Mohapatra Debahuti, Sahoo Nibedita, Dehuri Priyadarshini, Das Prateek, Mohapatra Ajit Surya, Govardhan Tulasi
Department of Pathology, IMS and SUM Hospital, Bhubaneswar, Odisha, India.
J Microsc Ultrastruct. 2022 Feb 4;12(1):21-26. doi: 10.4103/jmau.jmau_70_21. eCollection 2024 Jan-Mar.
One of the most challenging diagnostic categories in the sinonasal tract includes small-blue-round-cell tumors. These are malignant tumors which show many overlapping histomorphology and immunohistochemistry (IHC) findings. Limited, small biopsy of these not completely excisable tumors adds to the diagnostic confusion.
A cross-sectional study was done for 2 years (January 2018-December 2020) in a tertiary care institute, which included 70 cases of tumors of which 49 cases were malignant. All paraffin-embedded blocks were subjected to hematoxylin and eosin stain and IHC followed by molecular study wherever needed.
Of the total cases, small-blue-round-cell tumor constituted the major category comprising 20 rare and interesting cases which included sinonasal undifferentiated carcinoma (4 cases), malignant lymphoma (2 cases of diffuse large B-cell lymphoma and 2 cases of extranodal natural killer/T-cell lymphoma), rhabdomyosarcoma (2 cases), olfactory neuroblastoma (2 cases), malignant melanoma (2 cases), plasmacytoma (2 cases), atypical Ewing's sarcoma (EWS) (1 case), EWS (1 case), nuclear protein in testis (NUT) carcinoma (1 case), and small-cell neuroendocrine carcinoma (1 case).
Tumors of the sinonasal tract are very diverse, more so in small-round-cell tumor which present with a undifferentiated morphology. Thus, accurate diagnosis needs clinicoradiological parameters and special ancillary techniques such as IHC and molecular study in addition to histopathology for early diagnosis and therapy to prevent significant morbidity and mortality caused in these tumors.
鼻窦最具挑战性的诊断类别之一包括小蓝圆细胞肿瘤。这些是恶性肿瘤，具有许多重叠的组织形态学和免疫组织化学（IHC）表现。对这些无法完全切除的肿瘤进行有限的小活检会增加诊断的困惑。
在一家三级医疗机构进行了一项为期2年（2018年1月至2020年12月）的横断面研究，其中包括70例肿瘤病例，其中49例为恶性肿瘤。所有石蜡包埋块均进行苏木精和伊红染色及免疫组织化学检测，必要时进行分子研究。
在所有病例中，小蓝圆细胞肿瘤是主要类别，包括20例罕见且有趣的病例，其中包括鼻窦未分化癌（4例）、恶性淋巴瘤（2例弥漫性大B细胞淋巴瘤和2例结外自然杀伤/T细胞淋巴瘤）、横纹肌肉瘤（2例）、嗅神经母细胞瘤（2例）、恶性黑色素瘤（2例）、浆细胞瘤（2例）、非典型尤因肉瘤（EWS）（1例）、EWS（1例）、睾丸核蛋白（NUT）癌（1例）和小细胞神经内分泌癌（1例）。
鼻窦肿瘤种类繁多，小圆形细胞肿瘤更是如此，其呈现未分化形态。因此，准确诊断除了组织病理学外，还需要临床放射学参数以及免疫组织化学和分子研究等特殊辅助技术，以便早期诊断和治疗，预防这些肿瘤导致的严重发病率和死亡率。
