Sinonasal Polyps Research Articles

Study on anatomical variations of nose and paranasal sinuses in patients with sinonasal polyposis

Background: Knowledge regarding the sinonasal variations plays an important role in the management of sinonasal diseases. Despite being postulated as one of the risk factors for sinonasal diseases, its role in the pathogenesis of nasal polyp is still unclear. This study was done to determine the prevalence of sinonasal anatomical variations by CT imaging and examine its association with sinonasal polyposis (SNP). Method: A descriptive cross-sectional study was conducted from January, 2019 to January, 2020 at a tertiary care center after receiving ethical approval from the institutional review committee of the hospital. Patients above 17 years of age having sinonasal polyp and not responding to 3-4 weeks of medical treatment were included in the study. Convenience sampling was done. Data were collected and entered in Microsoft excel and analyzed using statistical package for the social sciences version 24.0. Results: Among 72 patients, 86.11% of the patients were found to have anatomical variations of nose and paranasal sinuses with Agger nasi (79.09%) and deviated nasal septum (DNS) (72.5%) being the most common variations noted, 29% of patients were found to have a single variation while multiple variations were seen 70.9% of patients. Conclusions: Our study showed that patients with sinonasal polyps have a higher prevalence of sinonasal anatomical variations and severity of polyp increased with the presence of more than one variation in a patient.

Study of Interleukin 21 Gene Polymorphism in Egyptian Patients with Allergic Rhinitis and Sinonasal Polyps

Study of Interleukin 21 Gene Polymorphism in Egyptian Patients with Allergic Rhinitis and Sinonasal Polyps

The Effect of Three Forms of Local Corticosteroids on Sinonasal Polyposis.

Since sinonasal polyposis (SNP) has a high recurrence rate after surgery, various studies have investigated the effect of corticosteroid medications to prevent disease recurrence. The present study was designed to compare the effect of three forms of local corticosteroids on preventing SNP recurrence post-operatively. This double-blind, randomized clinical trial study was conducted on 108 patients with SNP who underwent functional endoscopic sinus surgery (FESS). Permuted Block Randomization randomly assigned patients into three groups of 36 people: budesonide spray, betamethasone drop, and budesonide nebulizing suspension groups. One and six months after surgery, the patients were evaluated for recurrence of SNP by nasal endoscopy. SNOT 22 questionnaire was used to assess patients' subjective improvement rate pre- and post-operatively. According to the scores obtained in the Modified Lund-Kennedy Scoring, budesonide nebulizing suspension showed better effects on preventing the recurrence of sino-nasal polyps after FESS compared with betamethasone nasal drops. The score was significantly lower in the budesonide nebulizing suspension group compared to the betamethasone drop group (P=0.043). There was no statistically significant difference in the scores between the budesonide nebulizing suspension group and the betamethasone spray group (P=0.178). Also, we observed significant improvement in facial fullness in patients who received Budesonide nebulizing suspension. Budesonide nebulizing suspension, compared to betamethasone nasal drops, showed better effects on preventing the recurrence of SNP after FESS.

Histopathologic study of sinonasal lesions: A hospital based retrospective study, from January 2016 to August 2020

Background: Sinonasal area is a host to various neoplastic and non- neoplastic lesions. The presenting symptoms of sinonasal lesions are similar and pose difficulty for diagnosis based on clinical features and advanced imaging modalities, which makes histopathology the principal diagnostic tool approach for these lesions. The aim of this study is to determine the various histopathologic types of Sinonasal lesions, their classification and relative distribution with regards to age and sex in our setting. Materials and Methods: A retrospective cross-sectional descriptive study conducted on 306 cases of sinonasal lesions over the period from January 2016 to August 2020. All the sinonasal tissues were received and diagnosed at histopathology section of Department of Pathology in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. The Pathology reports were collected from the pathology data archives; and the variables of study were extracted by using a data extraction sheet, and data analysis was done using SPSS version 26.0. Results: Most affected age group was 21-30 years 81(26.5%). Male predominance was observed with M: F ratio of 1.4:1.Nasal cavity was the commonest anatomical site involved 237(77.5%).There were 137(44.8%) Non-neoplastic lesions and 169(55.2%) Neoplastic lesions. Inflammatory Sinonasal Polyps 100(73.0%) were the most common among non-neoplastic lesions; inverted Sinonasal Papilloma 34(41%) the most common among the benign neoplastic and squamous cell carcinoma and nasopharyngeal carcinoma accounting for 21(25.6%) cases each, were the commonest malignant lesions. Conclusion: clinical findings and advanced image modalities can reach to a presumptive diagnosis for the sinonasal lesions but histopathology remains the gold standard for categorizing and diagnosis of non-neoplastic and neoplastic lesions of sinonasal tract.

A Rare Case of Angiomyomatous Nasal Polyp - A Case Report

Introduction and Objective: Angiomatous nasal polyps are distinct variants, constituting only 2%–5% of all sinonasal polyps. The heretofore-reported case of angiomyomatous nasal polyp is a unique entity and is infrequently reported in the literature. Case Report: A 56-year-old male presented with chief complaints of intermittent epistaxis, progressive obstruction of the left nasal cavity, and discharge for 8 months. An endoscopic examination of the nasal cavity was performed, which showed a soft, fleshy polypoid mass in the left lateral wall posterior to the posterior end of the middle meatus with no active bleeding. The clinical findings led to a provisional diagnosis of an antrochoanal polyp, whereas computed tomography gave an impression of an angiomatous polyp, and then the patient was taken up for endoscopically-assisted excision of the nasal mass. The surgery was performed under general anesthesia. Histopathological examination reported it to be an angiomyomatous nasal polyp. The patient’s recovery was uneventful, and follow-up revealed no remission. Conclusion: Angiomyomatous nasal polyps are a unique entity that can be difficult to diagnose with differentials. Endoscopic resection is the treatment of choice, and local recurrence is unlikely.

To Study the Efficacy of Coblation in the Endoscopic Surgery of Sinonasal and Skull Base Masses.

To study the efficacy of coblation in the endoscopic surgery of sinonasal and skull base masses. Prospective Interventional Study. 100 patients with signs and symptoms of nasal obstruction were enrolled for 14 months. On the basis of diagnosis they underwent endoscopic sinus surgery using coblator and their intra-operative blood loss, operation time, post-operative pain threshold using VAS(Visual analogue scale) were enlisted. 80% had Sinonasal polyp followed by Inverted papilloma in 8%, Angiofibroma in 5%, Hemangioma in 3%, Esthesioneuroblastoma in 2% and Rhinosporidiosis in 2%. The Minimum blood loss was 50 ml and Maximum was 600 ml. 30% patients had no pain, 60% had Mild pain and 10% had Moderate pain post procedure. Mean Operation time was 112.86min. Coblation has proven to have reduced operation time, blood loss and faster wound healing. It has now established itself as an essential tool for advance tumours in nasal surgeries.

Nasal polyps and its histopathological classification: A retrospective study

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.

Bilateral antrochoanal polyp: a case report of an extremely rare entity managed conservatively with a review from the past 26 years

We report a rare case of a middle-aged man presenting with nasal obstruction, rhinorrhea, and sleeping disturbances, eventually diagnosed with bilateral ACPs. After confirming the diagnosis with imaging and biopsy studies, the patient was treated conservatively, with marked improvements in his symptoms during 2-3 months of regular follow-ups. A review of the relevant literature regarding the presentation, diagnosis, and outcome of this rare entity is presented, highlighting its controversial etiopathogenesis. Presenting symptoms of ACP in most cases is unilateral progressive nasal obstruction. The occurrence of ACP bilaterally is rarely encountered in clinical practice. Diagnosis is mainly clinical and is achievable via nasal endoscopic examination and supported by computed tomography imaging. Treatment remains to be surgical, with 2 years of regular follow-ups being advised to detect any recurrence. This case report adds to the scarce data pool on bilateral ACPs and highlights the necessity of prudent and timely diagnosis of this uncommon entity to avoid unnecessary investigations and lengthy medical or surgical treatment. Additionally, a trial of medical therapy may provide symptomatic relief for patients who do not qualify for surgery.

Sinonasal angiomatous polyp: a case report

<p>Sinonasal angiomatous polyp (SAP) is a rare variant of sino-nasal polyp. Sinonasal inflammatory polyps are classified histo-pathologically into 5 types: edematous, glandular, fibrous, cystic and angiomatous. They present with various different patterns and clinical features like epistaxis, nasal discharge, nasal blockage and characterised histo-pathologically by presence of prominent dilated capillary-type blood vessels. It constitutes about 4-5% of all nasal polyps. They usually present as a unilateral, painless, soft, gelatinous, translucent and polypoidal mass in nasal cavity. These polyps can grow rapidly and aggressively causing erosion of bone and severe bleeding like a cancerous lesion, making difficult to differentiate it from malignant lesion. Various differential diagnosis of SAP include inflammatory polyp, haemangioma, mucocele, fungus ball, inverted papilloma, juvenile naso-pharyngeal angiofibroma, and malignant tumors like squamous cell carcinoma, adenoid cystic carcinoma, and melanoma MRI is considered better than CT scan for diagnosis. Treatment of choice is endoscopic surgical excision with restoration of sinus drainage.</p><p>.</p>

Clinical characteristics of central compartment atopic disease in Southern China.

Central compartment atopic disease (CCAD) is a newly reported subset of chronic rhinosinusitis. It was considered associated with inhalant antigen. However, CCAD in Chinese population is not fully studied yet. Prospective cohort study. This study aimed to describe the clinical manifestations of CCAD and compared the following two subtypes: sinonasal polyps and concomitant polypoid disease in the central compartment (CRSwNP/CC) and CRSwNP not otherwise specified (CRSwNP NOS). Also, we compared the clinical manifestations of atopy CCAD and non-atopy CCAD. We consecutively enrolled CRSwNP patients without prior sinus surgery, and assessed the nasal endoscopy and computed tomography of the paranasal sinuses. Allergy was confirmed by skin or serum testing. Eosinophilic CRSwNP (ECRS) was considered as tissue eosinophils to total inflammatory cells>10%. We enrolled a total of 116 patients, including 39 with CCAD, 38 with CRSwNP/CC and 39 with CRSwNP NOS. Atopy was detected in 37.1% of the CCAD group, an incidence showing no significant difference from those in the other two groups (37.1% in the CRSwNP/CC group, 31.0% in the CRSwNP NOS group; p=0.846). However, the incidence of ECRS in the CCAD group was the highest among the different groups (97.4% in the CCAD group vs. 67.6% in the CRSwNP/CC group vs. 35.1% in the CRSwNP NOS group; p=0.000). In addition, the incidence of asthma in the CCAD group (33.3%) was significantly higher than that in the CRSwNP NOS group (10.3%), but quite similar to CRSwNP/CC (34.2%). In the subgroup analysis of CCAD, only total serum IgE and sIgE demonstrated significant differences between atopy CCAD and non-atopy CCAD. CCAD in Southern China may associate with asthma and significant eosinophilia, with a lower incidence of systemic allergy based on skin and serum testing.

Predictors and prognosis of respiratory epithelial adenomatoid hamartoma in sinonasal cavities.

ObjectiveRespiratory epithelial adenomatoid hamartoma (REAH) is classified as a histopathologic diagnosis and often identified in sinus surgery for chronic rhinosinusitis (CRS). The purpose of this study was to clarify the frequency and predictors of REAH and prognosis of CRS with REAH in CRS cases.MethodsIn the first study, we histologically reviewed sinonasal polyps and mucosal tissue specimens obtained from patients who underwent endoscopic sinus surgery (ESS) for CRS to reveal how many REAH were involved in ESS cases. We compared REAH and non‐REAH groups in terms of preoperative symptoms and endoscopic, imaging and blood examination findings to elucidate predictors of REAH genesis. In the second study, we compared the data 3 months after surgery such as endoscopic and imaging findings and olfactory test to evaluate prognosis of CRS with REAH.ResultsThe prevalence of REAH was 15.5% of all 304 cases in the first and second studies combined. Higher polyp score in the middle meatus was an independent predictor of the presence of REAH (p = .02). Presence of REAH was significantly associated with the enlargement of olfactory cleft polyps (p < .01), increasing postoperative scores of standard olfactory tests (p = .03), and decline of ratio of improvement (p < .01) measured using T&T olfactometry.ConclusionsHigher polyp score in the middle meatus is an independent predictor of REAH. Olfactory function is difficult to recover after surgery in REAH patients because it is associated with recurrent polyps in the olfactory cleft.

Clinicopathological Challenges in Tumors of the Nasal Cavity and Paranasal Sinuses: Our Experience.

Background and objectiveNasal and paranasal lesions are one of the most common otorhinolaryngological presentations encountered in clinical practice. Common presenting symptoms of these lesion range from nasal blockades, facial swellings, pain, nasal discharge, and epistaxis to orbital and ear symptoms. Diagnosis can be tricky as these symptoms are common in inflammatory conditions and tumors. The aim of our study was to observe the epidemiology and clinical pathological findings in patients with nasal and paranasal masses presenting to our institute and discuss the challenges in proper diagnosis and management due to similar presentations, and the role of histopathological examination (HPE) and immunohistochemistry (IHC) in overcoming these challenges.MethodsThe IPD records of 396 patients were taken up for the study. All the specimens were sent in 10% neutral buffered formalin for examination as biopsy for diagnosis or after surgical excision. After adequate fixation, the biopsy specimen was submitted for routine processing, followed by paraffin embedding, and stained with hematoxylin and eosin (H&E). Special stains like periodic acid-Schiff (PAS) and Ziehl-Neelsen (ZN) stains for acid-fast bacilli (AFB) were used as required. IHC was performed in the required samples. IHC markers were performed on representative paraffin-embedded sections according to the streptavidin-biotin immunoperoxidase technique as needed. The findings were noted, and histology was correlated with clinical presentations and investigations, tabulated, and statistically analyzed using SPSS Statistics (IBM, Armonk, NY).ResultsOf note, 67.92%% were non-neoplastic lesions whereas 18.18% came out to be benign neoplasms and 13.88% were malignant lesions on HPE. Nasal obstruction was the most common presenting symptom (73.23% of patients) followed by nasal mass (64.14% of cases). Inflammatory sinonasal polyps were the most prominent cases in our study, accounting for 41.16% of all lesions; 18.68% fungal RS (mucormycosis) were seen in our study and 4.54% were cases of juvenile nasopharyngeal angiofibroma (JNA). The majority of benign neoplasms encountered were Schneiderian papilloma or inverted papilloma (06.81%). Eighteen (4.54%) cases of squamous cell carcinomas (SCC) were seen in our study and 2.77% (n=11) cases were of adenoid cystic carcinoma. Of 18 cases of SCC, moderately differentiated SCC carcinoma accounted for 10 cases followed by poorly differentiated SCC (5/18) and nonkeratinizing SCC (3/18). IHC for p40 was performed in all the cases of nonkeratinizing SCC, which showed strong and diffuse nuclear positivity.ConclusionThe nasal cavity is the site of the most varied presentation of tumors in the upper respiratory tract. Mass in the nose and paranasal sinus (PNS) form a heterogeneous group of lesions with varied histopathological features. The proximity of the area to the eyes and brain warrants early definitive diagnosis so that the lesion is treated before it can involve important and vital centers. Even though malignant nasal tumors have a very low incidence, they cause a lot of morbidity due to their long course and frequent local recurrences. Nasal tumors tend to become polypoidal. Epithelioid papilloma of the nasal cavity often resembles a nasal polyp. Clinical diagnosis can be challenging due to similar presentations and appearances, and hence histological examination is a vital tool for the timely diagnosis of such patients.

Inflammatory cell distribution accrediting Th2 inflammation in Sinonasal polyp in Indian Population

The pathophysiology of Chronic Rhino-Sinusitis with Nasal Polyposis (CRSwNP) showed distinct ethnic and geographic differences whereas the Western Caucasian population revealed Th2 eosinophilic inflammation in contrary to the Asian Mongolian population with Th1-Th17 non-eosinophilic inflammatory pattern. Prospective Observational study was undertaken from December 2019 to December 2021 on 50 patients who were diagnosed to have sinonasal polyposis. The collected polyp tissue was sent to the histopathological department for further microscopic evaluation. The types of inflammatory cell infiltrate studied in the tissue specimens obtained during surgery included lymphocytes, eosinophils, neutrophils, mast cells, and plasma cells. The age of patients ranged from 11 to 70 years with a mean age of 31.80±17.69 years. The male to female ratio was 1.3:1. The 62% of patients showed the predominance of eosinophil which was of grade III and grade IV category, Lymphocyte infiltrate of grades III and IV was present in 46% of cases, Mast cell was 30% and 10% of grade III and Grade IV respectively, and the Neutrophils were found only in 22% and 105 of cases of grade III &amp; Grade IV, respectively which was the least of all inflammatory cells found in polyp tissue. The cellular predominance was shifted toward the Th2 type of inflammation with the predominance of Eosinophil, Lymphocytes, Plasma cells, and mast cells in the Asian Aryan sub origin population contrary to the Th17 type of inflammation as indicated by the least infiltration of Neutrophils as reported in Asian Mongolian Populations.

Histopathological Study of Lesions of Nasal Cavity and Paranasal Sinuses

Context: The lesions of nasal cavity and paranasal sinuses provides problem in their diagnosis, prognosis and management because of limited anatomical space and certain unusual clinicopathological features. Aims: The present study was undertaken to study the incidence &amp; frequency of various non-neoplastic and neoplastic lesions. It also aimed to describe the histomorphologic features of lesions of nasal cavity and paranasal sinuses. Settings and Design: This is a simple retrospective observational study. Methods and Materials: The material for present study was obtained as excisional biopsy of the lesions. The specimens were received in 10% formalin along with requisition form which also included the clinical data. The material was processed as routine histopathological examination. Special stains were done wherever required. Results: Total 62 cases were analyzed. The lesions were classified as non-neoplastic and neoplastic. The non-neoplastic lesions were classified according to classification given by Friedman and Osborn. Tumors of nasal cavity and paranasal sinus were classified according to WHO classification and observations compared with other studies. Conclusions: Non-neoplastic lesions were more common than neoplastic lesions. Sinonasal polyps were the most common lesions in the present study (50%). The age incidence ranges from 1st decade to 7th decade. There was slight female preponderance. The incidence of malignant tumours was slightly more than the benign tumours. Thus categorizing the sinonasal lesions according to histopathological features into various types helps clinicians to know the clinical presentation, the best management, clinical outcome and prognosis of the disease. Keywords: Histopathology, Nasal, paranasal, Sinonasal, Polyp, WHO

Effectiveness and safety of dupilumab in patients with chronic rhinosinusitis with nasal polyps and associated comorbidities: a multicentric prospective study in real life

BackgroundBiologics are currently one of the main treatment options for a number of diseases. The IgG4 monoclonal antibody dupilumab targets the Interleukin-4 receptor alpha chain, thus preventing the biological effects of the cytokines IL-4 and IL-13, that are essential for the Th2 response. Several controlled trials showed that dupilumab is effective and safe in patients with atopic dermatitis (AD), severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), thus resulting in approval by regulatory agencies. Aim of the study was to evaluate the efficacy and safety of dupilumab in adult patients with CRSwNP stratified by common overlapping comorbid conditions.MethodsWe performed a multicenter, observational, prospective study enrolling adult patients with severe CRSwNP who had started dupilumab treatment in the context of standard care from January 2021 to October 2021. Data were collected from twentynine Italian secondary care centers for allergy and clinical immunology, all of which were part of the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). A number of efficacy parameters were used. Patient data were compared using the Wilcoxon test for paired data. All statistical analyses were performed with SPSS version 20 (IBM, Armonk, NY, USA).ResultsIn total, 82 patients with nasal polyposis were identified. A significant improvement was detected for all the applied efficacy parameters, i.e. 22-item Sino-Nasal Outcome Test (SNOT-22) and bilateral endoscopic nasal polyp score (NPS) scores for CRSwNP, Rhinitis Control Scoring System (RCSS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores for allergic perennial rhinitis, Forced Expiratory Volume in the 1st second (FEV1) and Asthma Quality of Life Questionnaire (AQLQ) scores for asthma, Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI) scores for AD. A non-significant improvement was also obtained in the Urticaria Activity Score over 7 days (UAS7) for chronic spontaneous urticaria. Treatment with dupilumab was well tolerated.ConclusionsThese data suggest that dupilumab treatment in patients suffering from CRSwNP and associated comorbidities may be suitable. Such outcome, although confirmation by trials is warranted, suggests the possibility to treat different disorders with a single therapy, with favorable effects especially under the cost-effectiveness aspect.

Clinicopathological analysis of sinonasal lesions

The sinonasal tract is exposed to a variety of infections, chemical irritants, antigens and trauma giving rise to diverse inflammatory as well as neoplastic lesions. The aim was to study the clinicopathological profile of lesions of nose and paranasal sinuses in this area of western Maharashtra. The study included 59 biopsies/resection specimens received in the department during Jan 2015 to June 2019. Clinical and pathological details were analysed. There were 33 females and 26 males. Out of 59 cases, 46 were nonneoplastic and 13 neoplastic, with 10 benign and three malignant. The most common nonneoplastic lesion was sinonasal polyp (42 cases). Other nonneoplastic lesions included three cases of mucormycosis and one case of rhinosporidiosis. In the benign neoplasms, there were three cases of hemangiomas, two hamartomas, two inverted papillomas with one case each of hidradenoma, angiofibroma and schwannoma. We had three malignant tumors, one case each of, melanoma, poorly differentiated carcinoma and squammous cell carcinoma. Nonneoplastic lesions were much more common than neoplastic ones in the sinonasal tract. Histopathological examination plays an important role in correct diagnosis and management.

Prospective Study to Evaluate the Role of Multidetector Computed Tomography in Evaluation of Paranasal Sinus Pathologies

Background: The use of computed tomography (CT) combined with functional endoscopic sinus surgery (FESS) has empowered the modern sinus surgeon to treat patients more effectively, facilitating reduced morbidity and complications. This study aimed to evaluate the role of multidetector computed tomography (MDCT) in the evaluation of paranasal sinus pathologies.Materials & Methods: This cross-sectional study was conducted among the adult subjects attending the department of radiology at a tertiary care center in Lucknow for CT scan of paranasal sinuses for suspected paranasal sinus pathology from August 2018 to January 2020. The study included subjects above 12 years of age visiting the facility for CT of paranasal sinuses with a suspected paranasal sinus pathology and were also undergoing FESS.Results: A total of 74 patients falling in the sampling frame were enrolled in the study. Majority of cases were aged <40 years (n=41; 55.4%). Age group of 21-30 years was most affected (24.3%). Mean age of patients was 38.39±14.48 years. Inflammatory pathologies diagnosed on MDCT-included sinusitis (n=25), sinonasal polyps (n=17), sinusitis with polyps (n=15), and mucocele (n=2), respectively. FESS/histopathological diagnosis was done in 73 cases and revealed inflammatory pathology in 59/73 (80.8%) and neoplastic pathology in 14 (19.2%) cases. FESS/histopathological break up of inflammatory pathologies included 22 cases of sinusitis, 20 cases of sinonasal polyps, 14 cases of sinusitis with polyps, and three cases of mucocele. Agreement between MDCT and final diagnosis was seen in 67/74 (90.5%) cases assessed.Conclusion: The findings of the present study showed that MDCT is a useful modality for preoperative assessment of paranasal sinuses. With its high precision in diagnosis, it can help in further treatment planning and management in patients with paranasal sinus pathologies.

Immunolocalization of CD1a expressing dendritic cells in sinonasal polyposis

ABSTRACT Sinonasal polyps are benign projections of edematous nasal mucosa lined by respiratory epithelium. Langerhans cells (LCs) belonging to the dendritic cell family located in respiratory epithelium are involved in antigen presentation and maintenance of local immunological homeostasis. This study aims to elucidate the morphology and distribution of CD1a positive LCs in normal nasal mucosa and compare the same with polypoid nasal mucosa by immunohistochemistry. Normal nasal mucosa (n = 20) was obtained from patients who underwent septoplasty for deviated nasal septum. Polypoid nasal mucosa (n = 22) was obtained from patients with chronic rhinosinusitis (CRS) or allergic fungal rhinosinusitis who underwent excision of nasal polyps. The tissues obtained were processed for immunohistochemistry and stained with CD1a-EP80 Rabbit monoclonal antibody. In the tissues studied, CD1a positive LCs were observed in both the epithelium and lamina propria. Different morphological subtypes of LCs were noted in the epithelium. The cells were distributed adjacent to walls of subepithelial capillaries and cysts. The median number of CD1a positive LCs was significantly higher in polypoid category (13.5 per mm2) as compared with normal nasal mucosa (2.5per mm2) (p = .001). Presence of CD1a positive LCs in polypoid nasal mucosa hints at a critical immunological role in the etiopathogenesis of nasal polyps.

Angiomatous Nasal Polyp: The Great Emulator-A Case Report.

Angiomatous nasal polyps are rare, benign and non-neoplastic lesions rarely reported in literature. Clinically and radiologically it mimics sinonasal neoplasm. In 5% of inflammatory or allergic sinonasal polyps, extensive vascularisation and ectasia with pseudoamyloid deposition is noted. Pathognomic features of ANP are angiogenesis, accumulation of amorphous eosinophilic substance and atypical stromal cells. In this case report we elaborate probable etiology, clinical features, histopathology (HPE) and radiological findings in a unique case of ANP which mimicked sinonasal mass. Patient presented with U/L nasal obstruction and recurrent episodes of epistaxis. He was operated for similar complaints 8years ago, details of which were not available with the patient. Patient was recently diagnosed with Hypertension (HTN) and Diabetes Mellitus (DM). On Diagnostic Nasal endoscopy and Radiological imaging, the nasal mass appeared to be a sinonasal vascular lesion. Revision Functional endoscopic sinus surgery was done and on HPE, ANP was reported. Thus, we conclude that ANPs are rare pathological entity and can cause a significant diagnostic dilemma. Thorough knowledge about the clinical presentation and histopathological features is important in establishing an early definitive diagnosis. Also we have made an attempt to establish the possible role of DM and HTN in pathophysiology of ANP.

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