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Question: 20120088
Status
Final

References
Source 1:   2007 MP/H Rules
pgs:  
Notes:  
Source 2:  
pgs:  
Notes:  


Question
MP/H Rules/Multiple primaries--Head & Neck: How many primaries does this person have and which MP/H rule did you use to determine your answer? See discussion.

Discussion
MRI IMPRESSION: 1. Extensive tumor mass which likely originated within the left ethmoid sinus and extends intracranially via the cribriform plate into the anterior cranial fossa. There is involvement of the left orbit and extension into the superior aspect of the left maxillary sinuses as well as the nose. 2. There is a second enhancing lesion within the inferior aspect of the right maxillary sinus and measures almost 2 cm in diameter and is worrisome for a second primary sinus tumor.

CT NECK W CONTRAST Oct 13 2008 - 15:21 FINDINGS: Again seen is the mass filling the left ethmoid air cells and nasal cavity with disassociated destruction of the medial wall of the orbit and extension into the left orbit. There is extensive tumor involvement of the medial canthus region of the orbit, abutting the left globe. There is a second mass within the floor of the right maxillary sinus with similar imaging characteristics and also consistent with malignant involvement. Also, Drs. state carcinoma in Hem/Onc chart notes.

Patient has a mass in the left ethmoid sinus (but this is not listed as a paired organ). Also noted on the MRI was a separate focus of tumor involving the floor of the right maxillary sinus (this is a paired organ). A biopsy of the ethmoid tumor showed squamous cell carcinoma. There is no pathology for the maxillary sinus tumor. The patient was treated with chemoradiation and then an ethmoidectomy, which showed no residual malignancy.

Why aren't the ethmoid sinuses considered a paired organ (see AJCC Manual for Staging 7th edition, page 70)?

Answer
Rule M10 applies. This is a single primary. Squamous cell carcinoma originating in the ethmoid sinus and "carcinoma" originating in the maxillary sinus are a single primary. We will review the list of paired organs for the next edition of the MP/H rules.

History


Last Updated
12/14/2012

Date Finalized
12/14/2012