOMS: depend location & size

 Hoarseness - Earaches
 Lump in the neck - Dysphagia (susah menelan)
 Sore throat - Odynophagia (sakit sewaktu makan)
 Persistent cough - weight loss
 Stridor - coughing blood
 Bad breath (tjd necrosis)

TREATMENT
 Surgery : tracheotomy/ partial or total laryngectomy
 Radiotherapy
 Chemotherapy: alone or in combination based on location,type, and stages

DDX:
 Inflammation
 Laryngeal TB
 Mycotic laryngitis
 Laryngeal granuloma

 Benign tumor : papilloma

 Laryngeal nodule: (polyp; singer’s nodule)