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Nasopharyngeal angiofibroma: Collagenised fibrous stroma and vessels lined by endothelial cells. H&E x 400
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An analysis of clinicopathological features of 240 cases presenting as mass in nasal cavity, paranasal sinuses and nasopharynx observed, both retrospectively and prospectively, over a period of 5 years in Jawaharlal Nehru Medical College. Aligarh. The incidence of masses in nasal cavity, paranasal sinuses and nasopharynx was 34.3 cases per year. Am...
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Leiomyoma of nasal cavity is a rare and benign tumor of smooth muscle origin that uncommonly arises from the nasal septum. We present an unusual case of histopathologically diagnosed locally extensive leiomyoma of the nasal septum which was clinically and radiologically misdiagnosed as malignancy of the nasal cavity. This case report emphasizes the...
Citations
... For an accurate diagnosis, the histologic examination through biopsy of the lesion should be additionally evaluated for patients with suspected symptoms, smoking history, or old age. [19][20][21][22][23][24][25] It should be recommended to perform nasal endoscopy in conjunction with biopsy and radiologic study regardless of the impression on endoscopy. ...
Objectives: Discrimination of nasal cavity lesions using nasal endoscopy is challenging because of the differences in clinical manifestations and treatment strategies. We aimed to investigate the diagnostic accuracy of clinical visual assessment (CVA) of nasal cavity masses using endoscopic images and determine whether there is a difference according to pathologic class and the examiners’ experience. Methods: We collected pathologically confirmed endoscopic images of normal findings, nasal polyp (NP), benign tumor, and malignant tumor (each class contained 100 images) randomly selected. Eighteen otolaryngologists, including six junior residents, six senior residents, and six board-certified rhinologists classified the test set images into four classes of lesions by CVA. Diagnostic performance according to the pathologic class and the examiner's experience level was evaluated based on overall accuracy, F1-score, confusion matrix, and area under the receiver operating characteristic curve (AUC). Results: Diagnostic performance was significantly different according to the pathological class of nasal cavity mass lesions with the overall accuracy reported high in the order of normal, NP, benign tumor, and malignant tumor (0.926 ± 0.100; 0.819 ± 0.135; 0.580 ± 0.112; 0.478 ± 0.187, respectively), F1 score (0.937 ± 0.076; 0.730 ± 0.093; 0.549 ± 0.080; 0.554 ± 0.146, respectively) and AUC value (0.96 ± 0.06; 0.84 ± 0.07; 0.70 ± 0.05; 0.71 ± 0.08, respectively). The expert rhinologist group achieved higher overall accuracy than the resident group (0.756 ± 0.157 vs. 0.680 ± 0.239, p < .05). Conclusion: CVA for nasal cavity mass was highly dependent on the pathologic class and examiner's experience. The overall accuracy was reliably high for normal findings, but low in classifying benign and malignant tumors. Differential diagnosis of lesions solely based on nasal endoscopic evaluation is challenging. Therefore, clinicians should consider further clinical evaluation for suspicious cases.
... Tumorous lesions in the nasal cavity and paranasal sinuses are of several histopathological types and are highly heterogeneous [1][2][3]. Non-neoplastic and neoplastic lesions are common in the nasal cavity [2]. The majority of nasal cavity mass lesions are non-neoplastic, such as nasal polyps (NPs), which are typically bilateral and multiple and have a prevalence of 1%-4% [4,5]. ...
... Tumorous lesions in the nasal cavity and paranasal sinuses are of several histopathological types and are highly heterogeneous [1][2][3]. Non-neoplastic and neoplastic lesions are common in the nasal cavity [2]. The majority of nasal cavity mass lesions are non-neoplastic, such as nasal polyps (NPs), which are typically bilateral and multiple and have a prevalence of 1%-4% [4,5]. ...
Nasal endoscopy is routinely performed to distinguish the pathological types of masses. There is a lack of studies on deep learning algorithms for discriminating a wide range of endoscopic nasal cavity mass lesions. Therefore, we aimed to develop an endoscopic-examination-based deep learning model to detect and classify nasal cavity mass lesions, including nasal polyps (NPs), benign tumors, and malignant tumors. The clinical feasibility of the model was evaluated by comparing the results to those of manual assessment. Biopsy-confirmed nasal endoscopic images were obtained from 17 hospitals in South Korea. Here, 400 images were used for the test set. The training and validation datasets consisted of 149,043 normal nasal cavity, 311,043 NP, 9,271 benign tumor, and 5,323 malignant tumor lesion images. The proposed Xception architecture achieved an overall accuracy of 0.792 with the following class accuracies on the test set: normal = 0.978 ± 0.016, NP = 0.790 ± 0.016, benign = 0.708 ± 0.100, and malignant = 0.698 ± 0.116. With an average area under the receiver operating characteristic curve (AUC) of 0.947, the AUC values and F1 score were highest in the order of normal, NP, malignant tumor, and benign tumor classes. The classification performances of the proposed model were comparable with those of manual assessment in the normal and NP classes. The proposed model outperformed manual assessment in the benign and malignant tumor classes (sensitivities of 0.708 ± 0.100 vs. 0.549 ± 0.172, 0.698 ± 0.116 vs. 0.518 ± 0.153, respectively). In urgent (malignant) versus nonurgent binary predictions, the deep learning model achieved superior diagnostic accuracy. The developed model based on endoscopic images achieved satisfactory performance in classifying four classes of nasal cavity mass lesions, namely normal, NP, benign tumor, and malignant tumor. The developed model can therefore be used to screen nasal cavity lesions accurately and rapidly.
... Nasal obstruction being most common complaint, which was similar to the study done by Narayan Swamy [7] et al (76.6%). N Khan [8] et al found that 86.6% of cases had inflammatory nasal polyp as the most common non-neoplastic lesion, which is discordant to our study, where we got antrochoanal polyp (40%) as the most common. In a study by Janice [9] et al, squamous cell carcinoma was the commonest malignant lesion, which is similar to our finding of SCC to be highest among malignant lesions (7.5%). ...
Introduction: Sinonasal masses are one of the common findings among ENT patients. The incidence of
sinonasal mass is increasing and a variety of lesions involving nose and paranasal sinuses are encountered in
day-to-day practise.
Objective: he study was undertaken with an objective to study the clinico-pathological profile of sinonasal
masses in a tertiary care center of upper Assam, India.
Materials and Methods: A total of 40 cases were studied in the from the period August 2021 to July 2022
attending the OPD of Department of ENT and Head and Neck Surgery, Assam Medical College Dibrugarh.
Results: Most of the cases belonged to age group of 41-60 years. Mostly encountered non-neoplastic lesion was
antrochoanal polyp (40%). Inverted papilloma being the most common benign lesion (15%) and metastatic
undifferentiated carcinoma (7.5%) was most common malignant neoplastic mass noted.
Conclusion: Sinonasal masses encompass broad pathology. Early detection and management help to improve
prognosis.
... Although adolescence or early childhood is stated to be the most common age of occurrence, there are reports of this disease occurring in all age groups. 19 The present observations also correlate with the study of Jareoncharsri et al. 20 Kakoi and Hiraide studied a series of 175 patients, subdivided polyps into edematous polyps comprising 60% of the total cases observed, whereas cystic or glandular polyps were second most common type comprising 27% and least number of cases were found of fibrous polyps 13%. 15 Davidson and Hellquist analyzed 95 patients and classified sinonasal polyps histologically into four categories: edematous or eosinophilic polyps (86.3%), fibroinflammatory polyps (7.3%), polyps with seromucinous gland hyperplasia (5.3%), and polyps with stromal atypia (1.1%). ...
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.
... In our study, the mean age for benign lesions and malignant lesions was 34.69 and 48 years respectively. In a study by Khan et al., the mean age for benign lesions was 26.8 years, and for malignant lesions, it was 35.3 years [4]. The most affected age group was 41-50 years (29.4%), and the least number of cases was seen in 0-10 years (2.9%) seen in a study by Agarwal et al. [5]. ...
... The male to female ratio was 2:23 in our study as compared to 2:3 in Khan et al., 1:54 in A. Lathi et al. and 1:8 in S.S. Bist et al. [4,7,8]. Thus, in most of the studies, males were more commonly affected than females. ...
... Orbital involvement was seen in 21% of cases in our study. In other studies, it was 10.7% and 17% [4,7]. More involvement in our study was because we had not included the cases having sinonasal polyposis. ...
Background
Different types of space-occupying lesions can arise from the nasal cavity and nasopharynx. They can be neoplastic (benign and malignant) or nonneoplastic lesions producing wide range of clinical symptoms. The correlations of clinical, radiological and histopathological findings are necessary in these types of cases.
The aim of the study is to evaluate clinical behaviours of sinonasal cavity and nasopharyngeal masses, to correlate the radiological and pathological findings of masses, to evaluate the methods for early diagnosis of masses and to determine and evaluate the outcome of sinonasal cavity and nasopharyngeal masses following various modalities of treatment.
Materials and methods
This was a prospective study conducted in a tertiary care hospital of Vadodara, Gujarat. A total 42 cases were included in the study. Clinical, demographic, radiological and histopathological details were noted in each case. Follow-up period was about 3 months to 18 months in the study.
Observation
A total 42 cases were included in the study with 20 benign neoplastic lesions, 19 malignant lesions, and 3 nonneoplastic lesions. The incidence was noted between 8 and 75 years of age with a male to female ratio of 2:23. Angiofibroma was the most common benign neoplastic lesion. Squamous cell carcinoma was the most common malignant lesion noted. Thirty-three patients were successfully operated for the excision of tumour. The most common symptom was nasal obstruction present in 66.67% of cases followed by swelling over local site in 62% of cases followed by nasal discharge in our study.
Discussion
The nasal cavity contains different types of epithelial (squamous, neural, olfactory) and mesenchymal (bone, cartilage, muscle and vascular) tissues. Tumours can arise from any of these tissues. Symptomatology is indistinguishable from nasal polypi, chronic rhinosinusitis and granulomatous diseases of the nose. Utmost care is needed in the examination and diagnosis of these cases before starting the treatment.
Conclusion
Clinical, radiological and histopathological correlations are necessary in sinonasal masses as it will be helpful in deciding the treatment plan and any adjunctive treatment if necessary like chemoradiation in malignant lesions. Continuous follow-up is also necessary to look for patency of nasal cavity, any complication and recurrence.
... A provisional diagnosis was made after clinical assessment and radiological investigation but final diagnosis was made after histopathological examination. 4 Early diagnosis plays an important role in the establishment of faster planning of the treatment and early recovery which eventually provides good prognosis. ...
A complete assessment of nasal masses along with early diagnosis and management of the disease is very important to prevent complications. Epistaxis and nasal obstruction are the signs of suspicion of malignant tumors. Patient‘s presentation depends upon the site and extent of the mass. This article comprises of study done on Three patients who presented to the department of otorhinolaryngology (ENT) with nasal mass with symptoms of nasal obstruction and nasal bleeding. All patients were subjected to clinical examination, diagnostic nasal endoscopy, radiological evaluation, surgical intervention and histopathological assessment. Thorough assessment helps the surgeon to come to a diagnosis which includes even rare cases and helps to treat the disease and to prevent further progression of the disease and it’s complications.
... Male to female ration of 1.27:1 was calculated in this study. Similar findings of male preponderance were observed in studies conducted by Tondon et al. [8] , Khan et al. [9] , and Kulkarni et al. [10] . We observed higher frequency of non-neoplastic lesions (32 cases) in comparison with neoplastic (18 cases). ...
... We observed higher frequency of non-neoplastic lesions (32 cases) in comparison with neoplastic (18 cases). Our findings was in concordance with khan et al. [9] , Kulkarni et al. [10] . and Mane et al. [7] . ...
... [8] But in the study done by Agarwal and Panigrahi [9] capillary haemangioma was diagnosed more than sinonasal papilloma. Lathi et al. [12] and Khan et al. [15] also reported capillary haemangioma more than sinonasal papilloma. Two cases of respiratory epithelial adenomatoid hamartoma (REAH) and one case of pleomorphic adenoma of salivary gland was also reported. ...
Introduction:
The worldwide annual incidence of carcinomas of the sinonasal tract is 0.5 to 1.0 patients per 100,000 per year. P63 plays a role in epithelial development and is used as a marker for basal and myoepithelial cells. Expression of p16 occurs as a result of functional inactivation of the retinoblastoma protein (pRb) by the human papilloma virus (HPV) E7 protein.
Aims:
This study aims to study the histological spectrum of benign and malignant sinonasal mass lesions and to study the immunohistochemical expression of p63 in different type of sinonasal mass lesions. It also aims to ascertain the incidence of high-risk HPV in primary sinonasal mass lesions with p16 immunohistochemistry and delineate the histological spectrum of HPV-related sinonasal lesions.
Materials and methods:
This cross-sectional study was conducted on 80 cases from June 2018 to June 2020 at a tertiary care hospital. Clinical history including demographic parameters were collected in the study proforma. The gross findings of the specimens noted and histopathological examination by H&E staining done. Immunohistochemistry staining for p63 and p16 expression was performed on all cases.
Results:
Most common age group affected was 41-60 years with male:female ratio of 1.67:1. Nonneoplastic lesions (38.7%) comprised majority of the cases followed by benign neoplastic lesions (31.3%) and malignant neoplastic lesions (30%). Among the malignant neoplastic lesions, p63 showed positive expression in 75% (p = 0.005) and p16 showed positive expression in 41.7% (p = 0.023). Among benign and nonneoplastic lesions, p63 showed positivity in 21.4% (p = 0.000) and p16 showed positivity in 44.6% (p = 0.040).
Conclusion:
We analyzed p63 and p16 expression in varied lineages like carcinomas, papillomas, and neuroectodermal differentiation arising from the sinonasal tract and also in relation to other clinicopathological parameters. This study revealed p63 expression was associated more with the squamous cell carcinomas and nasopharyngeal carcinomas. Sinonasal tract malignancies are also associated with HPV infections that are identifiable by p16 immunostaining and, thus, could provide new prospects in identifying any definite biological and clinical characteristics associated with HPV as well as advancement in the targeted therapies for this patient population.
... The most common primary sinonasal malignant tumour is squamous cell carcinoma, followed by adenocarcinoma and adenoid cystic carcinoma. 6 Indolent fungal infections, tuberculosis and inflammatory processes, such as sarcoidosis or Wegener granulomatosis, are also differential diagnoses. 3 ...
A woman in her 70s presented with reduced vision in her left eye, progressive narrowing of right eye opening for 6 months and anosmia. On examination, she had right enophthalmos and pseudoptosis with inferior globe dystopia. Her visual acuity was 6/9 and nil light perception in the right and left eyes, respectively. Extraocular muscle examination showed limited right up gaze. Funduscopy showed a normal right optic disc and left optic disc atrophy. Systemic examination revealed left breast ulceration with skin tethering. CT revealed an infiltrative mass invading the ethmoidal sinuses, frontal sinuses and both orbits. A histological diagnosis of infiltrative ductal breast carcinoma was made after nasal endoscopic and left breast biopsy. She underwent palliative chemoradiotherapy and survived with good disease control after 1 year. Metastatic carcinoma is a differential diagnosis of a sino-orbital mass, and comprehensive clinical assessment is indicated for all patients presenting with non-acute eye injury.
... Least common benign sinonasal mass was angiofibroma in 2 (14.3%) patients shown in the Figure 1. 2,4,9,11,13 In present study, most common malignant sinonasal mass ...
... In present study the non-neoplastic sinonasal masses (73.75%) more than neoplastic sinonasal masses are similar with study done by Agarwal et al (59%), Bist et al (60%) and Khan et al (60%) respectively.4,6,11 In present study, most common non-neoplastic sinonasal mass was ethmoidal polyposis (44.07%) which is similar with study done byLathi et al (62.5%), ...
p> Background: Nasal masses are finding in an ENT (Ear, nose, throat) outpatient department. Most patient present with complaints of nasal obstruction.Other symptoms are nasal discharge, epistaxis and disturbances of smell. Sinonasal mass may be neoplastic (benign or malignant) or non-neoplastic (congenital, inflammatory) in nature. It is difficult to determine actual pathology underneath every nasal masses so, histopathological evaluation is mandatory for definitive diagnosis.
Methods: The present study is prospective observational study of symptomatology, demographic profile and histopathological correlation of sinonasal masses in samplw size 80, these are the total number of patients presenting at tertiary health care centre from 1<sup>st </sup>Jan 2019 to 30<sup>th </sup>June 2020 (18 months) the study include, patients of any age and sex presenting with nasal symptoms
Results: Majority of patients with sinonasal masses where in the age group 2<sup>nd</sup> decade. Male female ratio was 1.28:1. Nasal obstruction was the most common presentation. Most common non neoplastic lesion was ethmoidal polyposis and most common benign lesion was hemangioma. Most common malignant lesion was squamous cell carcinoma.
Conclusions: Presenting features of all sinonasal masses may be indistinguishable and post diagnostic dilemma. Correlation of clinical and histo-pathological modalities is of utmost importance for accurate diagnosis.</p
