Sinonasal Carsinoma

Sinonasal CarsinomaPresented By Nurul AS, Noni G, Putri MS, Erlinda RP, Novia D, Dinidr. Lily Setiani Sp.THT-KL1BAGIAN / SMF ILMU KESEHATAN THT-KLFAKULTAS KEDOKTERAN UNIVERSITAS SYIAH KUALARSUD Dr. ZAINOEL ABIDINBANDA ACEH 2015IntroductionThe most cancer case at ENT field after nasapharynx carsinoma in AsiaMan : 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)

2Case Report

AnamnesisWoman, 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 fundAfter 5 months, patient back to hospital with worse condition.4AnamnesisPatient ever treated for same complian in 2014 in district hospitalPatient have controlled hypertension and have no DMPatient use nasal spray medication that gave from district hospitalPatient have ikan asin in her menu.

Physical ExaminationGeneral findingsLocal findingsGeneral contition : GoodConsciousness : CMBP : 140/80mmHgHR : 84 beat/m, regularRR : 20 time/mT : 37.0 0CEar : there was secrets in AS, other in normal limitNose : there was mucosal hiperemic, secrets, airways obstruction, and hyperthropy inferior conca in left nasal cavum. Other in normal limitOropharynx : in normal limitMaxillofacial : in normal limitNeck : lymph node in normal limit

6Work UpLaboratory findings

Jenis pemeriksaan13 Mei 201515 mei 201517 mei 2015Hb 6,0 gr/dl6,9 g/dl11,6 g/dlErytrocyte3,0.106/mm3 3,2. 106/mm35. 106/mm3Leucocyte6,0.103/mm36,0.103/ mm36,4. 103/mm3Trombocyte559.103 / mm3443.103/ mm3434. 103/mm3Ht 20 % 22 %37 %Eosinophils 9822Basophils000Segmental neutrophils485339Lymphocytes 34622Monocyte91317AST/SGOT18 U/L16 U/LALT/SGPT9 U/L9 U/LUreum36 mg/dl29 mg/dLKreatinin0,80 mg/dl0,75 mg/dL

Work UpRadiology (Thorac X-ray)/May 19thCor : 56%Pulmo : in normal limitCostophrenicus angle left and right : in normal limitAbces and subcutaneous emphysema

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Work UpRadiology (SPN CT-Scan)/May 18thSolid 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

9Left nasal cavum biopsy/Dec 12thFindings : Inverted papillomaLeft nasal cavum biopsy /June 4thFindings : Non Keratinizing Squamous Cell Carcinoma

DiagnoseSinonasal Carsinoma + Anemia

TreatmentIn hospital wardIVFD RL 20gtt/iPRC transfusion 4 kolf until Hb>10Ceftriaxon 1gr/12 hoursPost Partial MaxillectomyTransamin 3x500mgKetorolac 3x30mgVit K 2x1 ampDiovan 1x1 tabamlodipin 1x1 tabSurgical InterventionPerform lateral rhinotomy with webber-ferguson incision.

12PrognosisQuo ad Vitam : Dubia ad bonamQuo ad Functionam : Dubia ad malamQuo ad Sanactionam : Dubia ad malam

Literary

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Risk FactorsTobaccoalcoholAgeGenderSpecific inhalation agent such as heavy metal, textile material, and timber industry dust.Viral : Epstein-barr and HPV.

16Mechanism17ClassificationEpitel Non epitelKarsinoma sel squamousDifferensiasi Squamous basaloid Adenosquamous Karsinoma sel nonsquamous Adenoid cystic carcinoma Mucoepidermoid carsinoma Adenocarcinoma Neuroendocrine carcinoma Hyalinizing clear cell carcinomaMelanoma malignaOlfactory neuroblastomaSinonasal undifferentiated carcinoma ChondrosarcomaOsteogenic sarkomaSoft tissue sarcoma Fibrosarcoma Malignant fibrous histiocytoma Hemangiopericytoma Angiosarcoma Kaposis sarcoma Rhabdomyosarcoma Lymphoploroferative Lymphoma Polymorphic reticulosis Plasmacytoma Metastatic 18Ceratinizing Squamous Cell Carsinoma

Non-Ceratinizing Carsinoma

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FindingsAdenocarsinoma SinonasalUndifferentiated CarsinomaHistopatologyDiagnose

Anamnesis21

Physical ExaminationMaxilofacial examRinoscopy anterior and posterior examOrapharynx examHearing exam22Work UpRadiology ExamBiopsyPositron Emission Tomography

MRI

23Stagging24

Treatment

Complication26BleedingDiplopiaEpiforaCerebro fluid leakage

PrognosisCommonly 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

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