International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors

BACKGROUND: Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field. METHODS: In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format, and completed sections underwent a thorough and iterative consensus-building process. The final document underwent rigorous synthesis and review prior to publication. RESULTS: The ICSNT document consists of four major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention. CONCLUSION: As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses

HIV Presenting as Inflammatory Pseudotumor of the Skull Base: Case Report and Review of the Literature

A 52-year-old woman presented with frontal headaches, panhypopituitarism, and right cranial nerve VI palsy. MRI of the brain with gadolinium revealed a destructive process involving the clivus and bilateral petrous apices, and extending into bilateral cavernous sinuses with encasement and narrowing of the bilateral cavernous carotids. There was soft tissue enhancement of the pre-pontine cistern with extension into the sella and enlargement of the pituitary gland. CT scan showed bony erosion of the skull base. Transnasal transsphenoidal biopsy showed friable bone in the rostrum of the sphenoid sinus. Pathology revealed connective and adipose tissue with acute and chronic inflammation and granulation tissue. Cultures were negative. Patient was also diagnosed with HIV during her hospital stay. She responded well clinically and radiographically to steroids. A 3-month follow-up MRI revealed persistent erosive lesion in the base of the occiput and clivus with decreased extension into the cavernous sinus, sella, and suprasellar region. Inflammatory pseudotumor of the anterior skull base is a rare entity that can be diagnostically challenging. Few cases are present in the literature and are idiopathic or caused by inflammatory or autoimmune diseases. We present the first case of inflammatory pseudotumor of the anterior skull base associated with HIV with a review of the literature and stress the importance of endoscopic transnasal biopsy for the diagnosis and management of this disease

Orbital Exenteration for Advanced Peri-orbital Skin Cancer: Prognostic Factors and Survival

Objectives: Orbital exenteration for advanced periorbital malignancies is a relatively rare but highly morbid procedure, often done for cancers arising from periorbital skin. The purpose of this research is to investigate and describe cases of cutaneous malignancy of the periorbital skin for which orbital exenteration was done. Methods: This is a retrospective single institution case series at a tertiary care university hospital, including all cases of orbital exenteration for advanced periorbital malignancies performed between January 2002 and January 2012 at the University of Miami/Bascom Palmer Eye Institute/Jackson Memorial Hospital. Patient demographics, tumor characteristics, operative reports, histologic, radiologic and clinical follow-up data were recorded. Outcome measures were overall survival and disease free survival, univariate analysis for multiple clinical factors including prior surgery, bony erosion on pre-operative CT scan, intracranial involvement, and surgical margins. Results: There were 64 patients with a mean age of 70 years (41 male, 23 female) who underwent orbital exenteration for periorbital skin cancers. Of these, 24 patients had squamous cell carcinoma, 24 basal cell carcinoma, 11 sebaceous carcinoma, and 5 cases of malignant melanoma. The most common sites of origin were facial skin (17), medial canthus (14), inferior lid (14), and upper lid (11). Conclusions: Surgical outcome and survival were reviewed with relation to significant prognostic variables