CLINICOPATHOLOGICAL PROFILE OF SINONASAL MASSES: A RETROSPECTIVE STUDY AT A TERTIARY CARE HOSPITAL

Abstract

The clinicoapthological profile of sinonasal masses at a tertiary care hospital.

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CLINICOPATHOLOGICAL PROFILE OF SINONASAL MASSES: A RETROSPECTIVE STUDY AT A TERTIARY CARE HOSPITAL.
Afshan Fathima*
Senior Resident, Department of ENT, Bangalore Medical College & Research Institute, Bangalore - 560002. *Corresponding Author
Original Research PaperENTINTRODUCTIONThe nose and paranasal sinuses (PNS) form a single functional unit with common pathological mechanisms. Sinonasal masses (SNM) are commonly encountered in the outpatient department which requires a careful evaluation for all possible differential diagnoses for a better overall management. Most patients present with complaints of nasal 1obstruction . Other symptoms include nasal discharge, epistaxis and disturbances of smell etc.A sinonasal mass can have various origins and presentations such as congenital, inammatory, neoplastic (benign or malignant) or traumatic. A congenital SNM may be intranasal, extranasal or may 2present as external nasal mass with nasal obstruction .These are predominantly midline swellings such as dermoids, glioma and 3encephaloceles.Nasal polyps as a part of SNM have been medically recognised since the ancient Egyptian timeline and their removal with a snare was described by Hippocrates, a method which persisted till the second half th4of 20 century . In the general population, the prevalence of nasal 5polyps (allergic and infective) is around 4% . In cadaveric studies, this 6prevalence can be as high as 40% .Neoplasms of the nose and PNS can be benign or malignant in nature. 6Benign neoplasia is not uncommon , whereas malignant tumours account for less than 1% of all malignancies and about 3% of all head 7and neck malignancies . These tumours can remain clinically silent for months to years. Coexisting infection can mask the clinical signs and symptoms, further delaying the diagnosis.The aim of this study was to evaluate the clinicopathological prole of sinonasal masses (SNM) in a tertiary care hospital.MATERIALS & METHODOLOGYThe present study titled 'Clinicopathological Prole Of Sinonasal Masses: A Retrospective Study At A Tertiary Care Hospital' was carried out between July 2018 to December 2019. Patients having clinical features of SNM were included in the study. Previously treated cases of sinonasal disease with recurrence and patients not consenting evaluation were excluded from the study.Study Design:Hospital based Retrospective Study.Methodology:106 consecutive patients with clinical features of a sinonasal mass were included in the present study. A detailed history of the patients including age, gender, occupation and clinical symptomatology was documented. A thorough examination was carried out including diagnostic nasal endoscopy as per standard protocols. Laboratory investigations and radiological evaluation (Computed tomography of nose & PNS) were carried out as required.Patients with clinical diagnosis of benign inammatory polyps underwent functional endoscopic sinus surgery (FESS) while others had endoscopic examination under anaesthesia with incisional and excision al bio psy. All mas ses ex cised were subje cted t o histopathological examination. Data was collected and tabulated in an excel sheet. Results presented as percentages and proportions.RESULTSA total of 106 consecutive patients presenting with SNM were enrolled in the present study. 62(58.5%) were males and 44(41.5%) were females (Table 1). The male to female ratio was 1.71: 1. The most common age group affected was between 31- 40 years having 42 patients (39.62%) (Table 2).Table 1: Gender DistributionTable 2: Age DistributionThe patients presented with a wide array of symptomatology. The most common symptom was nasal obstruction in 82 patients. The next frequent symptom was nasal discharge (71 patients) followed by headache (48 patients) (Table 3).The presenting features in non-neoplastic versus neoplastic SNM were indistinguishable and ambiguous. The most common clinical sign was a eshy mass in either or both nasal cavities.Introduction: Sinonasal masses may appear simple in nature but tend to create diagnostic ambiguity. They are broadly classied as non-neoplastic/ inammatory and neoplastic lesions. A thorough evaluation and conrmation of diagnosis becomes crucial for overall management. The aim of the present study was to evaluate the clinicopathological prole of sinonasal masses (SNM) at our tertiary care hospital. Methods & Methodology: 106 patients with features suggestive of a SNM were included in the present study between July 2018 and December 2019. A detailed history and thorough clinical examination was carried out and data recorded. Patients were subjected to laboratory and radiological evaluation as deemed necessary. Histopathological evaluation was done to conrm the diagnosis.Results: Sinonasal masses were more commonly noted in the males with a male to female ratio of 1.71:1. 39.62% of the study population comprised of patients in the age group of 31-40 years. Non-neoplastic masses (66.98%) were more common in comparison to neoplastic masses (33.02%). Squamous cell carcinoma was the most common malignancy (9.43%).Conclusion: Sinonasal masses are commonly encountered in the otorhinolaryngology outpatient department. The clinical features and presentation are indistinguishable and pose a great deal of ambiguity in diagnosis and treatment. Patients presenting with sinonasal masses should be thoroughly evaluated clinically, radiologically and histopathologically for effective and appropriate managementABSTRACT
Volume - 11 | Issue - 07 | July - 2021 | . PRINT ISSN No2249 - 555X | DOI : 10.36106/ijar
KEYWORDS : Sinonasal masses, inammatory, neoplastic, polyps
B Viswanatha
Professor and Head of Department, Department of ENT, Bangalore Medical College & Research Institute, Bangalore.
GENDER
NUMBER OF PATIENTS
PERCENTAGE
Male
62
58.5
Female
44
41.5
Total
106
100
AGE (IN YEARS)
NUMBER OF PATIENTS
PERCENTAGE
1-10
02
1.89
11-20
07
6.60
21-30
29
27.36
31-40
42
39.62
41-50
11
10.38
51-60
08
7.54
61-70
05
4.72
>70
02
1.89
Total
106
100
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INDIAN JOURNAL OF APPLIED RESEARCH

Table 3: SymptomatologyAfter appropriate clinical, laboratory and radiological evaluation the SNM were broadly classied into non-neoplastic and neoplastic (benign & malignant) (Table 4). All patients underwent biopsy followed by histopathological examination of the SNM which helped in conrming the diagnosis and plan appropriate management.Table 4: Distribution Based On Type Of LesionNon- neoplastic masses were seen in 66.98% of the patients whereas neoplastic masses were noted in 33.02%. Among the non-neoplastic lesions, allergic polyps were most common in 43 patients (60.56%) followed by rhinosporidiosis in 5 patients (7.04%). Inverted papilloma was the most common benign lesion noted in 8 patients (47.06%). A variety of malignant tumours were noted in our study where squamous cell carcinoma was the most common in 10 patients (55.55%). This was followed by variants su ch a s ly mphom as ( 11.11% ), adenocarcinoma (11.11%) and extramedullary plasmacytoma (11.11%) (Table 5).Table 5: Histological Classification Of Sinonasal MassesDISCUSSIONMasses arising from the sinonasal tract are difcult to differentiate based on macroscopic features. In our study, SNM were more common in males with a male to female ratio of 1.71:1. Similar ndings were 8noted in a study by Zafar et al. with a male to female ratio of 1.7: 1. This may be due to the increased awareness or an overall higher male attendance in the hospital. In our study, the most common age group affected was 31-40 years with 42 patients (39.62%). Similar ndings 9 were noted in a study by Bakari et al. in which 31-40 years showed a higher number of patients with a peak at 33 years.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, 11studies done by other authors.Nasal polyposis is a result of chronic inammation of the nose and PNS mucosa. They can have strong association with allergy, asthma or infection. In our study, nasal polyps (inammatory and allergic) accounted for 91.55% of the non-neoplastic SNM (71 patients). Of these 60.56% were allergic polyps and 30.99% were inammatory polyps. Our ndings were consistent with a similar study done by 10Dasgupta et al. where nasal polyps were the most common SNM noted. Rhinosporidiosis is an endemic disease in India, relatively rare and lesser documented in literature. In a study done by Pradhananga et 11al. had only one patient of rhinosporidiosis whereas in our study 5 patients were diagnosed with rhinosporidiosis which is slightly higher than the ndings in other studies.Inverted papilloma is a benign neoplastic lesion of the sinonasal tract which shows a percentage of malignant transformation as high as 1211%. In our study, inverted papillomas were the most common benign neoplastic lesion in 8 patients (47.06%) followed by haemangiomas in 136 patients (35.29%). In a similar study done by Chavan et al, 5 patients presented with inverted papillomas in their study population. 14In the study done by Lathi A et al. 47% of their study population presented with nasal haemangiomas which is higher than the number reported in our study.15Malignant lesions in the sinonasal tract are rare. In our study 18 (16.98%) of the 106 patients were diagnosed with sinonasal malignancies. Squamous cell carcinoma was the most common variant in 10 patients (55.55%). This was followed by adenocarcinoma, lymphoma and extramedullary plasmaytoma in 2 patients (11.11%) 1each. In another study done by Abu Hena et al. squamous cell carcinoma was noted in 41.67% of their study population. The prevalence of squamous cell carcinoma was slightly higher in our 16study. In a study done by N Khan et al. malignant melanoma was noted in 10% of their study population. This was in accordance to our present study.Histopathological examination is conclusive in diagnosing the SNM in terms of aetiology and cellular features. It gives a denitive determination of the nature of lesion, i.e. inammatory or neoplastic. Radiological investigations may also help in understanding the type of pathology, extension of lesion and provide a road map to the surgeon when planning surgery. Most of non-neoplastic and benign neoplastic nasal masses require surgical excision, while malignant neoplastic nasal masses require wide surgical excision, radiotherapy or chemotherapy either alone or in combination.CONCLUSIONSinonasa l masses are commonly encounter ed in the otorhinoaryngology outpatient department. The presenting features of all sinonasal lesions may be indistinguishable and therefore represent diagnostic and therapeutic dilemma.Clinical, radiologic and histopathological correlation is of utmost importance for accurate diagnosis. All these modalities are complementary to each other. Most importantly, a thorough histopathological evaluation- a gold standard for diagnosis, is essential and mandatory for a suitable and timely intervention.REFERENCES1. Humayun AHM, Zahurul Huq AHM, Ahmed SMT, et al. Clinicopathological study of sinonasal masses. Bangladesh J Otorhinolaryngol 2010; 16: 15-22.2. Harley EH. Pediatric congenital nasal masses. Ear Nose Throat J 1991; 70: 28-32.3. Valencia MP, Castillo M. Congenital and acquired lesions of the nasal septum: a practical guide for differential diagnosis Radio Graphics 2008; 28: 205-23.4. Wright J: History of laryngology and rhinology. St Louis: Lea and Febiger 1893, 57-9.5. Hedman J, Kaprio J, Poussa T, et al: Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Int J Epidemiol 1999, 28:717-22.6. Laren PL, Tos M: Anatomic site of origin of nasal polyps: endoscopic nasal and paranasal sinus surgery as a screening method for nasal polyps in autopsy material. Rhinology 1994, 33:185-8.7. Settipane GA: Epidemiology of nasal polyps. Allergy Asthma Proc 1996, 17:231-6.8. Zafar U, Khan N, Afroz N, et al. Clinicopathological study of non-neoplastic lesions of nasal cavity and paranasal sinuses. Indian J Pathol Microbiol 2008; 51: 26-9.9. Bakari A, Afolabi OA, Adoga AA, Kodiya AM (2010) Clinicopathological prole of sinonasal masses: an experience in national ear center Koduna, Nigeria. BMC Res Notes 3:18610. Dasgupta A, Ghosh RN, Mukherjee C. Nasal polyps – Histopathologi spectrum. Indian J Otolaryngol Head Neck Surg 1997; 49: 32-6.11. Pradhananga RB, Adhikari P, Thapa NM, et al. Overview of nasal masses. J Inst Med 2008; 30: 13-6.12. Barnes L, Tse LLY, Hunt JL. Schneiderian papillomas. In: Barnes L, Eveson JV, Reichart P, et al., editors. World health organization classication of tumors. Lyon: Pathology of the Head and Neck Tumors. Lyon: IARC Press; 2005. pp. 28-32.13. Chavan SS, Deshmukh S et al. (2012) Case study of clinicopathological correlation of benign sinonasal masses. World Articles Ear Nose Throat 5(1).14. Lathi A, Syed MMA, Kalakoti P, Qutub D, Kishve SP. Clinico-pathological prole of sinonasal masses: a study from a tertiary care hospital of India. Acta Otorhinolaryngol Ital. 2011; 31: 372-7.
Volume - 11 | Issue - 07 | July - 2021 | . PRINT ISSN No2249 - 555X | DOI : 10.36106/ijar
SYMPTOMS
NUMBER OF PATIENTS
Nasal obstruction
82
Nasal discharge
71
Epistaxis
22
Headache
48
Sneezing
45
Smell abnormalities
24
Facial swelling
11
Facial pain
19
Proptosis
08
Hearing loss
05
TYPE OF LESION
NUMBER
PERCENTAGE
Non- neoplastic
71
66.98
Benign
17
16.04
Malignant
18
16.98
Total
106
100
HISTOLOGY
NUMBER
PERCENTAGE
Non-neoplastic mass
Allergic polyp
43
60.56
Inammatory polyp
22
30.99
Rhinosporidiosis
5
7.04
Rhinoscleroma
1
1.41
Total
71
100
Benign neoplastic mass
Haemangioma
6
35.29
Angiobroma
3
17.65
Inverted papilloma
8
47.06
Total
17
100
Malignant neoplastic mass
Squamous cell carcinoma
10
55.55
Adenocarcinoma
2
11.11
Lymphoma
2
11.11
Malignant melanoma
1
5.56
Extramedullary plasmacytoma
2
11.11
Undifferentiated carcinoma
1
5.56
Total
18
100
INDIAN JOURNAL OF APPLIED RESEARCH
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15. Zimmer LA, Carrau RL. Neoplasms of the nose and paranasal sinuses. In: Bailey BJ, Johnson JT, Newland SD, editors. Head & Neck Surgery - Otolaryngology. 4th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2006.16. Khan N, Zafar U, Afroz N, Ahmad SS, Hasan SA. Masses of nasal cavity, paranasal sinuses and nasopharynx: a clinicopathological study. Indian Journal of Otolaryngology and Head and Ne Surgery. 2006; 58(3): 259-63.
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