Sinus and Skull Base Tumours
Mr Ali Qureishi treats the full range of benign and cancerous nasal and anterior skull base tumours. He is a member of the Oxford Skull Base and Head and Neck Cancer
Multidisciplinary Teams (MDTs).
Osteoma
What is an osteoma?
An osteoma is a usually slow-growing, benign bony growth, most often found in the frontal or ethmoid sinuses. Many cause no symptoms and are discovered on scans performed for another reason. Larger growths can obstruct sinus drainage or press on nearby structures.
Incidence and frequency
Osteomas are among the commonest benign sinus tumours. A study of 1,500 sinus CT scans found osteomas in 46 patients, about 3%. This is prevalence in a scanned group, not the annual risk of developing an osteoma in the general population.
Diagnosis
CT usually shows the dense bony growth and its relationship to sinus drainage pathways, the eye socket and skull base. Symptoms and any change on earlier scans help determine whether it is clinically significant. A typical scan appearance may avoid the need for a separate biopsy.
Treatment strategies
Small, symptom-free lesions may be monitored. Surgery is considered for troublesome symptoms, growth, blocked drainage or threatened nearby structures. Removal may be endoscopic, through the nose, or require an external or combined approach depending on size and location.
What is an inverted papilloma?
This is a benign tumour arising from the nasal or sinus lining. It often causes one-sided blockage and may resemble a polyp. Unlike ordinary inflammatory polyps, it can recur and has an association with squamous cell cancer, so specialist diagnosis and follow-up matter.
Incidence and frequency
Published estimates suggest around 0.6 to 1.5 new cases per 100,000 people each year. It is one of the commonest benign epithelial tumours in this area, but remains uncommon overall.
Diagnosis
Nasal endoscopy and a biopsy establish the tissue diagnosis. CT maps the bony anatomy and may suggest the attachment site; MRI can help distinguish tumour from retained secretions and assess its extent. Imaging guides safe surgery.
Treatment strategies
Treatment usually involves complete surgical removal, including attention to the site of attachment, often through the nostrils. More extensive disease may require an additional approach. Long-term endoscopic surveillance is important because recurrence can be delayed. If cancer is identified, the treatment plan changes accordingly.
Inverted papilloma
Squamous cell carcinoma
What is squamous cell carcinoma?
Squamous cell carcinoma, or SCC, is a cancer arising from surface-lining cells. It is the most common sinonasal cancer. Symptoms can include persistent one-sided obstruction, bleeding or facial discomfort; these symptoms also occur in non-cancerous conditions.
Incidence and frequency
Cancer Research UK reports that more than 60% of nasal cavity and paranasal sinus cancers are SCC. Estimates vary with the population and the tumour categories included. This is the proportion among cancers, not the annual chance of an individual developing SCC.
Diagnosis
An endoscopic examination and biopsy confirm the diagnosis. CT and MRI assess the tumour’s extent and possible involvement of the eye socket or skull base. Further scans assess lymph nodes or distant spread when appropriate.
Treatment strategies
Treatment may involve surgery, often followed by radiotherapy. Some cases are treated with radiotherapy and chemotherapy, particularly when surgery is unsuitable or as part of a combined plan. The team balances tumour control with preserving sight, swallowing, speech and facial function. Follow-up checks recovery and recurrence.
What is adenocarcinoma?
Adenocarcinoma arises from gland-forming cells. There are several subtypes, including intestinal-type and non-intestinal-type tumours. Certain forms are associated with occupational wood or leather dust exposure, so your work history is relevant.
Incidence and frequency
Cancer Research UK describes adenocarcinoma as the second most common sinonasal cancer and quotes approximately 30% of cases. The proportion differs between datasets and subtype definitions; it is not an annual population incidence.
Diagnosis
Biopsy with specialist pathology review identifies the subtype and grade. Nasal endoscopy and CT or MRI assess local extent. Additional investigations may be needed to distinguish a primary sinonasal tumour from disease originating elsewhere.
Treatment strategies
Surgery is often central to treatment when the tumour can be removed safely. Radiotherapy may follow, depending on grade, margins and extent. Chemotherapy or other systemic treatment is considered selectively, especially for advanced or unresectable disease.
Subtype matters: the appropriate plan cannot be chosen from the word adenocarcinoma alone.
Adenocarcinoma
Sinonasal lymphoma
What is sinonasal lymphoma?
Lymphoma is a cancer of immune cells. In the nose and sinuses, important subtypes include diffuse large B-cell lymphoma and extranodal NK/T-cell lymphoma. Their behaviour and treatment differ, so an accurate subtype diagnosis is essential.
Incidence and frequency
Sinonasal involvement is uncommon. A specialist review reports that it accounts for approximately 1.5% of lymphomas. This is a proportion of all lymphomas, not an annual incidence or a percentage of all nasal tumours. Frequency and subtype distribution vary geographically.
Diagnosis
A sufficiently representative biopsy is needed for specialist laboratory testing. Occasionally repeat sampling is necessary. Imaging, often including PET-CT, and other tests assess whether disease is localised or present elsewhere. Care is coordinated with haematology.
Treatment strategies
Treatment usually uses systemic medicines, such as chemotherapy with subtype-appropriate immunotherapy, with radiotherapy in selected cases. NK/T-cell lymphoma requires a different regimen from B-cell lymphoma. Surgery generally provides diagnostic tissue rather than being the main curative treatment. The plan depends on subtype, stage and fitness.
What is olfactory neuroblastoma?
Also called esthesioneuroblastoma, this rare cancer arises in the smell-related tissue high in the nasal cavity, close to the skull base. It may cause blockage, nosebleeds or reduced smell and can extend towards the eye sockets or brain.
Incidence and frequency
The US National Cancer Institute estimates about one new case per 2.5 million people each year, equivalent to 0.4 per million annually. It is included here because of its particular relevance to skull base care, rather than because it is common.
Diagnosis
Endoscopy and biopsy establish the diagnosis, usually with specialist pathology review. CT and MRI map the relationship to the skull base and brain. Further tests assess spread, including to neck lymph nodes when indicated.
Treatment strategies
Treatment is individualised at an experienced centre. Surgery is commonly combined with radiotherapy; some patients receive radiotherapy as their main treatment. Chemotherapy may be added in selected advanced, high-risk or metastatic cases. The likely benefits and effects on smell, vision and nearby structures need discussion.
