Difference between revisions of "Nasal polyps"

Latest revision as of 22:30, 9 October 2021

Nasal polyps are a common head and neck lesion. They are typically benign but may be malignant.

Overview

DDx (benign - multiple):^[1]

Autoimmune/idiopathic:
- Asthma.
- Allergic rhinitis.
- Churg-Strauss syndrome (AKA allergic granulomatous angiitis).
  - Features: asthma, eosinophilia, granulomatous inflammation, necrotizing systemic vasculitis, and necrotizing glomerulonephritis.^[2]
- Nonallergic rhinitis with eosinophilia syndrome (NARES).
Infectious:
- Fungal infection (with allergic component - AFS = allergic fungal sinusitis).
- Chronic rhinosinusitis.
Genetic:
- Primary ciliary dyskinesia.
- Cystic fibrosis.
Associations:
- Alcohol intolerance ~ 50%.
- Aspirin intolerance - upto ~ 25%.
Tumours:
- Juvenile nasopharyngeal angiofibroma - young males.
- Nasopharyngeal carcinomas.
- Sarcomas.
- Hemangioma.
- Schneiderian papilloma.
- Other.

Memory devices:

GAIT = Genetic, Allergic/idiopathic, Infectious, Tumours.
Allergic causes As - allergic, asthma, allergic granulomatous angiitis (Churg-Strauss syndrome), nonallergic rhinitis with eosinophilia.

Epidemiology

More commonly assoc. with nonallergic conditions.^[1]

Treatment

Recurrent polyps: functional endoscopic sinus surgery (FESS).

Inflammatory polyps with neutrophils

General

Histologic findings are non-specific; DDx includes:^[3]
- Cystic fibrosis.
- Primary ciliary dyskinesia syndrome.
- Young syndrome

Microscopic

Features:

Neutrophil predominant.
Edema.
+/-Mucus-impaction (dilated glands with mucus).
- Suggestive of cystic fibrosis.^[4]

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A. Nasal sinus tissue, right, excision:
- Inflamed edematous sinonasal mucosa with abundant neutrophils.
- Negative for malignancy.

B. Nasal sinus tissue, left, excision:
- Inflamed edematous sinonasal mucosa with abundant neutrophils and fragments of bone.
- Negative for malignancy.

Alternate

A. Contents of Left Ethmoid Sinus, Excision:
     - Mildly inflamed sinonasal mucosa with bone and fibrous tissue.
     - NEGATIVE for malignancy.

B. Contents of Right Ethmoid Sinus, Excision:
     - Mildly inflamed sinonasal mucosa with bone and fibrous tissue.
     - NEGATIVE for malignancy.

Allergic nasal polyp

General

People with allergies.
- Same type of polyps seen in those without allergies.^[5]

Gross

Polypoid mass - several millimetres to centimetres in size.
- Translucent.^{[citation needed]}

Microscopic

Features:^[6]

Normal respiratory epithelium.
Stroma with:
- Edema.
- Eosinophils.
- +/-Other inflammatory cells (plasma cells, lymphocytes, neutrophils).

DDx:

Inflammatory nasal polyp with abundant neutrophils.
Vasculitis.
- Wegener's granulomatosis.
- Churg-Strauss syndrome.
Biphenotypic sinonasal sarcoma - has hypercellular stroma.

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A. Left Nasal Polyp, Excision:
- Inflamed edematous sinonasal mucosa with abundant eosinophils.
- NEGATIVE for malignancy.

B. Right Nasal Polyp, Excision:
- Inflamed edematous sinonasal mucosa with abundant eosinophils and fragments of bone.
- NEGATIVE for malignancy.

A. Nasal sinus tissue, right, excision:
- Inflamed edematous sinonasal mucosa with abundant eosinophils.
- Negative for malignancy.

B. Nasal sinus tissue, left, excision:
- Inflamed edematous sinonasal mucosa with abundant eosinophils and fragments of bone.
- Negative for malignancy.

Block letters

A. NASAL SINUS TISSUE, RIGHT, EXCISION:
- INFLAMED EDEMATOUS SINONASAL MUCOSA WITH ABUNDANT EOSINOPHILS.
- NEGATIVE FOR MALIGNANCY.

B. NASAL SINUS TISSUE, LEFT, EXCISION:
- INFLAMED EDEMATOUS SINONASAL MUCOSA WITH ABUNDANT EOSINOPHILS AND FRAGMENTS OF BONE.
- NEGATIVE FOR MALIGNANCY.

Schneiderian papilloma

AKA Schneiderian polyp.
AKA sinonasal papilloma.^[7]

General

Lumpers vs. splitters debate about whether it is one entity or three.^[8]

Subclassification:^[8]

Inverted (Schneiderian) - most common ~60-65%.
Fungiform (Schneiderian) - less common ~30-35%.
Oncocytic (Schneiderian) - least common ~5%.

Inverted

AKA inverted papilloma.^[9]
Usually lateral wall (as the septum as little soft tissue to grow into).^[8]
May transform to carcinoma.

Fungiform

AKA exophytic papilloma, AKA septal papilloma.^[8]
Low risk of malignant transformation.

Oncocytic

AKA cylindrical cell papilloma.^[10]
Lateral nasal wall.^[8]

Microscopic

Inverted Schneiderian papilloma

Features:^[8]

Well-demarcated epithelial islands in the stroma.
Squamous +/-surface keratinization or respiratory type epithelium (with cilia).
+/-Neutrophils.
+/-Goblet cells.

Notes:

May mimic invasive SCC.

Images

Inverted papilloma & verrucous carcinoma (upmc.edu).

Schneiderian papilloma - very low mag. (WC)
Schneiderian papilloma - very high mag. (WC)

Fungiform Schneiderian papilloma

Features:

Exophytic growth pattern - key feature.

Oncocytic Schneiderian papilloma

Features:

Oncocytes - key feature.
Exophytic or endophytic growth pattern.

Antrochoanal polyp

Abbreviated ACP.

General

Benign.^[11]
Relative common ~5% of nasal polyps.^[12]

Epidemiology:

"Almost always" recur if incompletely excised.^[12]
Originates from maxillary sinus and extends to choana.^[13]

Microscopic

Features:^[14]

Respiratory epithelium.
Relatively pauciglandular - when compared to inflammatory nasal polyps.
Typically few eosinophils.

DDx:

Inflammatory nasal polyps.

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Ethmoid Sinus Contents (Right), Excision:
     - Benign nasal polyp (antrochoanal type) and mildly inflamed sinonasal mucosa.
     - NEGATIVE for malignancy.

References

↑ ^1.0 ^1.1 URL: http://emedicine.medscape.com/article/994274-overview. Accessed on: 16 March 2011.
↑ http://emedicine.medscape.com/article/333492-overview
↑ URL: http://emedicine.medscape.com/article/994274-diagnosis. Accessed on: 16 March 2011.
↑ Beju D, Meek WD, Kramer JC (April 2004). "The ultrastructure of the nasal polyps in patients with and without cystic fibrosis". J. Submicrosc. Cytol. Pathol. 36 (2): 155–65. PMID 15554502.
↑ Davidsson, A.; Hellquist, HB. (1993). "The so-called 'allergic' nasal polyp.". ORL J Otorhinolaryngol Relat Spec 55 (1): 30-5. PMID 8441521.
↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 144. ISBN 978-1416002741.
↑ URL: http://emedicine.medscape.com/article/862677-overview. Accessed on: 19 November 2011.
↑ ^8.0 ^8.1 ^8.2 ^8.3 ^8.4 ^8.5 Barnes L (March 2002). "Schneiderian papillomas and nonsalivary glandular neoplasms of the head and neck". Mod. Pathol. 15 (3): 279–97. doi:10.1038/modpathol.3880524. PMID 11904343. http://www.nature.com/modpathol/journal/v15/n3/full/3880524a.html.
↑ Vrabec, DP. (May 1994). "The inverted Schneiderian papilloma: a 25-year study.". Laryngoscope 104 (5 Pt 1): 582-605. PMID 8189990.
↑ Bravo Domínguez, O.; Vela Cortina, M.; Ramírez Ruiz, RD.; Ros Vergara, A.; Dinarés Jaumeandreu, D.; Encina Ruiz, L.; Arias Cuchí, G.; Ardíaca Bosch, MC. et al. (2005). "[Oncocytic schneiderian papilloma. A case report].". An Otorrinolaringol Ibero Am 32 (2): 115-23. PMID 15929584.
↑ Maldonado M, Martínez A, Alobid I, Mullol J (December 2004). "The antrochoanal polyp". Rhinology 42 (4): 178–82. PMID 15626248.
↑ ^12.0 ^12.1 Frosini P, Picarella G, De Campora E (February 2009). "Antrochoanal polyp: analysis of 200 cases". Acta Otorhinolaryngol Ital 29 (1): 21–6. PMC 2689564. PMID 19609378. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689564/.
↑ Balikci HH, Ozkul MH, Uvacin O, Yasar H, Karakas M, Gurdal M (May 2013). "Antrochoanal polyposis: analysis of 34 cases". Eur Arch Otorhinolaryngol 270 (5): 1651–4. doi:10.1007/s00405-012-2274-2. PMID 23179936.
↑ Min YG, Chung JW, Shin JS, Chi JG (July 1995). "Histologic structure of antrochoanal polyps". Acta Otolaryngol 115 (4): 543–7. doi:10.3109/00016489509139364. PMID 7572133.

[emedicine994274-1] 1.0 ^1.1 URL: http://emedicine.medscape.com/article/994274-overview. Accessed on: 16 March 2011.

[emedicine333492-2] ttp://emedicine.medscape.com/article/333492-overview

[emedicine994274dx-3] URL: http://emedicine.medscape.com/article/994274-diagnosis. Accessed on: 16 March 2011.

[pmid15554502-4] Beju D, Meek WD, Kramer JC (April 2004). "The ultrastructure of the nasal polyps in patients with and without cystic fibrosis". J. Submicrosc. Cytol. Pathol. 36 (2): 155–65. PMID 15554502.

[pmid8441521-5] Davidsson, A.; Hellquist, HB. (1993). "The so-called 'allergic' nasal polyp.". ORL J Otorhinolaryngol Relat Spec 55 (1): 30-5. PMID 8441521.

[6] Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 144. ISBN 978-1416002741.

[7] URL: http://emedicine.medscape.com/article/862677-overview. Accessed on: 19 November 2011.

[pmid11904343-8] 8.0 ^8.1 ^8.2 ^8.3 ^8.4 ^8.5 Barnes L (March 2002). "Schneiderian papillomas and nonsalivary glandular neoplasms of the head and neck". Mod. Pathol. 15 (3): 279–97. doi:10.1038/modpathol.3880524. PMID 11904343. http://www.nature.com/modpathol/journal/v15/n3/full/3880524a.html.

[pmid8189990-9] Vrabec, DP. (May 1994). "The inverted Schneiderian papilloma: a 25-year study.". Laryngoscope 104 (5 Pt 1): 582-605. PMID 8189990.

[10] Bravo Domínguez, O.; Vela Cortina, M.; Ramírez Ruiz, RD.; Ros Vergara, A.; Dinarés Jaumeandreu, D.; Encina Ruiz, L.; Arias Cuchí, G.; Ardíaca Bosch, MC. et al. (2005). "[Oncocytic schneiderian papilloma. A case report].". An Otorrinolaringol Ibero Am 32 (2): 115-23. PMID 15929584.

[pmid15626248-11] Maldonado M, Martínez A, Alobid I, Mullol J (December 2004). "The antrochoanal polyp". Rhinology 42 (4): 178–82. PMID 15626248.

[pmid19609378-12] 12.0 ^12.1 Frosini P, Picarella G, De Campora E (February 2009). "Antrochoanal polyp: analysis of 200 cases". Acta Otorhinolaryngol Ital 29 (1): 21–6. PMC 2689564. PMID 19609378. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689564/.

[pmid23179936-13] Balikci HH, Ozkul MH, Uvacin O, Yasar H, Karakas M, Gurdal M (May 2013). "Antrochoanal polyposis: analysis of 34 cases". Eur Arch Otorhinolaryngol 270 (5): 1651–4. doi:10.1007/s00405-012-2274-2. PMID 23179936.

[14] Min YG, Chung JW, Shin JS, Chi JG (July 1995). "Histologic structure of antrochoanal polyps". Acta Otolaryngol 115 (4): 543–7. doi:10.3109/00016489509139364. PMID 7572133.

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@@ Line 182: / Line 182: @@
 ===General===
 *Benign.<ref name=pmid15626248>{{cite journal |authors=Maldonado M, Martínez A, Alobid I, Mullol J |title=The antrochoanal polyp |journal=Rhinology |volume=42 |issue=4 |pages=178–82 |date=December 2004 |pmid=15626248 |doi= |url=}}</ref>
-*Relative common ~5% of nasal polyps.<ref name=pmid19609378>{{cite journal |vauthors=Frosini P, Picarella G, De Campora E |title=Antrochoanal polyp: analysis of 200 cases |journal=Acta Otorhinolaryngol Ital |volume=29 |issue=1 |pages=21–6 |date=February 2009 |pmid=19609378 |pmc=2689564 |doi= |url=}}</ref>
+*Relative common ~5% of nasal polyps.<ref name=pmid19609378>{{cite journal |authors=Frosini P, Picarella G, De Campora E |title=Antrochoanal polyp: analysis of 200 cases |journal=Acta Otorhinolaryngol Ital |volume=29 |issue=1 |pages=21–6 |date=February 2009 |pmid=19609378 |pmc=2689564 |doi= |url=}}</ref>
 Epidemiology:
@@ Line 200: / Line 200: @@
 <pre>
 Ethmoid Sinus Contents (Right), Excision:
-      - Benign nasal polyp (antrochonanal type) and mildly inflamed sinonasal mucosa.
+      - Benign nasal polyp (antrochoanal type) and mildly inflamed sinonasal mucosa.
       - NEGATIVE for malignancy.
 </pre>

Difference between revisions of "Nasal polyps"

Latest revision as of 22:30, 9 October 2021

Contents

Overview

Epidemiology

Treatment

Inflammatory polyps with neutrophils

General

Microscopic

Sign out

Alternate

Allergic nasal polyp

General

Gross

Microscopic

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Block letters

Schneiderian papilloma

General

Inverted

Fungiform

Oncocytic

Microscopic

Inverted Schneiderian papilloma

Images

Fungiform Schneiderian papilloma

Oncocytic Schneiderian papilloma

Antrochoanal polyp

General

Microscopic

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See also

References

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