Tumors of Nose and Sinuses Types

Tumors Of Nose And Sinuses Types

The benign tumors are:

• Squamous Papilloma 
• Inverted papilloma
• Pleomorphic adenoma
• Schwannoma 
• Meningoma
• Hemangioma
• Chondroma
• Angiofibroma
• Encephalocele
• Glioma
• Dermoid

The Malignant tumors are:

• Squamous cell carcinoma
• Adenocarcinoma
• Malignant melanoma
• Ethesioneuroblastoma
• Hemangiopericytoma
• Lymphoma
• Solitary plasmacytoma

Also Read: Nasal Polyposis: Clinical Types, Pathogenesis and Management

Important Nasal Tumors

• Inverted Papilloma
  • It is a Transition cell papilloma, also called as Ringertz tumor.
  • It develops at Schneiderian membrane of the nasal mucosa and from the lateral wall of the nose and is the most common benign tumor of the nasal cavity. 
  • It can be locally invasive and there is 10-15% risk of development of the malignant change.
  • Males 
  • Associated with HPV 6 and 11 infection
  • It has finger like projections and the unique point is that it grow towards the stroma into reverse direction, hence known as Inverted Papilloma.
  • It has a high recurrence rate.

Diagnosis

• There will be a history of blood stains in the nasal discharge/nasal obstruction.
• On clinical examination there will be a tiny finger like projections arising from the lateral wall of the nose.
• Biopsy is a confirmatory test.
• Histopathological examination shows finger like projections growing towards the stroma.

Treatment

• Medial Maxillectomy - It can be done either via an external approach or endoscopy. External approach is by lateral rhinotomy /midfacial degloving approach.
• Endonasal approach is also called as Endoscopic medial maxillectomy. Incision is made near the lateral wall of the nose and ala and mucosa over them is elevated. Then mucosa of subcutaneous tissue is reflected and lateral wall of the nose and medial wall of the maxilla are removed.

Basal cell Carcinoma/Rodent Ulcer

• Most common malignancy of the skin of the external nose.
• It is caused by prolonged exposure to UV rays.
• It involves the nose and other areas of face.
• The main site of predilection is line joining angle of mouth to ear lobule.
• It is locally aggressive.
• The diagnosis is done by biopsy. The margin of malignancy is resected and sent for a frozen section biopsy. If it is negative then surgical resection is stopped.

Also Read: EPISTAXIS- Anatomy, Classification and Management

Treatment 

• Mohs Microscopic Surgery- The margin of malignancy is resected and sent for a frozen section biopsy. If the frozen biopsy is positive then 2-3mm tissue rim is removed and resent for frozen biopsy. If its still positive then the cycle is continued otherwise the surgery is stopped.

Olfactory Neuroblastoma

• It is also known as Esthesioneuroblastoma and it arises from the olfactory cleft/olfactory neuroepithelium.
• Clinically it is presented as Blood- stained nasal discharge and obstruction. Test for urine catecholamines  is done because it is a neuroendocrine tumor that can secrete hormones.

Treatment

• Surgical resection +/- Radiotherapy
• KADISH classification is used for grading and staging.

1.  Tumors of paranasal sinuses

• The most common type is squamous cell carcinoma and rarely it can be adenocarcinoma and basal cell carcinoma.
• Most common sinus involved is Maxillary sinus.
• Softwood dust predisposes to Squamous cell carcinoma and Hardwood dust predisposes to adenocarcinoma of the ethmoid sinus.
• Clinical features involve Dull pain over sinus, Ipsilateral epiphora, Blood stained nasal discharge and Nasal obstruction.

Diagnosis

• Radiological study should be done before histopathological examination
• The studies include CT scans of nose and paranasal sinuses. MRI to look for involvement of the soft tissues, orbits and base of skull.
• It is advisable to do both CT and MRI with contrast as it helps to delineate the tumor correctly.
• Biopsy and histopathology are confirmatory tests.
• PET/CT scan are done to see the distant metastasis.
• Ohngrens line: It is the line drawn from the medial canthus to the angle of the mandible. This line is used to see the prognostication. Any malignancy above this line shows poor prognosis and anything below is good prognosis.

Treatment

• Surgical : Total Maxillectomy
• Structures to remove in total maxillectomy are:
• Maxillary sinuses
• Lateral wall of the nose
• Ethmoid sinus
• Ipsilateral palate
• Ipsilateral eyeball
• Chemotherapy
• Radiotherapy

Also Read: Olfactory Disorders – Pathway, Work up And Causes

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