Helsel Jay C, Bardales Ricardo H, Mukunyadzi Perkins
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
Cancer. 2003 Apr 25;99(2):105-12. doi: 10.1002/cncr.10956.
Primary and metastatic malignancies that originate in the sinonasal tract are rare and histologically diverse. The role of fine-needle aspiration biopsy (FNAB) and the cytomorphologic features of these tumors have not been specifically addressed.
The authors reviewed 22 cytology cases (20 FNABs, 1 sputum sample, and 1 pleural fluid sample) from 18 patients with malignancies originating in the sinonasal tract (17 carcinomas, 3 melanomas, and 2 sarcomas) and assessed the cytomorphology, cytohistologic correlation, and ability of cytology to render a specific diagnosis.
Primary and metastastic sites sampled by FNAB included masses in or around the nose (n = 2), orbit (2), maxillary sinus (2), frontal sinus (1), intraoral area (1), preauricular area (1), soft tissue neck masses, parotid and lymph nodes (10), and cervical spine (1). Exfoliative cytology was positive in two samples of sputum and pleural fluid, representing the initial cancer diagnosis before the sinonasal primary tumor was detected. Seventeen of 22 (77.3%) cases were classified as carcinoma not otherwise specified, carcinoma with specific differentiation, sarcoma, or melanoma. Cytology failed to correctly classify the specific subtype of three carcinomas. The cytologic features that were evaluated included cellularity, cellular arrangement, nuclear features, nuclear-to-cytoplasmic ratio, and the background appearance.
Sinonasal tract malignancies demonstrate a wide range of cytologic findings but specific features allowing for an accurate and definitive diagnosis are often present in many tumors. Fine-needle aspiration cytology is an important diagnostic tool in the management of sinonasal malignancies and can be complemented by the use of ancillary studies for the diagnosis of poorly differentiated or nonepithelial tumors.
起源于鼻窦道的原发性和转移性恶性肿瘤较为罕见，且组织学类型多样。细针穿刺活检（FNAB）的作用以及这些肿瘤的细胞形态学特征尚未得到专门研究。
作者回顾了18例起源于鼻窦道恶性肿瘤患者（17例癌、3例黑色素瘤和2例肉瘤）的22例细胞学病例（20例FNAB、1例痰液样本和1例胸腔积液样本），并评估了细胞形态学、细胞组织学相关性以及细胞学做出明确诊断的能力。
通过FNAB取样的原发性和转移部位包括鼻内或鼻周肿块（n = 2）、眼眶（2例）、上颌窦（2例）、额窦（1例）、口腔内区域（1例）、耳前区域（1例）、颈部软组织肿块、腮腺和淋巴结（10例）以及颈椎（1例）。痰液和胸腔积液的两份样本通过脱落细胞学检查呈阳性，这是在鼻窦原发性肿瘤被检测到之前的初始癌症诊断。22例病例中有17例（77.3%）被分类为未另行指定的癌、有特定分化的癌、肉瘤或黑色素瘤。细胞学未能正确分类3例癌的具体亚型。评估的细胞形态学特征包括细胞密度、细胞排列、核特征、核质比以及背景外观。
鼻窦道恶性肿瘤表现出广泛的细胞学表现，但许多肿瘤通常存在有助于准确明确诊断的特定特征。细针穿刺细胞学检查是鼻窦恶性肿瘤管理中的一项重要诊断工具，对于低分化或非上皮性肿瘤的诊断可通过辅助研究加以补充。
