Computed tomography evaluation of sinonasal masses with histopathological correlation

Abstract

Background and Aim: A variety of nonneoplastic and neoplastic conditions involving the nasal cavity (NC), paranasal sinuses (PNSs), and nasopharynx are commonly encountered in clinical practice. Etiological factors for the development of sinonasal masses are human papillomavirus 6 and 11, allergens, air pollution, and industrial carcinogens, tobacco, alcohol, and occupational exposure to heavy metal particles. The aim was to explicate and corroborate the CT radiological features of sinonasal masses of benign versus sinister differential diagnosis. Materials and Methods: A total of 50 cases of sinonasal masses were included in this study. Written informed consent from the patients was obtained. Detailed clinical history and local and general examinations were done according to the pro forma attached with a special reference to the nose, PNSs, and oral cavity. These cases were subjected to after routine hematological and biochemical evaluation, nasal endoscopy, X-ray PNSs/computed tomography scan, fine-needle aspiration cytology, and, whenever required, biopsy. Results: On radiological assessment, of 50 patients, 45 patients were declared benign, while as 5 patients were diagnosed as having primary or secondary malignancy involving sino-NCs. Based on bone erosions along with internal hyperdense contents and enhancement pattern, there was some amount of discordance among radiological and histopathological diagnosis. One case which was diagnosed as malignancy (likely metastasis) was found to have invasive fungal sinusitis. Among the three radiologically diagnosed inverted papillomas (based on focal hyperostosis, subtle calcification, and cerebriform enhancement on postcontrast study), only 1 case correlated histopathologically. The rest were hemangioma and schwannoma (very rare). Radiological esthesioneuroblastoma, hemangioma, angiofibroma, and rhinolith correlated well with histopathology. Conclusion: Imaging plays an important role in the evaluation of sinonasal masses. Benign lesions are diagnosed very accurately. The distinction between sinonasal and invasive fungal sinusitis is still debatable, and hence, histopathological correlation is necessary. The presence of significant cervical lymphadenopathy can serve as a surrogate marker of malignancy.