Elsevier

Auris Nasus Larynx

Volume 41, Issue 3, June 2014, Pages 290-293
Auris Nasus Larynx

Sinonasal tract chondrosarcoma: 18-Year experience at a single institution

https://doi.org/10.1016/j.anl.2013.10.011Get rights and content

Abstract

Objective

Sinonasal tract chondrosarcomas are considered rare malignancies. Few large series evaluated the clinicopathological characteristics of these tumors. The aim of this study was to describe clinical findings, management and outcome of 24 cases of sinonasal tract chondrosarcoma from a single institution and to focus on the validity and advantage of endoscopic technique compared with conventional surgery.

Methods

A retrospective analysis of clinical information was performed on 24 patients diagnosed as the sinonasal tract chondrosarcomas between 1994 and 2011.

Results

There were 10 males and 14 females (age range, from 7 months to 67 years; mean age, 34.9 years) in this study. The main complaints were nasal obstruction and swelling/mass. The most common affected sites were maxillary sinus and sphenoid sinus. Except one case of myxoid chondrosarcoma and two cases of mesenchymal chondrosarcoma, 17 patients (70.8%) and 4 patients (16.7%) were, respectively, grade I and II. Three patients were misclassified as other tumors at other hospitals. Two cases had a history of radiation. Five cases superimposed upon a preexisting benign bony conditions. Twenty-three of 24 patients were treated with wide surgical excision, including 15 patients with conventional surgeries by external approach and 8 patients with endoscopic surgeries. Local recurrence was observed in 12 patients. The mean interval of recurrence with endoscopic surgery (37.8 months) was longer than conventional approach (21.9 months), but it did not achieve statistical significance due to small sample size. The 5-year disease-specific survival rate was 83.3%.

Conclusion

Chondrosarcomas of the sinonasal tract are rare. The patients with earlier diagnosis and adequate surgical treatment have a more favorable prognosis. Uncontrollable local disease resulting in compression of adjacent critical structures is the most common cause of death.

Introduction

Chondrosarcomas are quite uncommon malignancies which may originate from bones or soft tissues. They can occur anywhere in the body, but the most common sites are pelvis, long bones and ribs [1]. The head and neck chondrosarcomas are much rarer, accounting for only 1–12% [2], [3]. They grow slowly, but they are locally aggressive and easy to relapse. About 50% of the head and neck chondrosarcomas arise from sinonasal tract [4]. Due to anatomical characteristics, chondrosarcomas in the sinonasal tract usually invade the vital structures, which lead to a poor prognosis if treated insufficiently.

To date, only a few series have been reported, many controversies are still persistent concerning the appropriate treatment modality. In the current study with a relatively large group, we reviewed the clinical features, diagnosis, treatments and outcomes of 24 patients with sinonasal tract chondrosarcomas treated in our institution from 1994 to 2011. Moreover, our study focused on the validity and advantage of endoscopic technique compared with conventional surgery.

Section snippets

Materials and methods

A retrospective study reviewed 24 patients diagnosed as sinonasal tract chondrosarcoma at the Eye, Ear, Nose and Throat Hospital of Fudan University between 1994 and 2011. This study was approved by the institutional review board of Fudan University. All the surgical specimens were proven by histological examination. Clinical information including gender, age, medical history, symptoms, radiographic findings, tumor site and grade, treatment, recurrence and outcome were recorded. Follow-up until

Patient demographics and clinical findings

There were 10 males and 14 females in the series. The ages at diagnosis ranged from 7 months to 67 years (mean age, 34.9 years; median age, 35.5 years). The most common sites were maxillary sinus (12 cases, 50.0%) and sphenoid sinus (11 cases, 45.8%). The chief complaints were nasal obstruction (11 cases, 45.8%) and swelling/mass (8 cases, 33.3%). Pain and visual impairment were other frequent symptoms. Symptoms can be present for up to 24 months with an average of 7.6 months before diagnosis.

Discussion

The etiology of chondrosarcomas remains uncertain. Various factors including irradiation, previous surgery and accidental trauma may associate with chondrosarcomas. In addition, some benign bony conditions such as chondromyxoid fibroma, fibrous dysplasia, multiple hereditary exostosis can be the risk factors [1], [5]. So a longer follow-up period is necessary for these tumors. Particularly, malignancy must be suspected when previous symptoms and signs become worse in a short time. In the

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    Theses authors contributed equally to this work.

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