Sinonasal Masses Research Articles

Expression Levels of Glutathione S-Transferase and Cytochrome P450 Isoenzymes in Nasal Polyp Tissue.

Nasal polyps are benign sinonasal masses composed of eosinophils and extracellular edema. Pathogenesis of the polyp formation is unclear but several studies strongly suggest a correlation with infection, inflammation and allergy conditions. Our aim is to investigate the potential link between allergy and nasal polyp in tissue level. Nasal polyp group included 60 patients whose diagnosis was confirmed with biopsy and the control group included 38 healthy patients. Tissue sample of the control group was taken from inferior turbinate mucosa under local anesthesia and nasal polyp tissue was collected from functional endoscopic sinus surgery. The glutathione S-transferase (GST) and cytochrome P450 (CYP) isoenzyme expressions of the tissue samples were investigated under light microscopy and graded by a senior pathologist. GSTP1 protein expression was significantly higher in tissue samples from nasal polyp group compared to that of control group (p < 0.05). However, CYP1A1, GSTM1 and GSTA1 isoenzymes were not different between the two groups (p > 0.05). We have found that GSTP1 isoenzyme was elevated in nasal polyp tissue compared to the control. The increase in protein expression of GSTP1 might have occured as a tissue response to the increased oxidative stress thus suggesting a role of GSTP1 in polyp formation.

Endoscopic Management of Ethmoidal Schwannoma: A Case Report.

Schwannomas of sinonasal origin are rare tumours with an incidence as low as 4% and may present with a wide range of clinical features. Due to non-specific endoscopic and radiological findings, diagnosis becomes difficult. We present a case of an ethmoidal schwannoma with nasal and nasopharyngeal extension in an elderly female patient who had a slow course of the long-standing disease. Her main complaints were nasal obstruction, nasal discharge, mouth breathing, snoring and recurrent nasal bleed. Nasal endoscopy showed a pale, firm, polypoidal mass with dilated vessels on the surface which bled on probing. It was a non-enhancing sinonasal mass with scalloping of adjacent paranasal sinuses and erosion of posterior nasal septum on contrast-enhanced computed tomography. Endoscopic excision of the mass was done in toto and histopathology report confirmed it as schwannoma. Long standing sinonasal masses especially in the elderly age group with an indolent medical history should arise suspicion of benign neoplasm especially schwannomas due to their high rate of incidence amongst benign sinonasal neoplasms.

A study of clinical and histopathological correlation of sinonasal masses

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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&lt;sup&gt;st &lt;/sup&gt;Jan 2019 to 30&lt;sup&gt;th &lt;/sup&gt;June 2020 (18 months) the study include, patients of any age and sex presenting with nasal symptoms&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Majority of patients with sinonasal masses where in the age group 2&lt;sup&gt;nd&lt;/sup&gt; 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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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.&lt;/p&gt;

Evaluation of clinical, radiological and pathological correlation of sino-nasal masses: our experience

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Purpose of study was to evaluate clinical, radiological, pathological correlation of sinonasal masses, to correlate age and sex with etiology of sinonasal masses and to evaluate percentage of patient having malignancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a hospital based prospective observational study. In this study total numbers of 69 cases of sinonasal mass were selected from those patients who were admitted in department of otorhinolaryngology and head and neck surgery SAMC and PGI Indore MP from June 2019 to August 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: Sinonasal masses are more common in 4&lt;sup&gt;th&lt;/sup&gt; to 6&lt;sup&gt;th&lt;/sup&gt; decade, males, farmers and lower socioeconomic status. Most common presented symptom with sinonasal mass was nasal obstruction. Patients shows polypoidal mass in nasal endoscopy, which was most common finding. Most of the patients radiological scan shows the opacity. 26.1% cases were neoplastic and rest non neoplastic. These rules however, may be broken in sinonasal imaging. The relative number of non-neoplastic and neoplastic lesions varies from region to region. A provisional diagnosis was made after clinical assessment and radiological investigation but final diagnosis was made after histopathological examination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;From the above study, it is clear that radiological examination and nasal endoscopy is helpful and important adjunct to overall clinicopathological evaluation of patients but it is not free of fallacies. Hence a thorough radiological, clinicopathological evaluation with pre op endoscopic evaluation and histopathology is necessary for better management of patients presenting with sinonasal masses.&lt;/p&gt;

Types and Clinical Profile of Unilateral Sinonasal Masses

Background: Unilateral mass in the sinonasal region is a common problem facing the otolaryngologist in daily clinical practice. There are various benign and malignant conditions originating in this area with different clinical features depending on their nature and extent.Objectives: To evaluate the types and clinical profile of unilateral sinonasal masses.Materials and methods: This study includes 60 patients who attended the outpatient clinic at Alyarmook Teaching Hospital, Baghdad, Iraq, between January 2017 and April 2018. A thourough history from each patient was taken. Moreover, the clinical examination was done according to standard clinical practice. The imaging results of the nose and paranasal sinuses were documented. Then biopsy was taken from the mass at the operating room under local or general anesthesia if indicated. The specimen was sent for histopathological examination and the results were documented on the data collection sheet. The patients were divided into two groups: non-neoplastic and neoplastic according to the histopathological results.Results: Out of 60 patients, there were 36 (60%) males. The age of our cases was ranged from 6 to 79 years with a mean age of 34.20 ± 18.126 years. Non-neoplastic causes were (n=38, 63.3%) more than the neoplastic group, and the majority of them were unilateral simple polyp (n=23, 38.3%). Inverted papilloma was the most common benign tumor (n=8, 13.3%), while, squamous cell carcinoma was the commonest malignant neoplasm (n=2, 3.3%). Non-neoplastic causes were more in both sexes. The most affected age group was 20-49 years (n=31, 51.7%). The non-neoplastic causes were mostly seen in the age group 20-49 years (n=22, 36.7%). There was no statistically significant difference between the age and gender and the causes of unilateral sinonasal lesions (P-value > 0.05). Nasal obstruction, nasal discharge, and hyposmia were more in non-neoplastic than neoplastic group. While epistaxis and facial pain were found to be higher in the neoplastic group.Conclusion: Non-neoplastic masses outnumber neoplastic ones. Among non-neoplastic lesions, inflammatory polyps were the most common. Benign neoplasms outnumber the malignant neoplasms with inverted papilloma and squamous cell carcinoma were the most common respectively.

Endoscopic Management of Maxillary Sinus Schwannoma.

Schwannomas are benign tumors originate from nerve sheath. In this article, the authors aimed to share our experience and review the literature on endonasal endoscopic intervention for a maxillary sinus schwannoma. A 30-year-old Caucasian female patient applying to ophthalmology clinic due to exophthalmos and proptosis in her left eye for the last 6 months. A well-defined mass was detected in left maxillary sinus that was filling and expanding the sinus. Endoscopic biopsy from the patient was reported as ancient schwannoma. The encapsulated mass was completely removed by performing a combined endoscopic medial maxillectomy and Caldwell-Luc procedure under general anesthesia. The authors have been following the patient for 2 years and there was no evidence of recurrence, however, a decrease in the volume of the maxillary sinus occurred, suggesting chronic maxillary atelectasis. In conclusion, schwannoma should be considered in the differential diagnosis of sinonasal masses.

Comparison of clinicopathological and preoperative computed tomography findings of sinonasal masses

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 *Correspondence: Santhi Thankappan Pillai, Department of Otorhinolaryngology, Government TD Medical College, Vandanam, Alappuzha, Kerala 688005, India. Email: sttpillai@gmail.com

CLINICOPATHOLOGICAL EVALUATION OF SINONASAL REGION LESIONS: A SINGLE CENTER EXPERIENCE

Benign and malignant lesions of the sinonasal area are frequently seen in the clinic. The aim of this study was to evaluate the pathological and clinical features of patients diagnosed with sinonasal lesions in the Department of Pathology of the University of Health Sciences Ankara Training and Research Hospital between 2016 and 2019. Evaluation was made of benign and malignant sinonasal lesions reported in the Department of Pathology of the University of Health Sciences Ankara Training and Research Hospital between 2016 and 2019. The data including age, gender, diagnosis, localization and clinical information of patients diagnosed with benign and malignant sinonasal lesions were obtained retrospectively from the hospital information system and patient files. The data sets created were then evaluated statistically and the results were discussed in the light of the relevant literature. From the data sets obtained from the patient data, it was observed that the number of benign lesions in the sinonasal region (91%) was higher than malignant lesions (9%). Patients with sinonasal masses were predominantly in the 41-50 years age group, with a male to female ratio of 2:1. Rhinorrhea and nasal obstruction were determined to be the most common symptoms at presentation. The anatomic localization of the lesions sent to the pathology department was classified by the clinician, and reported as 84.5% nasal cavity, 3.5% nasal septum, 1.6% nasal concha, 2.2% nasal vestibule, and 8.2% paranasal sinus. According to the pathological diagnoses of these cases, sinonasal polyps with benign characteristics were found at the rate of 82.6%, and inverted papilloma with the potential for malignancy and recurrence at 8.5%. Sinonasal lesions are often benign but malignant potential should not be ignored. It should be kept in mind that benign and malignant lesions of this region may show similar symptoms and indications in clinical evaluation. Therefore, endoscopic and pathological evaluation is important for lesions detected in the sinonasal region.

Clinicopathological study of lesions of nasal cavity and paranasal sinuses- A two year study

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.

Clinicopathological Profile of Sino-nasal Masses at a Tertiary Care Hospital: A Descriptive Study

Introduction The Sino-nasal mass is a common clinical entity. Although it has varied aetiology ranging from non-neoplastic to neoplastic, clinical presentation is overlapping that poses diagnostic dilemma. Objective of the study was to study the clinical profile of Sino-nasal masses in terms of demographic profile, clinical presentation and clinicopathological diagnosis. Materials and Methods A descriptive study was carried out at tertiary care hospital for 2 years. Clinically diagnosed cases of sino-nasal masses were included in the study. Previously treated cases, congenital lesions were excluded. Provisional diagnosis was made based on clinical and radiological evaluation. Diagnosis on histopathological examination was considered as definitive. Results Total of 75 patients were included in the study. Demographic data showed slight male predominance (M:F= 1.08:1), with most patients from age group 31-40 years (26.67%). Nasal obstruction was the most common presenting symptom. The number of patients with non-neoplastic lesion was 48; 17 patients had neoplastic benign lesions while 6 patients had neoplastic malignant lesions. Conclusion Large number of patients presents with trivial symptoms but need careful examination and appropriate diagnosis. Inflammatory lesions outnumbered neoplastic lesions in our study. Clinical suspicion and appropriate investigations can guide in timely intervention and management of these patients reducing the morbidity and mortality in these patients.

Differentiation of Benign From Malignant Sinonasal Masses Using Diffusion Weighted Imaging and Dynamic Contrast Enhanced Magnetic Resonance Imaging.

The sinonasal region is affected by a variety of neoplasms. A differentiation between benign and malignant masses is essential both for management and prognostication. Morphological analysis often does not allow this differentiation. This article aims to assess the value of advanced MRI (diffusion [DWI] and dynamic contrast enhanced MRI [DCE-MRI]) in differentiation of benign and malignant sinonasal masses. This prospective study included 40 patients with sinonasal masses who underwent advanced MR on 3T MR scanner. The lesions were analyzed based on morphological characteristics, qualitative, quantitative diffusion parameters, and time signal intensity curves. Apparent diffusion coefficient (ADC) values were acquired using b values of 50 and 1000 s/mm2. The accuracy of DWI, DCE-MRI, and combined DWI/DCE-MRI in differentiating benign from malignant sinonasal masses were analyzed. Perineural extension and growth pattern of the tumor were the best morphological discriminators. Mean ADC values for benign and malignant lesions were 1.675 ± 0.561 and 0.903 ± 0.405 × 10-3 mm2/sec, ,respectively. ROC revealed that ADC cutoff value of 1.005 × 10-3 mm2/sec provided an accuracy of 92.5% in differentiating benign from malignant masses (P value <.01). On excluding the benign vascular masses (Juvenile Nasopharyngeal Angiofibroma and hemangioma), the time signal intensity curve showed 78% accuracy (P value <.001). The highest diagnostic performance was achieved by combining DWI and DCE-MRI (95% accuracy). DWI has higher accuracy than DCE-MRI. Quantitative DWI is preferable over qualitative DWI. Accuracy of DCE-MRI can be increased by excluding vascular masses with characteristic imaging features. DWI and DCE-MRI have the highest accuracy when used in combination than either of them alone in differentiating benign from malignant sinonasal masses.

Role of Histopathological Correlation in Cases of Sino-Nasal Masses: A Retrospective Analysis

Role of Histopathological Correlation in Cases of Sino-Nasal Masses: A Retrospective Analysis

Histopathology of Sinonasal and Nasopharyngeal Neoplastic Lesions in a Tertiary Care Center of Western Nepal: A Descriptive Cross-sectional Study.

Sinonasal and nasopharyngeal regions harbor diverse clinical conditions including many non-neoplastic and neoplastic lesions presenting with nasal obstruction, facial pain and swelling, rhinorrhea, epistaxis, and other oral, ear, and orbital symptoms. Histopathology of excised lesions is the mainstay for the definitive diagnosis and management of neoplastic lesions. The aim of this study is to find out the prevalence of neoplastic lesions among sinonasal and nasopharyngeal masses. This was a descriptive cross-sectional study conducted among sinonasal and nasopharyngeal masses in the Department of Pathology of a tertiary care center of western Nepal with primary data of 20 years from January 2001 to May 2020. Ethical approval was taken from the Institutional Review Committee. Convenience sampling method was used. Data management and statistical analysis were done using Statistical Package for Social Sciences. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage. Out of 395 sinonasal and nasopharyngeal lesions, 134 (33.92%) (29.26-38.58 at 95% Confidence Interval) were neoplastic lesions. The malignant lesions were found to be 60 (44.77%). Inverted papilloma was the most common benign lesion comprising 28 (20.89%) of cases, and squamous cell carcinoma and nasopharyngeal carcinoma were the most common malignant lesions comprising 12 (8.95%) cases each. This study observed a variety of neoplastic lesions. The most common benign lesion was nasal polyp and squamous cell carcinoma and nasopharyngeal carcinoma were the most common malignant lesions.

: Sinonazal kitlelerde 6 yıllık histopatoloji sonuçlarımız

Purpose: In this study, it was aimed to compare patients with bilateral sinonasal mass and those who have unilateral sinonasal mass in terms of age, gender and histopathological diagnoses.&#x0D; Material and Method: The histopathological results of 549 patients who underwent incisional / excisional biopsy or sinonasal surgery in our clinic between January 2012 and December 2017 were examined. All histopathological diagnoses were divided into 3 groups as benign, malign and non-neoplastic. Distribution rates of cases with unilateral involvement and cases with bilateral involvement were evaluated by age, gender and years. &#x0D; Results: The average age of 549 patients was 40.12 ± 14.31.The most common histopathological diagnosis was nasal polyp (71%). It was observed that 10.6% of histopathological diagnoses were benign, 0.9% malign and 88.5% non-neoplastic. Right sided involvement was observed in 15.7% of the patients, left sided involvement was in 17.7%, and bilateral involvement was observed in 66.7% of the patients. The group which includes patients with non-neoplastic mass was found to have significantly more bilateral involvement than other groups (p = 0.001).&#x0D; Conclusion: The most common histopathological diagnosis of sinonasal masses is nasal polyps. Nasal polyps are often bilateral but they can also be unilateral. Unilateral sinonasal masses can be malign, therefore differential diagnosis should be made by biopsy.

High CT values relative to the brainstem differentiate inverted papillomas from nasal polyps

ObjectivesA diagnostic indicator for the differentiation of inverted papillomas (IPs) from inflammatory nasal polyps (NPs) has not been established. This study aimed to evaluate whether CT attenuation values relative to those of the brainstem (relative CT number) could be useful for differentiating IPs from NPs. Material and methodsConsecutive patients who were pathologically diagnosed with IP or NP between 2005 and 2019 were retrospectively identified. Relative CT numbers were compared between the two patient groups. The factors with predictive power for differentiating IPs from NPs were identified by univariate and multivariate logistic regression analyses. ResultsOne hundred and twenty-two sinonasal masses were finally analysed (IP, 51 cases; NP, 71 cases). Relative CT numbers were significantly higher in IP than in NP (P < 0.001). Univariate logistic regression analysis showed relative CT number, bone erosion and bone thickening to have predictive value for differentiating IPs from NPs (relative CT number, P < 0.001; bone erosion, p = 0.04; bone thickening, P < 0.001). In the multivariate logistic regression analysis, relative CT number and bone thickening had predictive value for distinguishing IP from NP (relative CT number, p < 0.001; bone thickening, p = 0.02). The optimum cut off value calculation from the area under the receiver operating characteristics curve indicated that a relative CT number >1.3 was significantly associated with IP (sensitivity, 72.6%; specificity, 87.3%). Within cases not showing bone thickening, only the relative CT number was a predictive factor for differentiating IPs from NPs in the univariate analysis. ConclusionsHigh relative CT numbers could potentially indicate IP, and their measurement could provide a basis for differentiating IPs from NPs.

English

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 and the policy of discarding a surgically removed nasal lesion which clinically appears unremarkable should be totally avoided. KEY WORDS Nasal Polyp, Pathology, Sinonasal Carcinoma

A clinicopathological study of nasal andparanasal sinus tumours

Introduction: A variety of benign and malignant tumours involving the nasal cavity and paranasal sinuses (PNS) are commonly encountered in clinical practice. The presenting features and symptomatology of all sinonasal masses are similar. It is impossible to determine clinically what pathology lies underneath. So a detailed history, clinical examination, proper imaging, and thorough histopathologic evaluation are essential to reach a diagnosis. Objectives The purpose of this study was to classify various types of Benign and malignant lesions presenting as nasal and paranasal mass and characterize their clinico-pathological profile in a tertiary care center.&lt;br/&gt; Materials and Methods: This was a prospective study where 120 cases of nasal and paranasal masses were included over a period of 24 months (sep 2013-sep 2015) Clinico-pathological study was carried out in these cases. A provisional diagnosis was made after clinical assessment and radiologic investigations, but final diagnosis was made after histopathologic examination.&lt;br/&gt; Results: The number of benign lesions were more than the malignant lesion, 66.66% versus 33.33% respectively. All age groups were involved and the mean age of presentation was benign tumours 29.5 years and malignant tumours 50.25 years. Male to Female ratio was 3:1 for benign tumours and 1.7:1 for malignant tumours. In our study, among benign lesions the occurrence of Angiofibroma was highest seen in 37.5% cases. In malignant lesions, Squamous cell carcinoma was most common seen in 67.5% cases. Carcinoma nasal cavity was the commonest malignant lesion seen in 70% cases. Nasal obstruction was the most common (91.6%) presenting complaint followed by intermittent epistaxis (69.16%) and nasal discharge (58.3%).&lt;br/&gt; Conclusion: We concluded that for proper evaluation of a sinonasal mass, clinical, radiologic, and histopathologic evaluation should be carried out conjointly in all the cases. Histopathology always gives a confirmatory diagnosis but in few cases immuno-histocytochemistry becomes the ultimate diagnostic technique for correct and timely intervention.

Sinonasal IgG4-related disease: a rare and emerging entity broadening the differential diagnosis in the sinonasal universe.

IgG4-related disease (IgG4-RD) is a multi-organ immune-mediated disorder characterized by fibroinflammatory mass-forming lesions, mimicking malignancy or infection. While well-documented in salivary glands, orbit and thyroid in the head and neck, sinonasal IgG4-RD is rare. Cases of sinonasal IgG4-RD were retrieved, and clinicopathological features reviewed. Seven cases of sinonasal IgG4-RD were identified over a 2-year period, including three males and four females, with an age range of 13-48years(median: 32years). Patients presented with cheek swelling, pain and visual disturbances. Serum IgG4 levels were mildly elevated. Storiform fibrosis, obliterative phlebitis and plasma cell infiltration were seen in varying proportions. Destruction of bone and subepithelialmucoserous glands was present. ALK-1 negativity distinguished from inflammatory myofibroblastic tumor. Sinonasal IgG4-RD expands the growing spectrum of IgG4-RD. A high degree of suspicion is required to include IgG4-RD in differential diagnosis of sinonasal masses, and perform detailed histological and immunohistochemical workup for accurate diagnosis.

Analysis of Disease Patterns in Patients with Unilateral Sinonasal Diseases: A Tertiary Care Hospital Experience.

The aim of the present study was to evaluate the clinicopathological profile of sinonasal masses and to identify features suggestive of neoplastic pathology. A retrospective review of all sinonasal masses in patients attending a tertiary care hospital between April 2019 to Feb 2020 presenting at a tertiary care hospital were analysed. The demographic data, presenting symptoms, radiological and histopathological diagnosis were analysed. In the present study total 23 patients with age ranging from 8 to 72years were analysed. The overall M:F ratio was 1.55:1. Most of the patients (56%) belong to 31-60year age group. The main presenting symptoms were nasal obstruction and rhinorrhoea. Epistaxis and extranasal symptoms like facial pain, dental and orbital complaints were found to be higher in neoplastic conditions. The number of non-neoplastic lesions were more than neoplastic with 78.2% being reported to be antrochoanal polyp and ethmoidal polyps, 8.69% being inverted papillomas and 13% cases were histopathologically reported to be malignant. Neoplastic conditions were significantly commoner in males and in the age group 40-60years. We concluded that clinical, radiologic, and histopathological evaluation is essential for proper diagnosis and stress the importance of immunohistochemistry which is the ultimate diagnostic technique in certain neoplastic lesions.

CLINICAL PROFILE OF PATIENTS WITH SINONASAL MASSES - A CROSS SECTIONAL STUDY

It is challenging to diagnose and distinguish sinonasal masses as they can have varying clinical presentations. This study was done to see if sinonasal masses can be detected by clinical symptoms, signs and examination itself without resorting to investigations. This cross sectional study was conducted in the department of Otolaryngology, Government Medical College Thrissur, Kerala for a period of one year from December 2017 to December 2018. Total 104 cases were studied. Most of the sinonasal masses were identied by doing proper anterior and posterior rhinoscopy which don’t require much expertise to master. This can be considered only as a screening because any intervention should be preceded by radiological investigations and biopsy for a denitive management.