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

Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.

An unusual presentation of neuroglial heterotopia: case report

We report a rare case of nasopharyngeal neuroglial heterotopia in a 16-year-old girl who presented with sore throat and feeling of a lump in her throat. Neuroglial heterotopia is a mass composed of misplaced neural tissue during embryonic development which has lost its intracranial connection. A careful review of literature in PUBMED shows most of the previously reported cases of nasopharyngeal glial heterotopia presented during neonatal or infancy period with symptoms of respiratory distress or airway obstruction. Our case caused a diagnostic dilemma due to late presentation and atypical radiological findings. Imaging, especially MRI, is vital for evaluating such nasopharyngeal masses in children for pre-surgical planning and more importantly to rule out any intracranial communication. Treatment is surgical resection by endoscopic or external approach, with a rare possibility of recurrence.

Oncocytic Cysts of the Nasopharynx: A Case Report

Background Nasopharyngeal oncocytic lesions are a spectrum of benign lesions that represent a reactive or hyperplastic response to chronic inflammation. Though oncocytic lesions are typically asymptomatic, unilateral, and benign, this article discusses a rare case of large, bilateral oncocytic cysts and downstream otologic sequelae with a focus on identifying and discussing similar disease processes. Methods Case report and literature review. Case Presentation: A 67-year-old patient with 57 pack year smoking history presented for one year of left sided hearing loss and aural fullness. Clinic endoscopic exam demonstrated severe inflammatory and cystic changes lining the bilateral tori. Imaging and tissue sampling confirmed the cause was minor salivary gland cysts with papillary projections lined by oncocytic cells within bilateral tori tubarius. He was successfully treated with myringotomy with pressure equalizing tube, counseling on tobacco cessation, and surveillance with serial nasopharyngoscopy. Conclusions Chronic eustachian tube dysfunction is a possible rare presentation and sequelae of large oncocytic cysts of the nasopharynx. Oncocytic cysts should be considered on the differential diagnosis for nasopharyngeal masses causing such dysfunction.

Histopathological Profile of Nasal Cavity, Paranasal Sinuses, and Nasopharyngeal Masses in Hill State of Himachal Pradesh, India

ABSTRACT Introduction: Nasal masses are common finding in the ear, nose, and throat outpatient department. Most patients present with complaints of nasal obstruction. A sinonasal mass can have various differential diagnoses. They may be congenital, inflammatory, neoplastic (benign or malignant), or traumatic in nature. A careful histopathological examination is necessary to decide the nature of any particular lesion. Materials and methods: The retrospective study was carried out between January 2011 and December 2013. A total of 185 cases diagnosed with masses of the nasal cavity, paranasal sinuses, and nasopharynx were included. Data from histopathological records were retrieved to confirm the diagnosis. Observations: Among 185 cases, 75% were non-neoplastic and 25% were neoplastic. Among neoplastic masses, 57% were benign and 43% were malignant. The age of presentation ranged from first to eighth decade of life (mean age 37.74 years). The lesions had a stronger predilection for males (1.68:1). Among non-neoplastic lesions, nasal polyp was the commonest lesion followed by ethmoidal mucocele (1.44%) and lupus vulgaris (0.72%). Among benign lesions, inverted papilloma (30.77%) and nasopharyngeal angiofibroma (30.77%) were the commonest followed by capillary hemangioma (15.38%), osteoma (7.68%), nasopharyngeal lymphoepithelioma (3.85%), chondroma (3.85%), pleomorphic adenoma (3.85%), and schwannoma (3.85%). Squamous cell carcinoma (40%) was the commonest malignant neoplastic lesion observed followed by adenoid cystic carcinoma (20%), malignant melanoma (15%), nasopharyngeal carcinoma (10%), esthesioneuroblastoma (10%), and non-Hodgkin lymphoma (5%). Conclusion: Among the noninflammatory lesion, nasal polyp is the commonest lesion. Nasal polyps are more common in hilly area may be due to exposure to pine pollens. There is no difference in the histopathological profile of benign and malignant lesions. How to cite this article: Guleria TC, Mohindroo S, Mohindroo NK, Azad RK, Kumar A. Histopathological Profile of Nasal Cavity, Paranasal Sinuses, and Nasopharyngeal Masses in Hill State of Himachal Pradesh, India. Clin Rhinol An Int J 2017;10(2):93-98.

Malignancy mimicking Juvenile Nasopharyngeal Angiofibroma

ABSTRACT Nasopharyngeal masses in young males can be benign or malignant. As the treatment regimen for these masses differs considerably, it is crucial to differentiate benign from malignant masses for successful and adequate treatment of patients and also for minimizing morbidity from unnecessary interventions. We are presenting two case reports of patients with nasopharyngeal carcinoma (NPC) mimicking juvenile nasopharyngeal angiofibroma (JNA). Both the cases were presumed as JNA and underwent excessive surgical intervention only to reveal NPC on final histopathology report. We wish to highlight the importance of complete clinical examination and preoperative imaging in differentiating an ideal management of nasopharyngeal masses. How to cite this article Kaur N, Tiwana H, Sawhney S, Gupta AK. Malignancy mimicking Juvenile Nasopharyngeal Angiofibroma. Clin Rhinol An Int J 2017;10(2):99-102.

To study the immunohistochemical profile of sinonasal and nasopharyngeal masses

<p>Introduction: Sinonasal and nasopharyngeal tract masses can be difficult to diagnose as they have unusual diverse morphology and histopathology with anatomic and embryonic distinction and immunohistochemistry (ICH) becomes mandatory for diagnosis. Aims and Objectives: A retrospective observational study of 5 years from 2011 to 2016 till date was conducted at a tertiary care center. Total analyses of 200 cases were done to study the clinical presentation and histomorphology of all sinonasal and nasopharyngeal masses with gender and age distribution and highlightling the entities with rare clinicopathological and histological presentation and study of ICH in these lesions. Results: Out of total 200 cases, 148 (74%) were inflammatory or infective non-tumorous masses and 52 (26%) were neoplastic, out of which 27 (13.5%) were benign and 25 (12.5%), were proven to be of malignant etiology. In benign neoplastic category, unusual entities were juvenile angiofibroma, meningioma, and hemangioma. Among the cases with atypical clinicopathological presentation and unusual entities which required ICH for diagnosis were chordoma, diffuse large B-cell lymphoma, esthesioneuroblastoma, sinonasal adenocarcinoma, adenoid cystic carcinoma, and nasopharyngeal carcinomas. Conclusion: Sinonasal and nasopharyngeal masses are having diverse clinical presentations at different sites having unusual clinical presentation and varied histopathology and the unusual varieties also occur which rare to these locations and should be promptly diagnosed with ICH for early, accurate and optimal treatment.</p>

A clinicopathological study of masses of nasal cavity paranasal sinuses and nasopharynx

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">A variety of inflammatory, non neoplastic and neoplastic masses involving nasal cavity, paranasal sinuses and nasopharynx are commonly encountered in ENT clinics. The objective was to study the demographic profile, clinical presentation, radiological findings and its correlation with the histopathological findings of masses of nasal cavity, paranasal sinuses and nasopharynx. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The study was conducted on patients having sinonasal and nasopharyngeal masses admitted in dept of ENT, GMC, Patiala from August 2014 to July 2016. The study was designed to evaluate demographic distribution, clinicopathological features, radiological findings of sinonasal and nasopharyngeal masses and to evaluate the correlation of clinical and radiological findings with histopathological diagnosis. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Analysis of 50 cases of masses in nasal cavity, paranasal sinuses and nasopharynx was done. Male to female ratio was 1.38:1. The commonest site was nasal cavity followed by paranasal sinuses. Nasal polyp was the most common non-neoplastic lesion. Among the neoplastic lesions studied, inverted papilloma was the most common benign lesion and squamous cell carcinoma was the most common malignant lesion observed. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">For proper evaluation of sinonasal and nasopharyngeal masses, clinical, radiological and histopathological evaluation should be done in all patients. Although radiology provides a road map to endoscopic surgeons for any existing or impending complications but histopathology always gives a confirmatory diagnosis.</span></p>

Nasopharyngeal non-intestinal-type adenocarcinoma: a case report and updated review of the literature

Background Non-intestinal-type adenocarcinoma is a malignancy traditionally found in the sinonasal cavity. To our knowledge, this case is the first reported of this rare condition originating in the nasopharynx.Case Presentation A 67-year-old woman with nasopharyngeal non-intestinal-type adenocarcinoma, with an accompanying parapharyngeal mass received primary radiation treatment for both lesions. Her tumour subsequently persisted, with a concomitant conversion in pathology from a low- to a high-grade malignancy.Results Non-intestinal-type and intestinal-type adenocarcinomas of the nasopharynx are extremely rare tumours and do not appear in the World Health Organization classification system. We review the pathophysiologic features of these malignancies and propose modifications to the current classification system.Conclusions Non-intestinal-type adenocarcinoma should be included in the differential diagnosis of nasopharyngeal masses. In our experience, this tumour in this location showed a partial response to primary radiation but later converted from a low- to a high-grade adenocarcinoma.