Sinonasal Carcinoma - Patterns of Spread
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Hello, everyone.
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3 00:00:02,130 --> 00:00:05,790 Dr. Sidney Levy here, continuing our discussion on the
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diagnosis and staging of sinonasal squamous cell carcinoma.
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In this vignette, I'd like to discuss patterns
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of spread of sinonasal squamous cell carcinoma.
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I have an example here of a nasal cavity squamous cell
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carcinoma with post-contrast T1-weighted imaging with fat
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suppression in axial, coronal, and sagittal projections.
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These malignancies can spread in almost all directions.
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I will start off with this particular one,
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which arose in the right nasal cavity here.
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And as you can see, it has spread superiorly
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into the ethmoidal air cells on the right-hand
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side, and then through the cribriform plate
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here into the anterior cranial fossa.
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So this is a superior pattern of spread.
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If the malignancy had arisen in the maxillary sinus, then
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it can spread superiorly into the orbit, either directly
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through the bony orbital floor or more indirectly via
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the pterygopalatine fossa and inferior orbital fissure.
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An alternative pattern of spread is inferiorly, in
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which case the structures which can become compromised
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are the hard palate here, particularly if it's a nasal
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cavity malignancy heading downwards, or alternatively,
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the maxillary alveolar process, if the malignancy has
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started in the maxillary sinus and then eroded the
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floor of that into the maxillary alveolar process.
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An alternative mode of spread is anteriorly, and
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sometimes these malignancies will spread directly
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into the soft tissues of the cheek or the nose.
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Alternatively, it can spread posteriorly into the
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retroantral fat pad, pterygopalatine fossa, or more
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laterally into the masticator spaces, which are here.
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One other mode of spread is perineural tumor spread,
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where a malignancy spreads along the course
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of major branches of the trigeminal nerve.
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For sinonasal squamous cell malignancy, it may spread via
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the maxillary, or V2 division of the trigeminal nerve,
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and its major branches, including the infraorbital nerve.
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This has not occurred in this particular case, but it
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is always something that is worth watching out for.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
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