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Nasal polyps - Histopathologic spectrum
Abstract
Analysis of 345 polypoidal masses in nose and nasal sinuses with clinical diagnosis of nasal polyp, observed in 10 years, revealed 175 (50.7%) non- neoplastic lesions and 170 (49.3%) neoplasms. Among the non- neoplastic lesions, there were 110 cases (62.8%) of true nasal polyps including 74 cases (67.3%) of allergic polyps and 36 (32.7%) inflammatory ones. The next common non- neoplastic polyp was due to rhinosporidiosis (31.4%). Benign neoplastic lesions consisted mainly of haemangioma (45.7%), angiofibroma (23.2%), fibroma (6.2%), transitional cell papilloma, inverted papilloma, adenoma-3.9% each. Squamous cell carcinoma was the commonest malignant lesion encountered (36.6%) followed by 19.5% of adenoid cystic carcinoma,17.1% of anaplastic carcinoma and 12.2% of transitional cell carcinoma. Adeno carcinoma (4.9%), Mucoepidermoid carcinoma (2.4%), non- Hodgkin lymphoma (4.9%) and embryonal rhabdomyosarcoma (2.4%) were the other malignant lesions.
... Nasal cavity is common site for broad spectrum of lesions ranging from congenital to infective and [1][2][3] from benign to malignant processes. Most of the [1][2][3][4] lesions of nasal cavity present as polyp. ...
... Nasal cavity is common site for broad spectrum of lesions ranging from congenital to infective and [1][2][3] from benign to malignant processes. Most of the [1][2][3][4] lesions of nasal cavity present as polyp. In majority of the cases, clinicians are able to diagnose 5 patients on the basis of history. ...
... Similarly, high frequency of fungal infection in young age has 8 been reported in a study from Pakistan. In India, common infective cause was rhinoscleroderma and 1,3,4,8,9 rhinosporidiosis. ...
... Other symptoms include nasal discharge, epistaxis and disturbances of smell. 1 A variety of non-neoplastic including congenital and infl ammatory lesions and neoplastic conditions involve the Parajuli S 1 , Tuladhar A 1 1 Department of Pathology, Kathmandu Model Hospital, Kathmandu, Nepal nasal cavity (NC), paranasal sinuses (PNS) and nasopharynx (NP) and these are very common lesions encountered in clinical practice. 2 Gliomas are a common congenital sinonasal masses. Nasal polyps result from chronic infl ammation of the nasal and sinus mucous membranes and are the most common tumors of the nasal cavity. ...
... We found 4 cases of rhinosporiodosis ( fig.1) accounting for 3.36% amongst the non-neoplastic lesions, while Pradhananga et al. 9 had encountered only one case (0.69%) during two year study period. Anjali et al. 2 analysed polypoidal lesions over a period of ten years and concluded that next to nasal polyp, rhinosporiodosis was the second common cause of nonneoplastic lesions. 2 Nasal glial heterotopia (NGH) is a congenital malformation of displaced, mature glial tissue (choristomas) in which continuity with the intracranial meningeal component has become obliterated. Nasal glioma is a rare lesion and accounted for a total of 1.68% (2 cases; fig.2) amongst the non-neoplastic lesions in our study. ...
... Anjali et al. 2 analysed polypoidal lesions over a period of ten years and concluded that next to nasal polyp, rhinosporiodosis was the second common cause of nonneoplastic lesions. 2 Nasal glial heterotopia (NGH) is a congenital malformation of displaced, mature glial tissue (choristomas) in which continuity with the intracranial meningeal component has become obliterated. Nasal glioma is a rare lesion and accounted for a total of 1.68% (2 cases; fig.2) amongst the non-neoplastic lesions in our study. ...
Retrospective cross-sectional study of different neoplastic and non-neoplastic lesions involving the nasal cavity, paranasal sinuses and nasopharynx
... 3 Tandon et al and Dasgupta et al took tremendous efforts to study sinonasal masses in the Indian population. 4 Still, owing to a large number of people living in different areas across the country , an analysis of state wise population of India is still lacking. We conducted this study to evaluate clinicopathological profile of sinonasal masses which we come across in day to day practice and to create awareness about various nasal masses among young otorhinolaryngologists of our region. ...
... We observed 81% of the sinonasal masses as nonneoplastic, which is comparable to the data available in literature. 5,6,4 In other studies Nasal polyp was the most common non-neoplastic mass. Inverted papillomas are as such rare benign tumors, but is the most commonly encountered lesion among sinonasal papillomas. ...
... Interestingly, Inverted papilloma was found associated with sinonasal squamous cell carcinoma in 6 (21.4%) of the 28 cases studied by Califano et al in USA. 4,7,14 Haemangioma is rarely seen in the nasal cavity, though if it occurs, it is predominantly capillary and is found that pedicle is attached to the nasal septum. 15 In our study also all cases were found to be attached from the cartilaginous part of the nasal septum. ...
Background: Sinonasal tumors are diagnostic challenge to the otorhinolaryngologist. Clinical features may vary from being asymptomatic or accidental finding on imaging studies. Sinonasal mass otherwise can present with mass effect, Nasal obstruction, epistaxis, epiphora, rhinorrhoea, and recurrent sinusitis. Our study is an observational study of patients with Sino nasal masses which was carried out in tertiary Care hospital in central India to create awareness about the various nasal masses in Chhattisgarh region of central India. Methods: A Retrospective observational study was carried out for patients of rural areas presenting with sinonasal masses treated at tertiary health centre from Jan 2019 to May 2020. Detailed clinical history and examination of the patient was recorded along with histopathological examination supplemented by radiological investigation. The data was analysed and observations were noted. Results: A total of 100 patients were analysed according to age, sex and histopathological diagnosis. Majority of the patients were in the age groups 0-20 years (34%). There were 66 (66%) male and 34 (34%) females with M:F ratio 2:1. On Histopathological Examination, 81 % cases were non neoplastic and 19% cases were neoplastic lesions. Conclusions: Sinonasal masses may have multiple differential diagnoses. With the treatment of more complex cases being undertaken endoscopically, the need for individual therapeutic consideration and close follow-up is essential. The sinonasal masses shows male predominance with peak during 2nd to 4th decade of life. In non-neoplastic lesion, Rhinosporidiosis is the commonest non neoplastic leison seen in our region while among malignant lesions undifferentiated carcinoma was commonest. This study will further add up to statewise database of India.
... At times it is impossible clinically to differentiate definitely between neoplastic and non-neoplastic polypoid masses. 1 The polypoid nasal masses can have diverse underlying etiologies and morphologies, meriting appropriately tailored management and follow-up. ...
... This preponderance of non-neoplastic polyps is in corroboration with various studies, where the reported proportion of such polyps varies from 50.7% to 73.6%. 1,6 The increased number of non-neoplastic masses in our study can be attributed to increased air pollutants, allergies and late reporting to the hospitals to seek medical advice. However, the proportion of inflammatory and allergic nasal polyps inanother conducted study by Garg et al is almost the same (89.5%) ...
... Microscopically there was lobular capillary architecture with surface epithelial ulceration; it has been reported as 18.2% of benign neoplasms by Garget al. 6 Angiofibroma (n=3, 21.4% of all neoplastic lesions) was the next common benign neoplastic mass represented by three patients, the common presentation was by recurrent epistaxis from a shiny white colored mass. Histopathologically it was characterized by thin walled dilated angulated or irregular shaped blood vessels set in fibrocollagenous stroma containing plump spindle to stellate shaped fibroblasts, reported as occurring in 23.2% of benign neoplasms by Dasguptaet al. 1 Inverted papilloma (n=2, 14.3% of all neoplastic lesions) was the third most common benign neoplastic mass (Figure-3), reported as 3.9% by Dasgupta et al. 1 These cases presented with progressive nasal obstruction and discharge. Nasal examination showed tan-pink, polypoid growth arising from the lateral nasal wall. ...
Objectives: The purpose of this study is firstly to signify the occurrence ofunusual nasal polypoid masses by analyzing their histopathological spectrum and to be on thelookout for them. Secondly to highlight the fact that nasal polypoid masses should not be takenlightly as they may be representing an underlying grave pathological process meriting urgentmedical advice. Study Design: Retrospective/observational study. Setting: Charsada TeachingHospital affiliated with Jinnah Medical College Peshawar. Period: March 2010 to March 2015.Methods: In this study, all the surgical pathology cases with clinical diagnosis of nasal polypswith no suspicion for malignancy were retrieved from archives of Charsada Teaching Hospitalaffiliated with Jinnah Medical College Peshawar. The slides and diagnoses of all the retrievedcases were reviewed. The number of cases for each diagnostic category were recorded andanalyzed according to the non-neoplastic, neoplastic and their subcategories. Results: Thereview of cases from March 2010- March 2015 showed that most of the polypoid masses werenon-neoplastic, while only few were neoplastic. Of all the non-neoplastic masses, inflammatory/allergic polyps were much more common followed bypolyps with fungal infections andeosinophilic angiocentric fibrosis. Amongst the neoplastic masses, benign tumors were morecommon than the malignant. The benign masses comprised of hemangioma, angiofibroma,inverted papilloma and schwannoma. The malignant nasal masses constituted one case eachof polypoid extraskeletal Ewings sacoma, plasmacytoma, non-Hodgkin lymphoma and renalcell carcinoma. Conclusions: Awareness about the occurrence of the usual and unusualentities in the nasal cavities needs to be increased. Important diagnostic categories requiringurgent management include polyps with invasive fungal infection, inverted papilloma and allmalignant cases. Therefore, all unilateral nasal cavity masses with frequent epistaxis, pain orbone erosions should be submitted for histopathological examination.
... Space occupying masses in the nasal cavity, Paranasal sinuses and Nasopharynx are a group of lesions with wide spectrum of Histopathological features. Clinically it is quite impossible to differentiate non-neoplastic, benign neoplastic and malignant lesions in most of the patients, and most of these lesions were clinically diagnosed as nasal polyps; imaging also cannot give clear cut differentiation between the non-neoplastic, benign neoplastic and malignant lesions in significant number of the patients [6] . Frequently these lesions were neglected by the clinicians as infective and allergic aetiology. ...
... Out of these 115 cases, 27 cases (23%) were Neoplastic lesions and 88 cases (77.3%) were non neoplastic lesions; similarly 25% were neoplastic lesions and 75% were nonneoplastic lesions in the study done by Trilok C Guleria et al. [9] , and 81.6% were of non-neoplastic lesions in the study done by Dinesh Garg et al. [10] , and 89% of cases were of non-neoplastic lesions in the study done by Zafar et al. [1] . Among the masses of nasal cavity and Paranasal sinuses in our study, nasal polyp constituting 82.1% was higher than the study done by Tondon et al. (64%) [11] and Dasgupta et al. (62.5%) [6] . In our study the most commonly encountered polyp was inflammatory polyp, (Fig 6). ...
... The incidence was slightly higher when compare to the study done by Ambrish Kumar et al. (9.6%) [13] and Dinesh Garg et al. (5.49%) [10] . In this study rhinosporidiosis incidence was 4.1% but the studies done by Dasgupta et al. (31.5%) [6] and Kulkarni et al. (14%) [15] Showed higher incidence for rhinosporidiosis. In our study, one case of hamartoma was reported which was in 2 nd decade. ...
... 3 There are instances where malignant tumors of nose and sinuses show polypoidal features and can present like simple nasal polyps. 4 Our study involved 120 cases of nasal mass, with a male predominance, with a male to female ratio of 2:1. Clinical studies on nasal mass lesions have shown that nasal mass lesions have a male preponderance. ...
... In general, bilateral or unilateral nasal obstruction has been reported as a main presenting symptom, which is seen in more than 80% of the cases. 4,7 Clinically, most of our cases had a diagnosis of inflammatory, non-neoplastic lesions (78%), out of which 66% were inflammatory polyp. Benign lesions consisted of % of the study population, and 11% were diagnosed as malignant lesions. ...
... The inflammatory polyp was the most common histopathological diagnosis in our study; this was the commonest in most of the studies, with a share of 60-85% of the total cases. 4,9 The clinico-histopathological correlation in our study was 92%. Interestingly, most of the studies done on the clinicopathological relationship of nasal mass lesions correlated by more than 95%. ...
Introduction
Mass in the nasal cavity presents with a wide range of symptoms, when a presumptive diagnosis is often made with the help of imaging and endoscopy. This study focussed on correlating clinical diagnosis with the histopathological diagnosis so that appropriate treatment can be offered to improve the quality of life of the patient.
Materials and Methods
The study included 120 cases who presented with symptoms and signs of mass in the nasal cavity, undergoing surgery or diagnostic biopsy. They were evaluated with a detailed history and clinical examination, diagnostic nasal endoscopy, and relevant radiological investigations. Histopathological examination of the biopsy of the excised specimen was performed by Haematoxylin and Eosin stain. Special stains and Immunohistochemistry (IHC) were performed whenever indicated. The clinical diagnosis was correlated with histopathological diagnosis.
Results
Nasal obstruction was the most frequent symptom followed by nasal discharge. Non-neoplastic lesions made up 85% of cases, while16% of cases were proved as neoplastic lesions. Among neoplastic lesions, 7% were benign, and 9% were malignant. The inflammatory polyp was the most common non-neoplastic lesion. Fischer's exact test showed a correlation between clinical diagnosis and histopathological diagnosis. Non-neoplastic lesions were common in the 4th decade of life; benign lesions were common in the 3rd decade of life, while malignant lesions were common in the 5th decade of life.
Conclusion
Sinonasal masses present with overlapping clinical features, and sometimes the definite diagnosis is possible only by histopathological examination of the specimen. However, in the presence of characteristic clinical features, accurate clinical diagnosis is possible in most cases, and appropriate treatment can be performed without delay, pending histopathological examination.
... Only one specimen was diagnosed as malignant, that being a squamous cell carcinoma. In our study, the benign neoplastic lesions encountered were hemangioma [3], inverted papilloma [4], angiofibroma [1], benign spindle cell lesion [1], sebaceous adenoma [1] and schwannoma [1]. The histopathological patterns of lesions found in our study are depicted in Figures 2 -5. ...
... Polypoidal masses in the nasal cavities often present a diagnostic conundrum to the treating ENT surgeon on clinical evaluation, it being difficult to distinguish clinically between neoplastic and nonneoplastic lesions. 4 8 True nasal polyps are tumor-like polypoid masses arising from nasal cavity and sinuses. Their formation is associated with inflammation, allergy, or mucoviscidosis. ...
... Benign tumors constituted 11 out of 62 lesions [17.74% of lesions analyzed]. Of these, inverted papilloma [4] and hemangioma [3] were the most commonly diagnosed lesions, others being a Schwannoma [1], benign spindle cell lesion [1], angiofibroma [ 1 Schwannoma in the nasal cavity are rare and we found only two other authors who reported these lesions in their series 2,9 . We were able to demonstrate Antoni A and B areas in the tumor that we reported as a Schwannoma. ...
Background: The aim of the study was to identify the pattern of pathologies involving nasal mass lesions which were received for histopathological evaluation at a tertiary hospital in Hyderabad during the period January 2014 to December 2016.
Methods: The data pertaining to samples of nasal mass lesions received for histopathological evaluation at the laboratory of a tertiary care hospital in Hyderabad from January 2014 to December 2016 were analyzed to determine the pattern of pathologies diagnosed during such evaluation and the age distribution of all lesions.
Results: A total of 62 specimens labeled as nasal masses were received during the period studied. The majority of patients, whose samples were received, were in the age group of 21 – 30 years [35.48%], with very few patients from either extreme of age. Inflammatory nasal polyp was the most common histopathological diagnosis given [26 out of 62 cases, 41.93%] followed by allergic nasal polyp [19 out of 62 cases, 30.64%]. Only one lesion was diagnosed as malignant [squamous cell carcinoma]
Conclusion: The majority of nasal mass lesions received for evaluation were inflammatory or else allergic nasal polyps. Most patients were in the third decade of life.
... Masses in nasal cavity, paranasal sinuses and nasopharynx form a heterogeneous group of lesions with a broad spectrum of histopathological features. A variety of these non-neoplastic and neoplastic lesions are quite impossible to differentiate clinically and they are mostly clinically diagnosed as nasal polyp [8]. They are frequently neglected by the clinicians as infective or allergic aetiology. ...
... A Nigerian study revealed female preponderance with opposite M: F ratio of 1:1.2 [9]. The common presentation of sinonasal masses were rhinorrhea, headache, nasal obstruction comparing favorably with other studies [8][9][10]. ...
... Its exact pathogenesis is not known but they have strong association with allergy, asthma, aspirin sensitivity and infection. Among, masses of nasal cavity and paranasal sinuses, the incidence of nasal polyp was 65.9% in concordance with Tondon et al., [6] (64%) and Dasgupta et al., [8] (62.5%). ...
Background: A variety of non-neoplastic and neoplastic lesions of nasal cavity, paranasal sinuses and nasopharynx are commonly encountered in clinical practice. The aim of this study was to study clinical and histopathological profile of space occupying lesions of nasal cavity, paranasal sinuses and nasopharynx in a tertiary care hospital of Ranchi over the period of January 2011 to January 2012. Materials and Methods: This was a prospective study of 90 cases of space occupying lesions of nasal cavity, paranasal sinuses and nasopharynx over the period of 12 months. All tissues after fixation in 10% buffered formalin, processed and then stained with Hematoxylin & Eosin to study various histopathological patterns. Results: These 90 cases were broadly categorized in two categories, one category as nasal and paranasal sinus masses and the other as nasopharyngeal masses with 63 and 27 cases, respectively. These lesions were common in second and third decades of life with male predominance. Among nasal and paranasal sinus masses, there were 52 (82.2%) non-neoplastic and 11 (17.8%) neoplastic lesions. Inflammatory polyps (86.5%) were the most common among the non-neoplastic masses. Out of 27 nasopharyngeal masses, there were 23 (85.2%) non neoplastic and 4 (14.8%) neoplastic lesions. Majority of these i.e. 20 cases were of adenotonsillar hypertrophy. Conclusion: We concluded that complete clinical, radiological and histopathological correlation helps us to categorize these sinonasal lesions into various non-neoplastic and neoplastic types. But final histopathological examination provides a confirmatory diagnosis.
... It includes various non-neoplastic lesions mainly allergic and inflammatory ones, as well as a number of neoplastic tumefactions in the nose and nasal sinuses. These lesions are quite impossible to differentiate clinically, therefore labelled as "nasal polyp" [9]. ...
... In the present study, there was a more predilection towards males as compared to females in both nonneoplastic and neoplastic groups which is similar to study conducted by Tondon et al and Dasgupta A et al [9,11]. The most vulnerable period for the development of the nasal masses were between 11-40 years. ...
... respectively; by Bist et al [15] with 87.27%, 69.06%, 50%, 60.9%, 68% respectively. These finding were corroborated by other researchers as well [9,16,17]. Allergic symptoms such as rhinorrhea, itchy nostrils, excessive sneezing was present in more than 50% of the patients which indicates that allergy still plays a major role in nasal polyp in our environment. ...
Introduction: Polypoidal mass in nose and paranasal sinuses are very common, that bulges or projects downwards from the normal nasal surface. The aim of the present study was to determine the incidence of nasal polypoidal mass and clinical and pathologic data of a group of consecutive cases. Materials and Methods: Clinico-pathological study of 92 consecutive cases of nasal polypoidal mass from single institution was performed for a period of 3 years. Clinical examination, routine investigations, Chest X ray PA were taken for all patients. Excised tissues were routinely processed for histopathologic examination. Results: Analysis of 92 polypoidal lesions in the nose and paranasal sinuses with clinical diagnosis of nasal polyps, revealed 52 cases were non-neoplastic and 40 were neoplastic; 34 (85%) were benign and 6 (15%) were malignant. True nasal polyps both inflammatory and allergic together comprised 49 cases of the 52 polypoidal lesions in the nasal cavity. Angiofibroma and capillary hemangioma were the most frequent benign tumour accounting for 30/34 (44%). The most common malignant tumour was squamous cell carcinoma 5/6 (83.3%). Conclusion: Majority of polypoidal mass in the nasal cavity were non-neoplastic, with histopathological examination being the easiest method for identification and distinguishing the type of sinonasalpolypoidal masses.
... Themale preponderance was more marked in malignancies (M:F= 2.5:1). Many authors have observed similar male preponderance [7,11,15], while only in few studies sino-nasal lesions were mo re common in females [12]. The mostcommon age groups for sino-nasal lesions in our study was second decade followed by 3 rd and 4 th decade. ...
... Similar finding was observed by A.Lathi et al [7]. In our study non-neoplastic, benign and malignant nasal lesions were common ly encountered in [11][12][13][14][15][16][17][18][19][20] year, 31-50 year and 41-60 year age group respectively which was in concordance with Parajuli et al [13]. Lathi et al concluded that malignant nasal masses are rarely encountered before fourth decade of life [7]. ...
... In our study, inflammatorypolyps (including allergic) were the most common nasal non-neoplastic masses. This observation was similar to several other studies [7,11,15,16]. Nasal polyps result from chronic inflammation of thenasal and sinus mucous membranes. Their exact pathogenesis is not known, however a strong association withallergy, infection, asthma and aspirin sensitivity has been imp licated [5,17]. ...
Background: Sinonasal lesions are a common finding in Otorhinolaryngology out patient department. Most commonly they present withnasal obstruction. Clinically many of these lesions resemble eachother but they have multiple differential d iagnosis ranging from congenital, inflammatory, trau matic to neoplastic causes that needs histopathological confirmat ion. Objecti ves: This study was undertaken to study the various histopathological patterns of sino-nasallesions, theirclassification and relat ive distribution of various lesions with regard to age and sex in our setting. Material and Methods: This was a retrospective study of Sino-nasal lesions specimens thatwas received at histopathology section of Depart ment of Pathology, Hamdard Institute of Medical Science andResearch andover a period of two years fro m June 2014 to May 2016. Results: A total of 62 cases of sino-nasal lesions were reported during the study period. Ageranged fro m 5 years to 75 years with malepredo minance. Among all the lesions forty five (45) were non-neoplastic, ten (10) benign and seven (7) were diagnosedas malignant tumors. Inflammatory polyp was the commonest non-neoplastic lesion while Sinonasal Papillo ma was the commonest benign lesion and Sinonasal carcinoma was themost common malignancy. Conclusions: Sino-nasal lesions comprises of wide spectrum of lesions but their presenting clin icalmanifestations are very limited. Hence, on the basis of clinical picture various nonneoplastic, benign and malignantlesions may mimic each other. Histopathological diagnosis forms the mainstay of diagnosis in these lesions which may even reveal clinically unsuspected rare malignancies as seen in our study.
... Otherwise, chronic rhinosinusitis and antrochoanal polyps were the most common nasal masses, comprising 14% (n=33) and 12% (n=27), respectively. Nasal polyposis was the predominant sinonasal mass, as per the study by Tondon et al. (64%) and Dasgupta et al. (62.5%) [11,12]. The most common nasal symptoms in our study were nasal obstruction (90%, n=204) followed by nasal discharge (74%, n=169), which is similar to other studies [6,7]. ...
... Tandon et al. [11] found that squamous cell carcinoma is India's most common histology of sinonasal malignancy, accounting for approximately half of all cases. Another study by Dasgupta et al. [12] also examined sinonasal masses in the Indian population and reported that adenocarcinoma is the third most common mucosal malignancy in the sinonasal region, after squamous cell carcinoma and adenoid cystic carcinoma. This may be due to the small sample size and getting the maximum number of referrals to our center. ...
Introduction: Diseases of the nose and paranasal sinuses have a significant impact on the patient's functional and structural aspects. They affect all age groups and both sexes. Due to its proximity to vital structures, diseases of the nose and paranasal sinuses sometimes lead to very grave prognoses.
Materials and methods: This was a retrospective study done in one of central India's largest tertiary care centers. We studied 227 cases of sinonasal masses in both the non-neoplastic and neoplastic categories. Clinicopathological characteristics of masses were analyzed with the help of clinical and imaging findings and subsequently confirmed by tissue diagnosis.
Results: The mean age of presentation was 45.5 years, with a male-to-female ratio of 1.25:1. Most of our patients were from lower-middle socioeconomic groups with educational qualifications below the 10th standard. Nasal obstruction was the most common symptom. A computed tomography scan was the preferred radiological investigation. Sinonasal undifferentiated carcinoma was the most common variant of malignancy, with a total number of six out of 22 (27%).
Conclusion: The evaluation of sinonasal masses should be carried out systematically and meticulously. Since the initial presentation of most of the diseases of the nose and paranasal sinuses is the same, a proper clinical, radiological, and tissue diagnosis should be carried out to avoid causing malignant lesions.
... Dasgupta et al. presented with 0.5% of patients of non-neoplastic nasal polyps with EIC [25]. Zafar et al. studied 0.6% of cases of EIC [10]. ...
... These cysts are usually common in a young age due to their developmental origin. The presence of these cysts in adults in the present study can be due to their origin from the follicular epithelium of NC [25]. ...
Objective: A variety of non-neoplastic lesions involving the nasal cavity (NC) and paranasal sinuses (PNS) are encountered in clinical practice. The clinical features, symptoms, and advanced imaging technique help to reach a provisional diagnosis but histopathological examination remains the mainstay of final definitive diagnosis. There is a lack of studies that exclusively cover non-neoplastic lesions of sinonasal region. Hence, this study was done with the aim of examining the clinicopathological features of various non-neoplastic lesions of NC and PNS. Methods: The formalin-fixed specimens of polypectomy/biopsy were received with complete clinical and radiological features in the department of pathology. Routine gross examination and required number of sections were taken and stained with hematoxylin and eosin stain. Periodic acid Schiff’s was used wherever necessary. Results: Histologically, maximum number of cases were of inflammatory polyp (IP) (57%), followed by Allergic polyp (AP) (18%) and Invasive Fungal Sinusitis-Mucormycosis (17%). Mucormycosis was found in patients who have recovered from COVID along with a steroid intake history or had diabetes mellitus or had multiple comorbidities along with COVID recovery and steroid intake. Conclusion: Among the non-neoplastic lesion, IP is the most common lesion followed by AP. The significant number of mucormycosis cases was seen due to the ongoing COVID pandemic and liberal use of corticosteroids in the treatment.
... The most common presenting complaint in our study was nasal obstruction in 82 patients followed by nasal discharge in 71 patients and headache in 48 patients. These ndings were in accordance to 10,11 studies done by other authors . ...
... Of these 60.56% were allergic polyps and 30.99% were inammatory polyps. Our ndings were consistent with a similar study done by 10 Dasgupta et al. where nasal polyps were the most common SNM noted. ...
The clinicoapthological profile of sinonasal masses at a tertiary care hospital.
... We observed that headache was present in 50% and hyposmia in 57.5% of patients. These ndings compare 8 favourably with other studies done Dasgupta et al . ...
... Nasal polyps were the commonest non neoplastic lesion of nasal cavity in our study. Its exact pathogenesis is not known but they have strong 8 association with allergy, asthma, aspirin sensitivity and infection . Out of 90 patients 24 patients had allergy as a risk factor in our study. ...
INTRODUCTION The nose is the most prominent part of the face with substantial aesthetic and functional significance. It is one of the few organs of body invested with an aura of emotional and cultural importance. Anatomical location of the nose and it passage have been regarded as the direct avenue to the brain, man’s source of intelligence and spirituality. AIMS AND OBJECTIVES To study the incidence, clinical presentation and pathological profile of various types of sinonasal masses at Tata Main Hospital, Jamshedpur, Jharkhand. To detect the variation of clinical presentation of sinonasal masses in relation to Age, Sex, Risk factors and Occupation, clinical presentation and the histopathological diagnosis of sinonasal masses. Compare the results of this study with the results of the previous workers. MATERIAL & METHODS: This Prospective, observational study was done in the department of Otorhinolaryngology, Tata Main Hospital, Jamshedpur, Jharkhand. 90 patients presenting with the features of nasal obstruction, nasal discharge, headache, anosmia / hyposmia, epistaxis, facial deformity, ear & eye symptoms will be evaluated by taking history and thorough ENT and head and neck examination(including nasal endoscopy) and subjecting them for the procedure. RESULT Out of 90 patients, 59(65.56%) were males and 31(34.44%) were females. In our study, among non neoplastic masses 34 were male and 26 were female. For non-neoplastic lesions the average age of presentation was 36.2 years. Mean age of presentation was 37.21 years. CONCLUSION Emergence of newer surgical, medical and radiological intervention have open up a new chapter with these type of patients. . Awareness regarding the disease process and health education should be provided to people regarding smoking, maintenance of hygienic condition and utilization of health facilities.
... This group constitutes of rhinosporidiosis and infective granuloma. The incidence of rhinosporidiosis in this group, as compared to Tondon 10 PL etal (29%) and Dasgupta A et al (31.4%), was low (94.7%). This 9 was because low endemecity of the disease in our region of study. ...
... The incidence of mesenchymal lesion predominated over epithelial 10 group with 66.6% which was similar to that of Dasgupta A et al study. ...
A diverse group of lesions may present themselves as polypoidal masses. They may be simple mucosal polyp or a variety of other pathological
entities like infective granulomatous diseases, papillomas, vascular masses or malignant neoplasms. A number of deceptively benign looking
polyps often turn out to be malignant lesions or vice versa. The aim of our study was to evaluate the Clinical and histopathological correlation of the
excised polypoidal masses. Study group included 100 patients with nasal polypoidal masses, who were treated at E.N.T Department, INSTITUTE
OF OTORHINOLARYNGOLOGY & HEAD-NECK SURGERY, IPGME&R, KOLKATA, since NOVEMBER 2018 to OCTOBER 2019.
In the study inverted Papilloma showed single as well as multiple sinus involvement, they are both homogenous and heterogenous in density. Few
cases showed bony changes and calcification. All rhinosporidios is cases were not involving any sinuses and had a homogenous density. Single case
of adenocarcinoma involved multiple sinuses with heterogenous density, bone erosion along with calcification. Single case of Adenocystic
Carcinoma involved multiple sinuses with heterogenous density, bone erosion along with calcification. Out of six cases of Squamous Cell
Carcinoma all of them showed multiples in us involvement, heterogenous density along with bony erosion.Half of the cases had
calcification.Keeping these considerations in the mind, all polypoidal masses in nasal cavity justify histopathological examination.
... 3 Tandon et al and Dasgupta et al took considerable efforts to study sinonasal masses in the Indian population. 23,13 Still, an analysis of the sinonasal masses in the rural population of India has been lacking. This study is aimed to evaluate clinicopathological profile and management of sinonasal masses in rural India. ...
... 2,12 Found 71.4% of the sinonasal masses to be nonneoplastic and this proportion of non-neoplastic lesions has been reported in previous studies. 7,8,13 Nasal polyp was the most common non-neoplastic mass and was similarly documented by those authors. ...
p> Background: A variety of mass lesions occur within the paranasal sinus (PNS) and nasal cavity and thus it becomes mandatory for otorhinolaryngologist to elicit detailed history and thorough examination before reaching a final diagnosis. This is retrospective study of all sinonasal masses who were undergone surgical management in the institute of rural India and so in the environment.
Methods: This is a retrospective observational study of 70 patients with sinonasal masses treated at a rural tertiary care hospital in rural western Maharashtra from period of Jan 2016 to May 2018. History, clinical assessment and histopathological examination (HPE) was done in all cases as per hospital record supplemented by radiological investigation as per requirement. The patients were grouped as per their histopathological diagnosis as non-neoplastic/inflammatory and neoplastic.
Results: A total of 70 patients were analysed age ranging (11-70 years). Majority of the patients were in the age groups 21-40 years (47%). There were 43 (61%) male and 27 (39%) female with M:F ratio 1.6:1. On HPE, 50 (71%) cases were non neoplastic/inflammatory and 20 (29%) cases were neoplastic lesions. HPE revealed that 50 (71%) cases were non neoplastic and 20 (29%) cases were neoplastic lesions.
Conclusions: Sinonasal masses have various differential diagnoses. They are fairly common with male predominance. Benign conditions show a peak during 2nd to 4th decade of life while malignancy increasing with the age after 4th decade. In non-neoplastic lesion, Allergic nasal polyp is the commonest histological pattern seen while in malignant lesions squamous cell carcinoma is noted with 100% male predominance.
</p
... In other studies as mentioned in Table 2 commonest Nonneoplastic lesion was Nasal Polyp. In the study of Dasgupta A et al [7], Lathi A et al [10], Kulkarni A et al [8] and Kumari KMK et al [5], second most common lesion was Rhinosporidiosis. In the study of Nair S et al [14], cases of Sinusitis were more common than Polyp as the study was based on clinical findings. ...
... These findings were related with the other studies like Bakari A et al [16], where 35 cases were inflammatory polyp and 10 cases were Allergic polyp, Kumari KMK et al [5], where 35 cases were inflammatory polyp and 9 cases were Allergic polyp. In the study of Dasgupta A et al [7] and Lathi A et al [10], Allergic polyps were more than inflammatory polyps. Biswas G et al [9] and Nair S et al [14], noted Antrochoanal polyps only (Table 4). ...
Background: The various lesions of the nose, paranasal sinuses and nasopharynx were subjected to histopathological evaluation over a period of 5 years (2010 to 2015) at the Department of Pathology, in a rural based hospital. Total 84 specimens were studied over the time of 5 years. Methodology: The formalin fixed specimens were received with complete clinical and radiological features. Routine gross examination and required number of sections were taken and stained with hematoxylin and eosin. Result: In the study, 84 cases were of Inflammatory and Non neoplastic lesions. Nasal polyps were the most common lesions with 77 (91.67%) cases. Among the all Nasal polyps, 77 cases, 20 (25.97%) cases were of Allergic polyp, 50 (64.93%) cases were of inflammatory polyp, while 7 (9.09%) cases were of Antrochoanal polyp. 2 cases (2.38%) each of Sinusitis and Intradermal naevus. Rhinosporidiosis, Mucocele and Nasolabial cyst comprised of 1 (0.77%) case each respectively. Conclusion: In our study, most common lesions were Nasal Polyps. Most of the cases were presented in 2ndand3rddecade of life with Male preponderance. Nasal obstruction was the most common clinical presentation in the present study.
... 9,10 Most polyps originate from the cleft's mucosa, ostia mucosa, and ostiomeatal complex region. 11 Diagnosis of nasal polyps can be made by history, clinical examination, nasal endoscopy, radiography, and additional tests for allergy, aspirin sensitivity, and pulmonary function tests. The common method to diagnose nasal polyp is radiography. ...
Background: The diagnosis of nasal polyp is made according to clinical and radiological criteria, while histopathologic examination is important for an accurate diagnosis. Histological classification of nasal polyps and its clinical implications are very rarely reported in the literature. Aims and Objectives: The aim of this study was to study clinical presentation and site of occurrence of nasal polyps and histologically classify nasal polyps in relation to studies published in the literature. We classified the histological changes as described by Davidson and Hellquist. Materials and Methods: Based on the inclusion and exclusion criteria, the 315 subjects were included in our study, which include eosinophilic polyp, fibro-inflammatory polyp, polyp with sero-mucinous gland hyperplasia, and polyp with stromal atypia. Results: Sinonasal polyps can be classified in the following way histologically: edematous or eosinophilic polyp 189 cases (60%); fibro-inflammatory polyp: 66 cases (21%); polyp with seromucinous gland hyperplasia: 35 cases (11%), polyp with stroma atypia: no case (0%), and fibrotic 25 cases (8%). Conclusion: We concluded that the nasal polyps mainly present as an edematous or eosinophilic pattern on histopathological examination. Studies on the histopathology of nasal polyps would help us to understand this disease more appropriately for treatment plan. Further differentiation of nasal polyps may help to develop new therapeutic strategies that are tailored according to the respective group.
... Dasgupta et al. have said that squamous cell carcinoma is the most common malignant tumor associated with nasal polyps. [17] The most frequent clinical presentation of patients in this study was nasal blockage (97%), followed by rhinorrhoa (52.23%). This pattern is seen in many other studies, [3,14,16] but a study in Sokoto, Nigeria rather has rhinorrhea as the most common presenting symptom. ...
Objectives
Nasal polyps are the commonest intranasal masses. It has a worldwide distribution and significantly reduces the productivity of affected individuals. Early diagnosis and treatment can lead to better treatment outcomes. The aim of the study were: To study the occurrence, types, associated co-morbidities, and management of polyps in Calabar, Nigeria.
Materials and Methods
A retrospective study of all nasal polyps seen between January 2009 and January 2019. Records of all intranasal masses seen during the period including age, sex, aetiopathological profile, and histopathology results were obtained from the records department, theater, and the wards. Patients who had nasal polyps either had nasal polypectomy with/without antral lavage, or Caldwell Luc operation.
Results
One hundred and eighty-two intranasal masses were seen during the study period. One hundred and thirty-four of them (73.625%) were nasal polyps; 62.6% were inflammatory polyps, 14.7% had chronic rhinitis, 9.7% inverted papilloma, and 2.24% squamous cell carcinoma. About 31.3% of the polyps were right-sided, 31.3% bilateral, 26.9% left-sided, and 10.44% antrochoanal polyps. About 97% of the patients presented with nasal blockage, 53.23% with rhinorrhoea, 41.79% signs of anosmia, and 29.85% sneezing. Comorbidities seen include diabetes mellitus 1.6%, hypertension 4.5%, allergy 70%, and asthma 25%.Squamous cell carcinoma was the most common malignancy found and inverted papilloma was the most common benign tumor present.
Conclusion
Nasal polyps occur globally. They are the most common intranasal masses. They seem to occur more in males and occurrence increases with age. Not all nasal polyps turn out as polyps histologically as this study shows; we had chronic rhinitis, inverted papillomas, squamous cell carcinomas, etc. The comorbidities found were diabetes mellitus, hypertension, allergy, and asthma. Diabetes and hypertension may have been incidental but the number of patients with asthma and allergy shows a definite link between these two and allergy. Treatment for nasal polyps may be medical or surgical and the best form of surgery is endoscopic sinus surgery. However, financial constraints could prevent patients access to FESS.
... 9,10 Most polyps originate from the cleft's mucosa, ostia mucosa, and ostiomeatal complex region. 11 Diagnosis of nasal polyps can be made by history, clinical examination, nasal endoscopy, radiography, and additional tests for allergy, aspirin sensitivity, and pulmonary function tests. The common method to diagnose nasal polyp is radiography. ...
Background: The diagnosis of nasal polyp is made according to clinical and radiological criteria, while histopathologic examination is important for an accurate diagnosis. Histological classification of nasal polyps and its clinical implications are very rarely reported in the literature.
Aims and Objectives: The aim of this study was to study clinical presentation and site of occurrence of nasal polyps and histologically classify nasal polyps in relation to studies published in the literature. We classified the histological changes as described by Davidson and Hellquist.
Materials and Methods: Based on the inclusion and exclusion criteria, the 315 subjects were included in our study, which include eosinophilic polyp, fibro-inflammatory polyp, polyp with sero-mucinous gland hyperplasia, and polyp with stromal atypia.
Results: Sinonasal polyps can be classified in the following way histologically: edematous or eosinophilic polyp 189 cases (60%); fibro-inflammatory polyp: 66 cases (21%); polyp with seromucinous gland hyperplasia: 35 cases (11%), polyp with stroma atypia: no case (0%), and fibrotic 25 cases (8%).
Conclusion: We concluded that the nasal polyps mainly present as an edematous or eosinophilic pattern on histopathological examination. Studies on the histopathology of nasal polyps would help us to understand this disease more appropriately for treatment plan. Further differentiation of nasal polyps may help to develop new therapeutic strategies that are tailored according to the respective group.
... Out of which majority were non-neoplastic which was in concordance with a study conducted by Prakash et al. 4 However, in another study conducted by Dasgupta et al reported an equal prevalence of non-neoplastic and neoplastic lesions. 5 The mean age of presentation in our study was 34.2 years which goes in the line with earlier studies conducted by Bist et al the mean age of presentation was 39.4 years. 6 13 We studied different occupational exposures among the study population and we surprisingly found that agricultural workers were the most vulnerable group amongst all (25.8%) followed by housewives (20.96%) and manual labour (19.35%). 1 female patient with squamous cell carcinoma had a 30 years history of firewood cooking and 1 male patient with SCC was a chronic smoker for 45 years. ...
Background: This study focuses on sino-nasal masses (SNMs) and their presentation with their radiological findings and corroboration with initial diagnosis and histopathological examination (HPE). Methods: A prospective study conducted in total 62 patients with SNMs presenting between the period (September 2020 to October 2022) in medical college, southern Bihar. Patients were subjected to detailed history and battery of tests with all necessary investigations. Final diagnosis was concluded after HPE. Results: Age distribution ranged from 10 to 64 years with mean age of 34.2 and M: F ratio of 1.14:1. Demography suggested predisposition in low socioeconomic strata (N=36; 58.06%). Majority fell in category of farmers (N=16; 25.8%) followed by housewives, laborers. Majority presented within a time frame of 1-2 years of onset of symptoms/appearance of the lesion (N=25;40.3%) followed by 6 months to 1-year. Most common presenting symptom was nasal obstruction (N=59;95.16%), followed by nasal discharge (n= 49, 79.03%). HPE concluded 45 samples (72.58%) as non-neoplastic, 15 samples (24.19%) as benign neoplastic (96.7%) and 2 as malignant neoplastic lesions (3.22%). In 58 out of 62 patients (93.54%) the clinical diagnosis was corroborated with HPE diagnosis. Conclusions: Nasal polyps, the most common benign lesions and SCCs, the most common malignant lesion of SNT. Malignant lesions common in elderlies should be differentiated from non-malignant lesions. Due to similar presentation of diversified aetiology, a clinical and radiological evaluation is of prime for initial management. HPE remains the gold standard for final diagnosis and definitive management.
... Patients present with vague symptoms like nasal obstruction, nasal discharge, bleeding, snoring, headache or facial pain. [5,6] In advanced stages patients have visual disturbances, neurological decits and facial deformities. Rigid or exible nasal endoscopy guided biopsies under local anaesthesia are essential for conrming the nal diagnosis. ...
Introduction: Nasal cavity & paranasal sinuses are close to important structures such as skull base, orbit,
cranial nerves and vital vascular structures. A Sino-nasal mass presents with complaints of nasal
obstruction, nasal discharge, epistaxis, loss of smell sensation, post-nasal discharge. Therefore the patient may ignore this
early symptoms and sometimes do not treat an early-stage malignancy thinking it to be a benign pathology.
Aim: To study the clinical presentation, histopathological types and management of some uncommon lesions of sino-nasal
cavities in an adult.
Material & Methods: The study evaluates the clinic-pathological & treatment prole of some uncommon entities of sino-nasal
mass in patients attending ENT Outpatient department of our Tertiary Centre from January 2020 to January 2021.
Results: Two rare varieties of benign lesions were sino-nasal schwannoma and paranasal pilomatrixoma. Pleomorphic type of
adult rhabdomyosarcoma, chondrosarcoma and esthesioneuroblastoma were the other types of rare malignant lesions.
Conclusion: Majority of patients with sino-nasal malignancies present at a late stage. Therefore a proper correlation of history,
clinical examination, nasal endoscopy and imaging is important for early diagnosis and treatment.
ABSTRACT
KEYWORDS : Sino-nasal mass; Adult; Histopathology; Surgery; Radiothera
... 13,14 Whereas there are studies like those done by Majumder et al, Dasgupta et al, Kulkarni et al that had shown haemangioma as the most common variety. 15,16,17 The most common presenting symptom was found to be nasal obstruction (90%) followed by nasal bleeding (85%) with similar results shown in study by Narayana et al. 6 In our study all patient with hemangioma had presented with epistaxis, however 1 case of JNA surprisingly did not have epistaxis. 75% of patients had mass seen on anterior rhinoscopy. ...
... 13,14 Whereas there are studies like those done by Majumder et al, Dasgupta et al, Kulkarni et al that had shown haemangioma as the most common variety. 15,16,17 The most common presenting symptom was found to be nasal obstruction (90%) followed by nasal bleeding (85%) with similar results shown in study by Narayana et al. 6 In our study all patient with hemangioma had presented with epistaxis, however 1 case of JNA surprisingly did not have epistaxis. 75% of patients had mass seen on anterior rhinoscopy. ...
... Dasgupta et al. 12 Among the cases studied, 20.92% of the subjects mainly belonged to the age group of 21-30 years with age range from 6 years to 76 years. A study by Lathi 55 males had lesions of nasal cavity and paranasal sinuses and the male to female ratio was found as 1.2:1. ...
Sinonasal masses are common in the ENT Outpatient Department. The incidence being 1-4% of population. The symptoms and signs frequently overlap, hence, a diagnostic dilemma exists. The aim of this study was to study the occurrence of various lesions, the age, site and sex wise distribution in a tertiary care hospital of Maharashtra over the period of two years.
The study aims to examine the occurrence of various lesions in nasal cavity and paranasal sinuses, to determine the age, sex and site wise incidence of different benign and malignant lesions of nasal cavity and paranasal sinuses and to correlate the clinical and histopathological findings.
Descriptive Study
A descriptive study was carried out in the Department of Pathology at Tertiary Health Care among patients with clinically diagnosed nasal and paranasal sinus lesions attending the OPD of ENT during a period of 2 years. The specimens were grossly examined; fixed and routine microscopic staining was done. Interpretation was done using colour of the nuclei and the specimens were classified as neoplastic and non-neoplastic lesions. The data was statistical analysed.
Mean, Median, Mode
The most common clinical presentation was nasal obstruction 97 (93.26%), rhinorrhoea 73 (70.19%) and facial pain 24 (23%). 1: Mean age for the lesions to occur was years with the range 21-30 years (20.92%); 2: Non-neoplastic lesions 82 (79.6%) were more common than neoplastic lesions; 3: Simple nasal polyp 74 (90.23%), hemangiomas (50%) and squamous cell carcinoma (50%) were most common.
The study concludes that complete clinical, radiological and histopathological correlation helps us to categorize these sino-nasal lesions into various non-neoplastic and neoplastic types. But final histopathological examination provides a confirmatory diagnosis, as a significant number of cases may be missed on clinical evaluation alone.
The clinical features of non-neoplastic and neoplastic nasal and paranasal sinuses lesions may be indistinguishable from each other leading to delay in proper diagnosis and treatment. Histopathological examination is a reliable, cost effective diagnostic tool for accurate diagnosis and management of such lesions, as a significant number of cases may be missed on clinical evaluation alone.
... Other previous works have reported similar sex ratio. [6][7][8][9][10] The most common site of biopsy was the throat which accounted for 415 (72.6%) while the least was in the ear representing 4.5%. Follicular hyperplasia/ obstructive adenoid were the most common diagnosis in this study representing 63.1%. ...
Objectives: There is a dearth in literature on the spectrum of Otorhinolaryngology (ORL) disorders in countries such as Nigeria despite its importance in making health care policies. Methods: We conducted a ten-year retrospective study of all ORL biopsies sent to our laboratory from January 2006 to December 2015. The slides were retrieved and reexamined microscopically. Special stains were performed in cases suspicious of fungal or tuberculous lesions. The age, sex, anatomical locations, and histological diagnoses were all recorded in pre-designed data forms. All the data were analyzed using the Statistical Package for Social Sciences (SPSS) version 18. Results: There were 572 biopsies received out of 21,633 samples during the period representing 2.64% of the total biopsies. The age range in this study was between 4 months and 87 years. The mean, mode and median ages were 21.19 ±22.10, 10 and 2 years respectively. There were 356 (62.2%) males and 216 (37.8%) females with a male to female ratio of approximately 1.6: 1. The most common site of biopsy was the throat (72.6%) while the least was in the ear (4.5%). Follicular hyperplasia was the most common diagnosis (63.1%). Nasal, benign polyps and carcinomas accounted for 14.7%, 10.7% and 8.6% respectively. Conclusion: Follicular hyperplasia was the most common diagnosis, while throat was the most common region of biopsy. Carcinoma peaked in the 6th decade.
... 3 Lesions of nasal cavity are quite common. 4 Tumors of nose are usually uncommon. Malignant tumors account for 0.2% to 0.8% of total malignancies and only 3% of all malignant tumors of upper aerodigestive tract. ...
Background: Prolapsed lining of the nasal sinuses are defined as nasal polyp. Diseases of the nasal cavity include viral, bacterial and fungal infections, nasal cavity tumors (benign and malignant) as well as inflammations of the nasal mucosa. This study was undertaken to note the various histopathological patterns of nasal masses, their classification and relative distribution of various lesions with regard to age and sex in our setting.Methods: The study is done for a period of 1 year (July 2018 to June 2019). In this study, 30 patients are selected who presented in our hospital with nasal masses and having multiple types of clinical presentations.Results: Total 30 cases presented as nasal mass. Overall male to female ratio was 2.3:1. Nonneoplastic nasal masses formed the largest group of lesions; 24 cases (80%), followed by 6 cases (20%) of neoplastic nasal masses. Inflammatory polyp was the commonest non neoplastic lesion constituting 22 cases followed by rhinosporidiosis with 2 cases. Out of the 6 neoplastic nasal masses, 5 were benign and 1 was malignant. Out of the benign neoplastic masses, inverted papilloma constituted 3 cases and nasopharyngeal angiofibroma constituted 2 cases. Malignant neoplastic mass was embryonal rhabdomyosarcoma.Conclusions: Nasal obstruction and rhinorrhea are the most common symptoms of presentation. Simple inflammatory nasal polyps are the most common histological pattern seen in our environment, and surgery is the best modality of treatment.
... Masses in nasal cavity and paranasal sinuses form a heterogeneous group of neoplastic and non-neoplastic lesions including the inflammatory polypoidal lesions. 1 These neoplastic and non-neoplastic lesions are quite impossible to clinically differentiate and mostly diagnosed clinically as nasal polyp. 2 Nasal polyps are usually symptomized by nasal obstruction; however, this obstruction is very common and caused by a wide range of aetiologies. 3 Various histopathologic findings ranging from nonneoplastic to sinonasal malignant tumours may mimic a simple polyp or mass. ...
BACKGROUND Sinonasal masses are commonly seen lesions in ENT practice with multiple aetiological factors. We wanted to study the clinico-pathological features of nasal mass specimens in a tertiary hospital and evaluate the utility of routine histopathological examination of the surgically removed nasal tissue specimens.METHODS All the histologically examined specimens of patients clinically presenting with nasal or sinonasal lesions over a period of one year were retrospectively studied and analyzed. RESULTS Out of total 36 patients with masses, 21 were males (58.3 %) and 15 (41.7 %) were females. The age ranged from 10 to 75 years with a mean age of 31.4 years and maximum patients were in the third decade (37.5 %). The most common presenting clinical symptom was nasal obstruction that was seen in 33 patients (91.6 %). Computed tomography (CT) scan was done in 94.5 % of cases prior to the surgical intervention. One fifth of the sinonasal lesions were neoplastic as per histopathology examination. The clinicopathological agreement percentage for detection of the nature of the nasal mass was 88.9 %. The applied interrater reliability in Cohen's kappa coefficient (κ) showed moderate agreement (0.55). CONCLUSIONS The clinical similarity between the histologically different lesions is common and may lead to improper management; so, correlation of clinical, radiologic and pathologic features is of utmost importance for accurate diagnosis
... Most studies agree to this, as they also quote this disease usually presents in second to third decade of life. [7][8][9] However, study by Lathi et al. reported a higher incidence of 10% which is not supported by studies by Zafar et al., Pradhanga et al., and Bakhari et al. [3][4][5]19 The symptoms were nasal obstruction and foul-smelling discharge. 20 Rhinosporidiosis was present in six cases, that is about 3% (Table 1 and Fig. 3). ...
Introduction
Nasal masses are an intriguing arena for a rhinologist. With diagnostic advancement from anterior rhinoscopy to three-dimensional endoscopic view at a blazing speed in rhinology, it has become easier to diagnose a nasal mass. Early detection is a key for better management. Incidence of an entity varies over time because of the ever-changing environmental scenario and availability of advanced diagnostics. Incidence of nasal masses is still of importance because the pathophysiology of the nasal masses is still under research. This study will bring into notice of a rhinologist the relative incidence of various nasal masses highlighting the areas of concern and hence bringing our focus to a better management.
Materials and methods
It is a prospective study with a sample size of 200. All the modern diagnostic facilities were used, including a computed tomography scan can and nasal endoscopy, to reach a presumptive diagnosis of various nasal masses, and histopathology was done to establish the final diagnosis.
Results
In the present study, 62% were males (124) while 38% were females (76). Majority of the patients were in age-group of 21–40 years (42.5%, n = 85), followed by 40% ( n = 80) in the age-group 41–60 years, and 14.5% ( n = 29) in 10–20-year age-group. Around 6 (3%) cases were in less than 10 years of age-group. Out of 200 cases, 160 cases were non-neoplastic masses. Out of 40 neoplastic masses, 24 were benign and 16 were malignant. The most common mass was nasal polyps (144 of 200).
Conclusion
Nasal polyps are still the most common nasal masses. Improvement in diagnostic modality mandates a more active research to understand their molecular biology for better management.
How to cite this article
Singh J, Bhardwaj B, Singh T. Relative Incidence of Nasal Masses: A Tertiary Care Hospital Experience. Clin Rhinol An Int J 2019;12(1):16–20.
... It is important to recognize non neoplastic and neoplastic benign lesions from malignant ones because of different treatment modality and to lessen economical burden to the patient. 2 In our study the male: female ratio was 1 The occurrence of nasal polyps was in our study was 25.6% which was comparable to other similar studies. [6][7][8] Chavan et al showed the most common benign sinonasal mass as the nasal polyp. 9 On examination, the mass was pale, glistening grape-like, insensitive to probing and did not bleed on touch. ...
p class="abstract"> Background: The study aimed to assess the profile of various pathological conditions that present with nasal mass in Indian patients.
Methods: This is a retrospective observational study of 43 patients of sinonasal masses who visited GMERS Medical College and Hospital, Sola, Ahmedabad, India during May 2017 to March 2020. The clinical profile of sinus or nasal masses were observed along with their radiological features on computed tomography scans of paranasal sinuses. The age and gender sub group were also assessed for distribution of these conditions. Most of the patients were managed with surgical techniques.
Results: Overall, clinical profile of 43 patients was observed. The clinicopathological examination aided by endoscopic and imaging studies revealed that 20 (46.5%) patients presented with the non-neoplastic masses and remaining were with neoplastic masses (53.5%). The overall M: F ratio was 1.5:1. Most of the patients belong to 11-30 years age group. The most common symptoms were mass in the nasal cavity and nasal discharge. Polyps were most common lesions seen (25.6%). Surgical intervention in the form of biopsy, excision of mass, functional endoscopic sinus surgery was performed in all patients.
Conclusions: This study gives an insight into various lesions presenting as sinonasal masses and their clinical and pathological profile. Overall, surgical management in form of excision by endoscopic or external approach is effective modality of treatment supplemented with appropriate medical management.</p
... The commonest benign tumour in our study was inverted papilloma and it accounted for 26.0 % (6 cases) of all the benign lesions in this region. The peak age of presentation was fifth 6 decade of life , similar to findings of Anjali et al . Microscopy revealed proliferating columnar or squamous epithelium with an admixture of mucin secreting cells. ...
This is a prospective study of 100 cases of patients presenting with a mass in the nasal cavity, paranasal sinuses and nasopharynx ,
within the age group 12-80 years of age, (2014-2016),over a period of 2 years(2014-2016),in MGM Hospital,Navi
Mumbai.. From these 100 cases, there were 77 cases of non-neoplastic lesions,16 cases of benign lesions and 7 cases of
malignant lesions. The male to female ratio was 2.2:1 for non-neoplastic lesions,1.6:1 for benign lesions and 1.3:1 for malignant
lesions. Most of the cases involve the nasal cavity (79%), followed by PNS (14%) and least number of cases involve the
nasopharynx (7%). The mean age of presentation for non- neoplastic lesions was 35.45 years ,benign lesions was 39.25 years and
malignant lesions was 55.29 years. These various masses have overlapping clinical and radiological features. In order to make a
definitive diagnosis, a histopathological examination is required.
... In our study the incidence of non neoplastic lesion was very high(96.52%) compared to neoplstic lesion, which was only 4.86%.This is comparable to earlier studies by Dasgupta et al. 5 and Mysorekar et al in which the incidence of non neoplastic lesion was higher than neoplatic lesions. 6 ...
p class="abstract"> Background: Benign nasal mass lesions may remain asymptomatic for a long time. Bothersome symptoms like nasal obstruction, bleeding from nose, headache prompts the patient to visit the hospital. Although these are not life threatening, but yet timely intervention not only relieves patient symptoms but also prevents its further progress which may necessitate a more extensive surgical approach. The aim of the study was to determine the incidence of various benign nasal mass lesions presenting to the ENT outpatient department, by reviewing the histopathological report postoperatively.
Methods: It’s a retrospective study over a period of 4 years and 1 month (from November 2012 to November 2016). Both males and females in the age group 1 yr to 70 yrs, who underwent surgery for nasal mass and histopathologically proved as benign mass, were included in the study. Patient data was collected from medical record section, operation theatre surgical records and histopathology register from the department of pathology.
Results: Histopathology review of 146 cases was done. Majority of the patients (139/146) had non neoplastic lesions and only 7 patients had benign neoplastic lesion. Majority were males and in the age group of 20 to 60 yrs.
Conclusions: Though the majority of nasal mass lesions studied are benign non neoplastic, yet these cause bothersome symptoms to the patients thereby requiring surgical intervention. </p
... In the present study maximum number of patients of nasal polyps were found in age group of [11][12][13][14][15][16][17][18][19][20] year and 21-30 years; comprising of 25% in each category. Sirola, R;(1966) found the maximum cases incidence in 2 nd decade of life. ...
... 5 Gupta et al had not reported any case of tuberculosis. 8 According to Waldman and Nayer at al sinonasal tuberculosis was rare entity and reported 2 cases in their study in which bits of tissue microscopically shows presence of round cells, epitheloid cells, giant cells of langhan's type with caseous Inflammatory (Neutrophil plasma cell predominance) ...
... Ethmoidal Maxillary Dasgupta et al found 62.8% cases of polyps. 6 Amongst the benign lesions they found haemangioma (45.7%) as commonest lesion and males were twice commonly affected than females. Swamy et al found 3 haemangiomas out of 13 vascular tumours. ...
p class="abstract"> Background: Benign lesions of the nasal cavity represent a diverse group of pathologies. Furthermore, each of these disorders may present differently in any given patient as pain and discomfort, epistaxis, headaches, vision changes, or nasal obstruction.
Methods: This study was carried out in a tertiary care center in India from October 2016 to March 2018. A total of 80 patients of age 10 years to 80 years were included. Detailed history and complete ENT examination including radiological studies was done. Patients were subjected to diagnostic nasal endoscopy and biopsy followed by histopathological examination. Depending on the diagnosis, medical or surgical treatment or combination of both was administered.
Results: In present study the commonest presenting complaint was found to be nasal blockage found in 76% of cases, followed by rhinorrhea in 40%, nasal mass in 30%, epistaxis in 16%, cheek swelling in 5%. Out of 80 benign lesions, polyp was noted in 65 cases, hemangioma in 8 and inverted papilloma in 3 cases. Out of 65 cases of polyps, 52 were antrochoanal, 10 ethmoidal and 3 maxillary. Medical treatment was given in ethmoidal polyp cases, out of which 5 were cured. Most common surgery was polypectomy. Lateral rhinotomy was done in 6 cases
Conclusions: Patients with benign lesions of the nose commonly presented in the second and third decade with slight male preponderance.Antrochoanal polyps are most common. Medical treatment works to a certain extent in patients with ethmoidal polyposis and surgery is the mainstay of treatment in the benign lesions of the nose.</p
... It may be due to the most frequently occurring simple nasal polyp or polypoidal lesions due to a variety of other pathologic entity ranging from infective diseases to polypoid neoplasm including malignant ones. 4 Tumors of nose are usually uncommon. Malignant tumors account for 0.2% to 0.8% of total malignancies and only 3% of all malignant tumors of upper aerodigestive tract. ...
ackground: Majority of the nasal lesions are polypoid. It is difficult to comment upon the nature of the nasal lesion- whether neoplastic or non-neoplastic. Hence histopathological examination is essential for both ENT surgeons as well as pathologists. Aim to study the incidence of different nasal lesion. Also, to find out frequency of inflammatory, benign and malignant conditions of nasal lesions and to compare various histopathological lesions of nasal mass in relation to age, sex and site distribution.Methods: The present study was undertaken in histopathology laboratory of Department of Pathology, P.D.U. medical college and hospital, Rajkot for period of 2 years from October 2013 to September 2015. A histopathological study of total 100 cases of nasal lesions was done. Tissue were processed and studied.Results: Out of 100 cases, 59 were males and 41 were females. Male to Female ratio was 1.44:1. Maximum numbers of nasal lesions were detected in age group of 11-20 years with 24 (24.00%) cases. Out of these 100 cases, 80 (80.00%) were non neoplastic and 20 (20.00%) were of neoplastic origin. In neoplastic lesions, 12(12.00%) were benign, 1 (1.00%) was borderline and 7 (7.00%) were malignant nasal lesions. Non neoplastic lesions were composed of the majority of cases followed by benign neoplastic lesions.Conclusions: Most of malignant neoplastic lesions were occurs after 40 years of age. Incidence of malignant neoplastic lesions was increase with advanced age.
Background: A variety of non- neoplastic and neoplastic conditions involve the nasal cavity and paranasal sinuses. Non-neoplastic conditions comprise bulk of these lesions and some of them clinically mimic neoplastic conditions. This study was conducted to analyse the histopathologic spectrum of sinonasal lesions. Methods: A total of 57 cases of sinonasal mass lesions received in department of pathology, world college of medical sciences and research hospital were evaluated. Patient details were obtained from histopathology forms and register. Histopathological examination was carried out according to standard protocol. Percentages and simple frequency tables were used for analysis. Results: Majority of the lesions were found in the nasal cavity (n=45) followed by paranasal sinus (n=12). Non-neoplastic (46 cases) lesions outnumbered neoplastic lesions (11 cases). Infective sinusitis (n=25) was the most common non-neoplastic lesion encountered. Among neoplastic, 6 lesions were benign and 5 were malignant. Conclusions: Nonneoplastic lesions are more common than neoplastic lesions. Clinical and radiological features may be overlapping, hence histopathological examination is essential for final diagnosis and further management.
Background: Sinonasal lesions of both non-neoplastic and neoplastic variants are frequently observed by clinicians in the nasal cavity and paranasal sinuses. Sinonasal lesions are important due to divergence in their behavior and prognosis. Hence, a careful histological workup remains the mainstay of a final definitive diagnosis and timely intervention. Materials and methods: A prospective analysis was done on 151 patients of Sinonasal masses who presented to the Department of Otorhinolaryngology, MVJ Medical College and Hospital, from 2014 to 2019. Their biodata, clinical profile, and histopathological diagnosis were analyzed. Results: Non-neoplastic lesions (135 cases, 89.4%) were more frequent than neoplastic lesions (16 cases, 10.59%), and showed male predominance with an M: F ratio of 1.7:1. Nasal polyp (119 cases, 88%) was the most common lesion. Nasal obstruction (89 cases 89.45%) was the most common presenting feature. Among the neoplastic lesions, lobular capillary hemangioma was the most common benign lesion (2 cases,50%), and squamous cell carcinoma 2 cases (18.1%), was the most common malignant lesion. Conclusions: Sinonasal masses can present with overlapping clinical features, hence, it is important to categorize them into non-neoplastic and neoplastic lesions for further management. Histopathology remains the gold standard for establishing the diagnosis in such cases.
Objective:
Nasal polyps are non-cancerous, soft painless growth of nasal mucosa. In this study, our aim was to investigate the Ki-67 expression level in nasal polyps by immunohistochemical method.
Patients and methods:
30 patients with nasal polyps were included in this study. Nasal polyps were processed for paraffin wax embedding protocol. Samples were fixed and embedded in paraffin blocks. 5 µm sections were stained with Hematoxylin-Eosin dye and immune stained with Ki-67 antibody. Sections were analyzed under light microscope.
Results:
Blood parameters showed that white blood cells, hematocrit and platelet were higher than normal range. In sections of hematoxylin-eosin staining, elevated basal cells, thin basement membrane, leukocyte infiltration, collagen fibers degeneration were observed. Masson trichrome staining revealed that degenerative epithelial cells, detached basement membrane and edema were observed. Ki-67 expression was observed in mucosal epithelial cells, vascular endothelial cells and plasma cells in immune staining.
Conclusions:
Epithelial degeneration in nasal polyps and leukocyte infiltration induce nasal adenoma. Ki-67 expression may be a diagnostic tool for epithelial leukocyte formation.
Introduction: The presence of unilateral symptoms or pathology should be regarded with extreme caution as sinonasal neoplasms in their early stages with subtle symptoms may mimic inflammatory pathology. It is always the otolaryngologist’s endeavour to diagnose a neoplastic pathology in the early stage to prevent further complications.
Aim: To study the aetiopathological profile, age, and sex distribution of unilateral nasal masses presented at a tertiary care centre, Telangana, India.
Materials and Methods: The present study was a hospital-based cross-sectional study consisting of 53 patients of all age groups, of both sexes, with unilateral nasal mass presenting to the Ear, Nose and Throat (ENT) Outpatient Department (OPD) at Krishna Institute of Medical Sciences, Secunderabad, Telangana, India from December 2020 to June 2021. A detailed history was recorded and the patient underwent a complete ENT check-up, and head-neck examination followed by Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and biopsy.
Results: The mean age of the study population was 44 years and there were 47 males and six females. Nose block was the most common presenting symptom in 43 (81.1%). Middle meatus was the common site seen in 12 patients (22.6%). Inflammatory lesions was the most common observed in 24 (45.3%), followed by fungal sinusitis in 6 (11.3%), granulomatous lesions in 2 (3.8%), benign lesions in 15 (28.3%), and malignant lesions in 6 (11.3%).
Conclusion: Unilateral nasal masses were found common in males than females, with a peak incidence in the 5th to 6th decades of life. Histopathologically inflammatory lesions are the most common followed by benign and then malignant lesions.Any unilateral nasal mass should be viewed with a high index of suspicion for malignant lesions and should be subjected to diagnostic nasal endoscopy, imaging, and histopathological examination after surgical excision of the mass.
Background and objectives: Computerized tomography (CT) scan with contrast can delineate soft tissue pathologies and is now the first choice in diagnosing sinonasal malignancy and inflammatory lesions. The present study compared the diagnostic nasal endoscopy (DNE) and CT scan to diagnose cases presented with sinonasal mass.
Materials and methods: This was a descriptive study conducted on patients with sinonasal masses attending at Government TD Medical College, Alappuzha, Kerala from 1/1/2014 to 30/6/2015. Each patient was examined by diagnostic nasal endoscopy and had undergone preoperative CT scan. Histopathological examination of the specimens was carried out and compared with the findings of DNE and CT scan.
Results: A total of 72 cases were enrolled in the study. Age group was from 13-85 years with a male to female ratio of 1.3:1. Nasal obstruction was the commonest symptom. Among the 72 cases, 59 belonged to the non-neoplastic group and 13 to the neoplastic group. Sinonasal polyps (65.3%) formed the majority of the non-neoplastic lesions. Vascular lesions (6.9%) were the commonest benign neoplastic mass and malignancy was seen in 6.9% of cases. Diagnosis by DNE and CT scan was same except in 3 cases. Histopathology and radiological scan result correlated well except in 3 cases.
Conclusion: Histopathology still remains the gold standard in the diagnosis of sinonasal masses. Clinical, CT scan and histopathology diagnoses were complementary with each other. However, CT scan is indispensible in studying the anatomical variants and providing the route map prior to and during endoscopic sinus surgeries.
IMC J Med Sci 2022; 16(1): 008. DOI: https://doi.org/10.55010/imcjms.16.006
*Correspondence: Santhi Thankappan Pillai, Department of Otorhinolaryngology, Government TD Medical College, Vandanam, Alappuzha, Kerala 688005, India. Email: sttpillai@gmail.com
BACKGROUND A variety of non - neoplastic and neoplastic conditions involve the nasal cavity, paranasal sinuses and nasopharynx and these are very common lesions encountered in clinical practice. Histopathological examination of these lesions is the gold standard for diagnosis because management and prognosis vary among different lesions. The aim of the present study was to evaluate the histopathological study of the lesions of the nasal cavity, paranasal sinuses and nasopharynx in relation to their incidence, age, gender and site wise distribution and to compare the results with the available data. METHODS A study of 88 cases was conducted for a period of 2 years from August 2017 to July 2019. After fixation, Processing and Haematoxylin and Eosin staining and special stains histopathological diagnosis was made. RESULTS Among 88 total cases, 58 were males and 30 were females. A male predominance was observed with a male to female ratio of 1.93 : 1. They were more common in third, fourth and fifth decade of life. Malignant nasal lesions were seen after fourth decade of life. Nasal lesions were more common in nasal cavity (67.05 %), followed by paranasal sinuses (18.18 %) and nasopharynx (14.75). Out of 88 total cases, 39 (44.32 %) were non - neoplastic, 30 (34.09 %) were benign and 19 (21.59 %) were malignant nasal lesions. CONCLUSIONS Sinonasal lesions and nasopharyngeal lesions can have various differential diagnoses. A complete clinical, radiological and histopathological correlation helps to categorize these sinonasal lesions into various non - neoplastic and neoplastic types. But histopathological examination remains the mainstay of definitive diagnosis. KEYWORDS Nasal Cavity, Paranasal Sinuses, Nasopharynx, Benign Tumours, Malignant Tumours, Histopathological Examination
The nasal cavity and paranasal sinuses occupy a relatively small anatomical space, but they give rise to some of the more
complex, histologically different group of tumors in the entire human body.1Thesinonasal cavity tumors have a similar presenting
symptomatology. A presumptive diagnosis is often made using advanced imaging and CT and/or MRI. However, the mainstay of
final definitive diagnosis is a careful histopathological examination. This present study was done to look for the occurrence of
different masses arising from the nasopharynx and sinonasal tract, and to compare between their histological types and clinical
mode of presentation.Comparison ofclinical findings with histopathological finding showed that 47 of the 70 patients had
clinically non-neoplastic polyps, of which the maximum were inflammatory polyps.Among the benign neoplastic lesions,
maximum cases to be found were Inverted Papilloma followed by Lobular Capillary Haemangioma.Among the malignant lesions
reported in this study, Squamous Cell Carcinoma was the most common.Most of the cases in present study presented with nasal
discharge, obstruction and nasal mass. Complaints of pain and headache were most common in malignant cases. Thorough
examination of patients with complaints of facial pain or headache should be done, to rule out paranasal sinuses malignancies at
an early stage.
Background: To study the incidence, clinical presentation and to observe comparison of different sinonasal masses. Materials and Methods: This Prospective study was carried out from January 2017 to December 2018. Data were collected from 100 patients presented with sinonasal masses. This study is based on history, clinical, radiological, laboratory and histopathological examination. Results: During the study period, 100 patients presented with sinonasal masses (male 60, female 40; age group 8-70 years).Nasal polyploid masses were non-neoplastic in 70 (70%) subjects, and neoplastic in 30 (30%) cases. Nasal obstruction was the most common (95%) presenting complaint, followed by rhinorrhoea (48%), hyposmia (30%), intermittent epistaxis (17%), headache (15%), facial swelling (10%) and eye-related symptoms (10%). The most common site of origin of polyploid masses was the middle meatus (54%) followed by the lateral wall of the nasal cavity (15%) and superior meatus (11%). unilateral nasal masses was present in 49% patients, while the remaining patients had bilateral nasal masses. Allergic (60%) and inflammatory (28.5%) polyps were the most common non-neoplastic mass, inverted papilloma (41.17%) and haemangioma (35.29%) were most common benign neoplastic mass; 92.3% of all malignant masses were squamous cell carcinoma. Surgery was the major mode of treatment. it included Caldwell-luc operation (7%), polypectomy (10%), excision of mass (25.0%) and functional endoscopic sinus surgery (44%). Malignancies were treated with radiotherapy or Surgery followed by radiotherapy or Chemoradiotherapy. Conclusions: The masses in nasal cavity, paranasal sinuses, and nasopharynx encompass a wide spectrum of common and rare diseases and are very common lesions encountered in clinical practice. Endoscopic examination and advanced imaging technique help to reach a presumptive diagnosis but histopathological examination remains the mainstay of final definitive diagnosis. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 49-53
A mass in nasal cavity is a condition commonly encountered by the
Otorhinolaryngologists. A diverse group of lesions may present themselves as such
masses.
This study is intended to clinically differentiate the various conditions presenting as
sino-nasal mass, to understand their exact nature by clinical evaluation,
histopathological examination & radiological findings learn the relative incidence of
individual conditions encountered, and discuss various diagnostic approaches.
A prospective study of total 200 patients with sino-nasal masses presenting between
the periods of 01 September 2011 to 31 August 2014 in Gauhati Medical College and
Hospital, Assam was done. All patients were subjected to detailed history and clinical
examination. All necessary investigations were done. The final diagnosis was made
after the histopathological examination of the excised masses. Finally the incidence,
clinical & radiological features and histopathological correlation of all the nasal
masses were ascertained.
A variety of non-neoplastic and neoplastic conditions involve the nasal cavity, paranasal sinus and are fairly common presentation encountered in clinical practice. Sinonasal lesions are a common finding in all age groups. The lesion of nose and paranasal sinuses are very deceptive so, the presenting features, clinical examination, nasal endoscopy, radiodiagnosis and histopathology are employed conjointly to reach a diagnosis. This cross sectional study was conducted between November 2014 and September 2016. 150 patients with nasal or paranasal sinus lesions attending ENT OPD were included. Among 150 patients there was a male predominance in all lesion except malignant lesions and most of the patients 72 (48%) were in the age group 11– 30 years. Mean age of presentation for benign lesions was 33.64 years and of malignant lesions was 49.14 years. The study showed that 96 (64%) of the nose and PNS lesions were of inflammatory nature followed by 22 (15%) benign, 18 (12%) granulomatous and 14 (9%) malignant, Inflammatory polyp being the most common diagnosis. Haemangioma was the most common benign neoplastic lesion whereas in granulomatous lesions most common diagnosis was tuberculosis. The maximum lesions 74 (49%) were in maxillary antrum. The most common clinical presentation was nasal obstruction, with unilateral nasal obstruction seen in 84 (56%) cases and bilateral nasal obstruction in 50 (33.3%) cases. Angiofibroma 6 (4%) was exclusively seen in adolescent males. Olfactory neuroblastoma 4 (2.6%) was diagnosed in females with mean age of presentation of 30 years. Sinonasal lesions display a complex and interesting spectrum of clinical, radiological and histopathologic features. The non-neoplastic lesions are numerous, the morphologic variants of neoplasms are many and most of them present as polypoid masses which are impossible to distinguish clinically. Hence a proper workup including histopathological and radiological categorization is essential in the management of these lesions.
Neoplasms of the upper respiratory tract and ear are tumors of visual localization; however, patients often go to specialized medical institutions in the presence of a widespread tumor process. This paper presents a brief overview of the most common benign and malignant tumors with localization in the oropharynx, nasopharynx, larynx and ear. The clinical picture, diagnosis and various treatment options are presented. Attention is paid to early diagnosis and the need for timely consultation with an oncologist and doctors of related specialties.
Nineteen nasal polyps from 13 patients were examined histologically. Nine polyps from seven cystic fibrosis (CF) patients could be positively identified by a triad of observations: delicate, barely visible basement membrane of surface epithelium without submucosal hyalinization, lack of extensive infiltration of eosinophils (Giemsa stains), and a preponderance of acid mucin in glands and cysts of the polyp and in its surface mucous blanket (Alcian Blue-periodic acid-Schiff stains). Two polyps from two patients with CF and atopy showed the characteristic findings of CF without modification. Eight polyps from four atopic patients without CF were identified by the reverse triad of changes: extensive thickening of the epithelial basement membrane and its extension into the submucosa as an irregular hyaline membrane, high stromal eosinophil count, and mainly neutral mucin in mucous glands, cysts, and mucous blanket. Hyperplastic mucous glands, mucous cysts of variable sizes, focal metaplasia of surface epithelium, and acid mucin in goblet cells were considered nonspecific lesions.
Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium Seeberi. Although a variety of sites may be affected, the principal site of infection is the nasal mucosa, the disease is endemic in India and Sri Lanka, smaller series are also described from East Africa and parts of America, but it is very rare in Europe. The 116 cases seen in the Medical College at Bankura during January 1983 to December 1987 are presented here. The disease is more prevalant in males and in the second decade of life. Excision by diathermy knife and electrocautery of the base proved to be helpful to prevent recurrence.
Thirty-seven cases of paranasal mucous gland tumors are presented. The natural history of these tumors is discussed, with emphasis on the relative frequency of nerve involvement (13 of 41) which is particularly common in ethmoidal and sphenoidal tumors. Most of the patients who died with disease had active local tumors (14 of 15 cases). Results of treatment are shown—the 5- and 10-year survival rates free of disease were 21% (6 of 28) and 0% (none of 12) respectively. Factors which may aftect the results of treatment of these tumors are discussed; the site of origin is important, with the best results reported in tumors of the nasal fossa. A combined approach by surgery and radiotherapy yields die best results with a 5-year survival rate of 33% (5 of 15). Apart from pleomorphic adenoma, there is no significant difference between the results of treatment of various histologic types. Paranasal mucous gland tumors are moderately radiosensitive with 8 of 22 tumors disappearing completely under treatment and another 4 showing very good regression. Cylindromas and adenocarcinomas appear to be the most radiosensitive tumors. The technique and dosage of radiotherapy are illustrated.
Two cases of typical fibrous histiocytoma and 1 case of histiocytic neoplasm resembling the xanthogranuloma of the retroperitoneum are described. The basic fibroblast histiocytic lesions encompassed the following benign lesions; nodular tenosynovitis (giant cell tumors of tendon sheath), dermatofibroma (sclerosing hemangioma, subepidermal nodular fibrosis), pigmented villonodular synovitis, atypical fibroxanthoma of skin, juvenile xanthogranuloma, xanthoma and xanthofibroma. Malignant or indeterminant are: storiform fibrous xanthoma (dermatofibrosarcoma protuberans), retroperitoneal xanthogranuloma, fibroxanthosarcoma (malignant fibrous xanthoma/malignant fibrous histiocytoma), histiocytoma, fibrous histiocytoma and some unclassified tumors. The histological criteria for diagnosing a fibrous histiocytoma include finding spindle cell (fibroblastic) and histiocytic elements in the tumor. The fibroblasts often align in a storiform or nebula pattern, while the histiocytes are often found with a foamy cytoplasm or as multinucleated giant cells. One or the other of these biphasic cellular components may dominate. If the spindle cells predominate, confusion with a fibrosarcoma is likely; if the histiocytes predominate, an inflammatory or granulomatous lesion of the paranasal sinuses is suggested. Only a small number of fibrous histiocytomas behave in a malignant fashion, but a prediction of the biologic behavior is difficult, for tumors with similar histologic patterns may be cured by simple excision, recur with an aggressive local growth, or may metastasize. In the head and neck, the most common variant of the fibrous histiocytoma is the socalled atypical fibroxanthoma. This lesion is almost exclusively one of the sun damaged skin of the elderly and only secondarily involves the superficial subcutaneous tissues. Histologically quite bizarre and hence distinctive, the atypical fibroxanthoma only rarely shows local aggressiveness. The histologic features manifested by the tumors in 2 of the 3 patients are much like those of the storiform fibrous xanthoma or dermatofibrosarcoma protuberans. This tumor is uncommonly found in the head and neck and is a lesion of the superficial soft parts. The histiocytic lesions in the 3rd patient are best considered as an unclassified histiocytoma. The mixture of histiocytes, xanthoma cells, and variable numbers of fibrocytes and a well defined chronic inflammatory component, composed largely of lymphocytes, in the tumors bear a striking resemblance to the xanthogranuloma of the retroperitoneum, mesentery, mediastinum and lung. No similar lesion in the upper airway could be found.
Of eighty-eight patients with embryonal rhabdomyosarcoma of the head and neck, forty-eight were female and forty were male patients. Ages ranged from two weeks to seventy-seven years. Sixty-three were children (average age: 6.8 years) and twenty-five were adults (average age: 37.6 years). In nearly 60 per cent of patients the tumor occurred in the orbit, nasopharynx, or nose. The presenting complaint was usually that of a rapidly enlarging, asymptomatic mass. Half the patients had had evidence of the tumor for three months or less and only six had had it for more than a year on admission.Seventy-eight per cent of patients are known to have died as a result of the tumor, 49 per cent within the first year, 20 per cent in the second year, and 9 per cent within three to five years after admission. Eight patients (nine per cent) are known to be alive and free of disease twenty-one months to twenty years after admission, one patient (1 per cent) is alive with tumor metastasis, and ten (11 per cent) have been lost to follow-up study. Of the eight surviving patients assumed to be free of disease, one was treated by surgery alone, five by combined surgery and radiation, and two by radiation only.Histologically, the tumor often presents a varied pattern that in part may be readily confused with many quite dissimilar neoplasms, among which are reticulum cell sarcoma, neuroblastoma, myxoma, and amelanotic melanoma. An error in tissue diagnosis may be minimized by securing adequate and representative tissue for biopsy and by awareness of a chance encounter with such a lesion.
As part of our review of non-epithelial tumors involving the nasal cavity, paranasal sinuses, and nasopharynx, nine fibrous histiocytomas (FH) are reported. FH probably are derived from undifferentiated mesenchymal stem cells that have the ability to differentiate into two different pathways, one fibroblastic and the other histiocytic. The proportion of these two different elements varies greatly in different lesions. The cell population ranges from cytologically benign (small bland nuclei and no mitoses) to overtly malignant (marked anaplasia and numerous mitoses). Based on our cases and on 12 previously reported tumors, FH involving the upper respiratory passages may cause clinical problems similar to those produced by other soft tissue neoplasms affecting this area, (nasal obstruction, a mass or swelling in the involved area, epistaxis, loosening of teeth, or facial pain). Physical examination may show a mass projecting into the nasal, sinus, or oral civity; facial asymmetry; proptosis; or a periorbital mass. Radiographic studies may demonstrate sinus opacification or cloudiness, a mass, or bone destruction. Treatment has included polypectomy, wide local excision, partial maxillectomy, or radical maxillectomy, depending on the size and extent of the lesion. When involving the upper respiratory passages, FH, if incompletely excised, may recur locally, requiring a more extensive resection. A minority of these tumors have metastasized via lymphatic and/or venous channels. Histologic features appear to correlate with clinical course.
Scott Brown's Otolaryngology, Rhinology Chapter 9. 5th edn. London, Butter-worths. 142-153 Jan-March, 1997 36 Nasal Polyps --Histopathologic Spectrum--Anjali Dasgupta et aL 5 Upper respiratory tract and ear
- Drake
- A B Lee
- Voi
Drake-Lee, A. B. (1987) : Scott Brown's Otolaryngology, Rhinology. Chapter 9. 5th edn. London, Butter-worths. 142-153. IJO & HNS/VoI. 49, No. 1, Jan-March, 1997 36 Nasal Polyps --Histopathologic Spectrum--Anjali Dasgupta et aL 5. Fechner, R. E. (1990) : Upper respiratory tract and ear. In Pathology. Vol-2.9th edn. ed. J. M. Kissane. Saint Louis, C. V. Mosby Co.,
Reticulum Cell Sarcoma of the nose and paranasal sinuses A profile of malignant tumours of paranasal sinuses. (Study of 57 cases) Immununoglobulins in nasal polyps
- B D Birt
- V N Chaturvedi
- R M Razada
- S K T Jain
- K K Haricharan
- A J Pakhan
Birt, B. D. (1930) : Reticulum Cell Sarcoma of the nose and paranasal sinuses. Journal of Laryngology and otology 84 : 615. Chaturvedi, V. N., Razada, R.M., Jain, S.K.T., Haricharan, K. K. and Pakhan, A. J. (1986) : A profile of malignant tumours of paranasal sinuses. (Study of 57 cases). Indian Journal of Cancer. 23: 14. Donovan, R., Johansson, S.G.O., Bennich, H. and Scothil, I.P. (1970) : Immununoglobulins in nasal polyps. International Archives of Allergy and Applied Immunology. 37 : 154. Drake-Lee, A. B. (1987) : Scott Brown's Otolaryngology, Rhinology. Chapter 9. 5th edn. London, Butter-worths. 142-153.
Scott Brown's Otolaryngology, Rhinology. Chapter 9
- A B Drake-Lee
Drake-Lee, A. B. (1987) : Scott Brown's Otolaryngology, Rhinology. Chapter 9. 5th edn. London, Butter-worths. 142-153.
Italy are glad to announce a programme of practical courses on Impedance Audiometry and BERA. Course Co-ordinator : Dr
- Elkon Studi
- Miano
ELKON & AMPLAID with the patronage of Amplifon Centro Ricerche and Studi, Miano, Italy are glad to announce a programme of practical courses on Impedance Audiometry and BERA. Course Co-ordinator : Dr. M. V. Kirtane I. Impedance Audiometry 9 31st May -1st June, 1997
Histopathological typing of upper respiratory tumours
- K Shanmugaratnam
Shanmugaratnam, K. (1978) : Histopathological typing of upper respiratory tumours, Geneva, W.H.O. P-15.
Course to be conducted by -Dr Anil Malhotra with Drs For Registration, please contact : Mr. Sanjay Kaul, Elkon Private Limited
- S K Kacker
- R C Deka
Venue : New Delhi --Basic principles of auditory physiology --Bera recordings, diagnostic significance --Oto-neurological disorders, practicals and hands on. Course to be conducted by -Dr. Anil Malhotra with Drs. S. K. Kacker and R. C. Deka. For Registration, please contact : Mr. Sanjay Kaul, Elkon Private Limited, Shopping Plaza, 2884, Hardhiansingh Road, Karol Bagh, New Delhi-110 005. Tel 9 5737059/5744781, Fax : 91 11 5737059. Mr S. L. Naik, Elkon Private Limited, B-33, Nandbhuvan Indl. Estate, Mahakali Caves Road, Andheri (East), Mumbai-400 093. Tel: 830 1030/832 3510, Fax : 8203373. IJO & HNS/VoI. 49, No. 1, Jan-March, 1997
Embryonal rhabdomyosarcoma of head and neck. Report of 88 cases
- J K Manon
- E H Soule
Immununoglobulins in nasal polyps
- R Donovan
- S G O Johansson
- H Bennich
- L P Scothil
Cancer of the nose and accessory sinuses
- E L Frazell
- J S Lewis
- E. L. Frazell