Abstract
A 21-year-old man presented with nasal obstruction of the right nasal fossa of 1 year duration. Nasal endoscopy revealed in the right inferior turbinate head a rounded neoplasm about 1 cm in diameter.Cytologic study of a nasal scraping specimen disclosed numerous clusters containing columnar cells with cytomegaly, prominent multinucleation, markedly sparse shortened cilia; the cytoplasm contained an acidophil area and a small round area that stained poorly; cells with a large intracytoplasmic vacuole that was acidophil and PAS+. Serology tests using the nested polymer chain reaction (PCR) technique on serum, nasal and pharyngeal smears revealed an Epstein-Barr virus (EBV) infection that was confirmed at electron microscopy. The clinical and cytological features resolved 19 months after the initial evaluation.ConclusionThe authors advise carrying out clinical (endoscopy, serology, etc.) evaluation of all endonasal neoplasms and to routinely perform cytological study on nasal scraping specimens. When samples test positive for EBV, nasal and nasopharyngeal endoscopy should be performed regularly to detect possible evidence for nasopharyngeal carcinoma (NPC).
Highlights
Introduced over a century ago, nasal cytology has become an indispensable diagnostic tool in the rhinology laboratory to differentiate various forms of rhino-pathologies, to follow the course of the disease and to monitor response to medical treatment [1,2,3,4,5].In rhino-pathologies of viral origin, the microscopic picture is characterized by fairly aspecific cellular changes gathered under the term "ciliocytophthoria", which comprises degenerative alterations of the ciliary ultrastructure, the cytoplasm, the nucleus [6,7]
Some have strongly linked with the carcinogenesis of several tumor types, Burkitt's lymphoma and nasopharyngeal carcinoma (NPC), or Epstein-Barr virus (EBV) [1012]
A interesting finding uncovered by electron microscopy was the small rounded rarefied area inside the cytoplasma of several multinuclear ciliate columnar cells where the herpes virus concentration was highest. These novel cellular alterations, described here for the first time, appear particular to EBV infection since they are absent in other viral infections of the nasal mucosa where we have consistently found only phenomena of "ciliocytophthoria", as mentioned above
Summary
The authors advise carrying out clinical (endoscopy, serology, etc.) evaluation of all endonasal neoplasms and to routinely perform cytological study on nasal scraping specimens. When samples test positive for EBV, nasal and nasopharyngeal endoscopy should be performed regularly to detect possible evidence for nasopharyngeal carcinoma (NPC)
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