Original article
Sinonasal tract seromucous adenocarcinomas: a report of 12 cases

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Abstract

Sinonasal seromucous adenocarcinomas may originate from the surface epithelium or from the submucosal glands. We reviewed the clinicopathologic material from 12 patients with sinonasal tract seromucous adenocarcinomas at the University of Texas M. D. Anderson Cancer Center (Houston, TX). There were nine men and three women age 30 to 87 years (mean age, 56.3 years). The clinical presentation included nasal obstruction, nasal mass, and epistaxis. Eight tumors were located in the nasal cavity, three in the ethmoidal sinuses, and one involved the nasal cavity and ethmoid. Histologically, in nine cases the neoplastic glands were lined by a single cell type, arranged back to back without intervening stroma and often inducing desmoplastic reaction. The remaining three tumors also had a cribriform and papillary pattern. All patients were treated by surgical resection. Three patients had recurrences, which occurred at 36, 36, and 48 months after initial therapy. Their treatment involved surgery and irradiation. Eleven patients are alive and free of disease at 36 to 108 months after diagnosis. One patient died 48 months after diagnosis of another cause. Sinonasal tract seromucous adenocarcinomas arise purely from submucosal seromucous glands. The diagnosis is facilitated by their anatomic location, the absence of tumor within the mucosal surface epithelium, and the striking similarity to terminal tubules of the seromucous glands.

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Materials and methods

Twelve cases of sinonasal seromucous adenocarcinoma were retrieved from the files of the Department of Pathology at The University of Texas M. D. Anderson Cancer Center (Houston, TX) covering a period from January 1, 1992 to December 31, 1999. Clinical and surgery reports and follow-up data were examined. In all case, hematoxylin-eosin stained histologic sections were available for review. Two to 18 slides (mean, eight slides) per case were reviewed, and the light microscopic features were

Results

The clinicopathologic findings in the 12 cases reviewed are summarized in Table 1. Patients’ ages ranged from 30 to 87 years (mean age, 56.3 years). Nine patients were white, one Asian, and race was unspecified in two cases. The ratio of men to women was 9:3. The most common presentation was nasal obstruction (six cases), with the remaining patients presenting with mass/sinusitis (four cases) and bleeding (two cases) as the primary complaint. The duration of the symptoms ranged from months to

Discussion

The normal sinonasal mucosa is covered by a pseudostratified columnar ciliated epithelium with goblet cells. The luminal lining of ciliated and goblet cells in varying proportions is separated from flattened basal cells by one or more layers of intermediate cells.7 Beneath the epithelium is the submucosa with the seromucous glands of the nasal respiratory tract, which are referred to as the “glandulae nasals.”7 These glands consist of irregularly branching tubules that often end blindly and

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