Sinonazal Tümörler
Özet
Sinonazal traktın malign tümörleri, üst solunum yolu tümörlerinin %3’ünü oluşturan ve nonspesifik semptomlar nedeniyle sıklıkla ileri evrelerde teşhis edilen nadir lezyonlardır. Bu tümörlerin tanı ve evrelemesinde bilgisayarlı tomografi (BT), manyetik rezonans görüntüleme (MR) ve PET-BT gibi radyolojik yöntemler kritik rol oynar. Histopatolojik olarak epitelyal, nonepitelyal, lenforetiküler ve metastatik karsinomlar olarak sınıflandırılırlar. En sık görülen benign nonepitelyal tümör osteoma iken, en sık rastlanan malign epitelyal tümör skuamöz hücreli karsinomdur (SCC). Adenokarsinom (AC), adenoid kistik karsinom (ACC), olfaktor nöroblastom (ONB) ve mukozal melanom (MM) diğer önemli malign tipler arasındadır. Tedavi yaklaşımları tümörün histopatolojik özelliklerine göre değişiklik gösterir; benign lezyonlarda en-blok cerrahi rezeksiyon altın standartken, malign ve agresif seyirli tümörlerde cerrahi, kemoterapi ve radyoterapiyi içeren çok disiplinli veya trimodal yaklaşımlar tercih edilir. Özellikle perinöral invazyon riski yüksek olan ACC gibi türlerde adjuvan radyoterapi ve uzun süreli takip zorunludur. Boyun metastazı yönetimi ve elektif boyun diseksiyonu gerekliliği ise tümörün alt tipine (örneğin SCC ve indiferansiye karsinomda daha yüksek oranlar) göre klinikte halen tartışılan veya özelleşen stratejiler içermektedir.
Malignant tumors of the sinonasal tract are rare lesions that account for 3% of upper respiratory tract tumors and are frequently diagnosed at advanced stages due to nonspecific symptoms. Radiological modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and PET-CT play a critical role in the diagnosis and staging of these tumors. Histopathologically, they are classified into epithelial, nonepithelial, lymphoreticular, and metastatic carcinomas. While osteoma is the most common benign nonepithelial tumor, squamous cell carcinoma (SCC) is the most frequently encountered malignant epithelial tumor. Adenocarcinoma (AC), adenoid cystic carcinoma (ACC), olfactory neuroblastoma (ONB), and mucosal melanoma (MM) are among other significant malignant types. Treatment approaches vary based on histopathological characteristics; en-block surgical resection is the gold standard for benign lesions, whereas multidisciplinary or trimodal approaches including surgery, chemotherapy, and radiotherapy are preferred for malignant and aggressive tumors. Adjuvant radiotherapy and long-term follow-up are mandatory especially for types like ACC, which carry a high risk of perineural invasion. Neck metastasis management and the necessity of elective neck dissection involve strategies that are still debated or tailored according to the specific tumor subtype, with higher rates observed in SCC and undifferentiated carcinoma.
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