Neuroectodermal tumours of the sino-nasal tract: a clinicopathological study of 18 cases with a newly proposed revised classification and a brief review of literature

• Published in: European archives of oto-rhino-laryngology Vol. 279; no. 3; pp. 1181 - 1191
• Main Authors: Stephen, Norton, Srinivas, Bheemanathi Hanuman, Ravi, Soundarya, Ganesh, Rajesh Nachiappa, Badhe, Bhawana A, Toi, Pampa, Jinkala, Sreerekha, Sekar, Raghul, Alexander, Arun, Narendhar, Pandjatcharam, Jagadesan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2022
• Subjects: Ameloblastoma; Esthesioneuroblastoma, Olfactory; Head and Neck Surgery; Humans; Medicine; Medicine & Public Health; Nasal Cavity - pathology; Neurosurgery; Nose Neoplasms; Otorhinolaryngology; Review Article; Sarcoma, Ewing - diagnosis; Sarcoma, Ewing - pathology; Sino-nasal; Nasal; Neuroblastoma; Neuroectodermal; Olfactory
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-021-07051-6

Aim
Sino-nasal tract tumours constitute 3% of the head and neck malignancies. Among these tumours, neuroectodermal tumours are rare with histo-morphological and immunohistochemical overlap making them a challenge for the pathologist. We included Ewing’s/PNET, olfactory neuroblastoma (OFN), mucosal malignant melanomas (MMM), Melanotic neuroectodermal tumour of infancy (MNTI), small-cell neuroendocrine carcinoma (SNEC), and the newest entity Adamantinoma like Ewing’s sarcoma (ALES) as part of the neuroectodermally derived tumours of the sino-nasal tract. The last three entities were added to the existing ones, which also has been emphasized in this paper.
Methods and results
A comprehensive analysis was done on all neuroectodermally derived tumours from 2016 to 2020. A total of 18 cases were collected, which included OFN (10 cases), SNEC (2 cases), MMM (2 cases), Ewing’s/PNET (2 cases), MNTI (1 case), and ALES (1 case). The most common presentation in NE tumours was nasal obstruction (80–100%). Except for OFN, all other tumours were confined to the nasal and paranasal sinuses. 4/10 cases of OFN showed orbital extension. Cervical lymph-node metastasis was seen in 50% of cases of SNEC and MMM groups. An array of relevant immune-histochemical markers were performed. The marker expression was very subtle among the groups. On follow-up, recurrence was seen in the OFN and MMM groups in 30 and 50%, respectively. Metastasis was seen in SNEC group (100%) and OFN group (10%).
Conclusion
As sino-nasal neuroectodermal tumours pose a diagnostic challenge and have different therapies and are prognostically different, the pathologist must be aware of the subtle morphological, immunohistochemical clues which have been dealt with in-depth in this study.