Sinonasal Carsinoma

Presented By
Nurul AS, Noni G, Putri MS, Erlinda RP, Novia D, Dini
dr. Lily Setiani Sp.THT-KL

BAGIAN / SMF ILMU KESEHATAN THT-KL

FAKULTAS KEDOKTERAN UNIVERSITAS SYIAH KUALA1
RSUD Dr. ZAINOEL ABIDIN
BANDA ACEH 2015

Introduction
The most cancer case at ENT
field
after
nasapharynx
carsinoma in Asia
Man : Woman = 1.5:1, 80% in
45-85 years old.
Common nasal problem can
mimic its symptoms in early
phase (unilateral epistaksis,
nasal obstruction, etc)

Case Report

Anamnesis
Woman, 72 years old came to RSUDZA with cheif complain

congestion of her nasal since one years ago and feel worse.
Patient also complain pus and blood come out from her nose.
Patient also feel pain in her left cheek and feel there is something
grow bigger and bigger in her left cheek too.
Patient ever treated for several days in ward for investigation her
disease and allowed to go home and must return for her therapy
but patient didnt came back to hospital cause lack of fund
After 5 months, patient back to hospital with worse condition.

Anamnesis
Patient ever treated for same complian in 2014 in district
hospital
Patient have controlled hypertension and have no DM
Patient use nasal spray medication that gave from district
hospital
Patient have ikan asin in her menu.

Physical
Examination
General
findings

Local findings

General contition :
Good

Consciousness : CM
BP : 140/80mmHg
HR : 84 beat/m, regular
RR : 20 time/m
T : 37.0 0C

Ear : there was secrets in AS, other in

normal limit

Nose : there was mucosal hiperemic,

secrets,
airways
obstruction,
and
hyperthropy inferior conca in left nasal
cavum. Other in normal limit

Oropharynx : in normal limit

Maxillofacial : in normal limit
Neck : lymph node in normal limit

Work Up

Laboratory
Jenis findings
pemeriksaan
13 Mei 2015

15 mei 2015

17 mei 2015

6,0 gr/dl

6,9 g/dl

11,6 g/dl

Erytrocyte

3,0.106/mm3

3,2. 106/mm3

5. 106/mm3

Leucocyte

6,0.103/mm3

6,0.103/ mm3

6,4. 103/mm3

559.103 / mm3
20 %
9
0

443.103/ mm3
22 %
8
0

434. 103/mm3
37 %
22
0

48

53

39

34
9

6
13

22
17

AST/SGOT

18 U/L

16 U/L

ALT/SGPT

9 U/L

9 U/L

Ureum

36 mg/dl

29 mg/dL

Kreatinin

0,80 mg/dl

0,75 mg/dL

Hb

Trombocyte
Ht
Eosinophils
Basophils
Segmental
neutrophils
Lymphocytes
Monocyte

Work Up
Radiology (Thorac X-ray)/May 19 th
Cor : 56%
Pulmo : in normal limit
Costophrenicus angle left and
right : in normal limit

Abces and
subcutaneous
emphysema

Work Up
Radiology (SPN CT-Scan)/May 18th
Solid mass from left maxillaris
sinus spread to nasal cavum, in
left ethmoid, left frontal, and
left sphenoid with maxilla bone
destruction and maxilla sinus
wall destruction

 Left nasal cavum biopsy/Dec

12th

Findings : Inverted papilloma

Left nasal cavum biopsy

/June 4th
Findings : Non Keratinizing
Squamous Cell Carcinoma

Diagnose
Sinonasal Carsinoma +
Anemia

Treatment
In hospital ward
IVFD RL 20gtt/i
PRC transfusion 4 kolf until
Hb>10
Ceftriaxon 1gr/12 hours

Post Partial Maxillectomy

Transamin 3x500mg
Ketorolac 3x30mg
Vit K 2x1 amp
Diovan 1x1 tab
amlodipin 1x1 tab

Surgical Intervention
Perform lateral
rhinotomy with
webberferguson
incision.

Prognosis
Quo ad Vitam : Dubia ad bonam
Quo ad Functionam : Dubia ad
malam
Quo ad Sanactionam : Dubia ad
malam

Literary

15

Risk Factors

Tobacco
alcohol
Age
Gender
Specific inhalation agent
such as heavy metal, textile
material, and timber
industry dust.
Viral : Epstein-barr and HPV.

Mechanism
Risk factors
Mutation in growth control gen such as
proliferation gen and differiantiation
gen (proto-onkogen and antionkogen)
Intiation phase,
promotion phase
Induction phase
In situ phase
and
dissemination
phase

17

Classification
Epitel
Karsinoma sel squamous
Differensiasi
Squamous basaloid
Adenosquamous
Karsinoma sel nonsquamous
Adenoid cystic carcinoma
Mucoepidermoid
carsinoma
Adenocarcinoma
Neuroendocrine
carcinoma
Hyalinizing clear cell
carcinoma
Melanoma maligna
Olfactory neuroblastoma
Sinonasal undifferentiated
carcinoma

Non epitel
Chondrosarcoma
Osteogenic sarkoma
Soft tissue sarcoma
Fibrosarcoma
Malignant fibrous
histiocytoma
Hemangiopericytoma
Angiosarcoma
Kaposis sarcoma
Rhabdomyosarcoma
Lymphoploroferative
Lymphoma
Polymorphic reticulosis
Plasmacytoma
Metastatic
18

Ceratinizing Squamous Cell Carsinoma

Non-Ceratinizing Carsinoma

Histopatology
Findings

Undifferentiated Carsinoma

Adenocarsinoma Sinonasal
19

Diagnose

Anamnesis

21

Physical Examination

Maxilofacial exam
Rinoscopy anterior and posterior exam
Orapharynx exam
Hearing exam

Work Up
Radiology
Exam

Biopsy

Positron
Emission
Tomography

MRI

Stagging

24

Treatment

Complicati
on

Bleeding
Diplopia
Epifora
Cerebro fluid
leakage

26

Prognosis

Commonly poor.
Based on multifactoral
condition such as histology
diagnose,
immunologic
condition, and moreelse.
Multidimension
therapy
can improve the survival
rate up to 75% for 5 years
27

Post operation lateral rhinotomy

Thank You
Lets Discuss