2. Tumours of nasal cavity
Benign Malignant
Squamous papilloma Carcioma
Inverted papilloma -Squamous cell Ca
Schwannoma - Adenocarcinoma
Meningioma Malignant melanoma
Haemangioma Olfactory neuroblastoma
Chondroma Haemangiopericytoma
Angiofibroma Lymphoma
Encephalocele Solitary plasmacytoma
Glioma Various types of sarcoma
Dermoid
3. BENIGN
1. Squamous papilloma :
Verrucous lesions similar to skin warts arise
from the nasal vestibule or lower part of nasal
septum.
Single or multiple, pedunculated or sessile.
Treatment : local excision with cauterisation of
the base.
Cryosrugery
Laser.
4. 2) Inverted papilloma (transitional cell papilloma or
Ringertz tumour)
Microscopically neoplastic epithelium is seen to
grow towards underlying stroma rather than on the
surface.
40-70 years male preponderance (5:1).
Arises from the lateral wall of nose
Always unilateral, red or grey masses
Translucent and oedematous marked tendency to
recur after surgical removal.
Associated with squamous cell carcinoma in 10-
15% of patients.
Treatment : Wide surgical excision by lateral
rhinotomy or medial maxillectomy and en bloc
ethmoidectomy.
5. 3) Pleomorphic adenoma :
Arises from the nasal septum.
Treatment : Wide surgical excision.
4) Schwannoma and meningioma :
Treatment : Surgical excision by lateral
rhinotomy.
Both the above mentioned are rare
tumours
6. 5) Haemangioma :
a) Capillary haemangioma (bleeding polypus of
the septum : Soft, dark red, pedunculated or
sessile tumour arising from anterior part of
nasal septum.
Present with recurrent epistaxis and nasal
obstruction.
Treatment : Local excision with a cuff of
surrounding mucoperichondrium.
b) Cavernous haemangioma : Arises from the
turbinates on the lateral wall of nose.
Treated by surgical excision with preliminary
cryotherapy.
8. 6)Chondroma :
Arise from the ethmoid, nasal cavity or nasal septum.
Treatment is surgical excision.
7)Intranasal Meningoencephlocele :
Herniation of brain tissues and meninges through
foramen caecum or cribriform plate.
Smooth polyp in the upper part of nose between the
septum and middle turbinate.
Seen in Infants and young children. Mass increases in
size on crying or straining.
CT scan is essential to demonstrate a defect in the base
of skull.
Treatment is frontal craniotomy, severing the stalk form
the brain, and repair of dural and bony defect. Intranasal
mass is removed as secondary procedure after cranial
defect has sealed.
9. 8) Gliomas :
Seen in infants and children.
9) Nasal dermoid :
Widening of upper part of nasal septum
with splaying of nasal bones and
hypertelorism.
10. MALIGNANT
1) Carcinoma of nasal cavity :
Primary carcinoma per se is rare. May be an extension of
maxillary or ethmoid carcinoma.
Squamous cell variety, adenoid cystic carcinoma or an
adenocarcinoma.
a. Squamous cell carcinoma : From the vestibule, anterior part of nasal
septum or the lateral wall of nasal cavity. In men past 50 years of age.
i. Vestibular : It arises from the lateral wall of nasal vestibule.
ii. Septal : Arises from mucocutaneous junction. “Nose-picker’s cancer”.
iii. Lateral wall : Site most commonly involved. Easily extends into ethmoid or
maxillary sinuses. Presents as a polypoid mass in the lateral wall of nose.
Treatment : Combination of radiotherapya nd surgery.
b. Adenocarcinoma and adenoid cystic carcinoma. Arises from the
glands of mucous membrane. Involve upper part of the lateral wall of
nasal cavity.
11. 2) Malignant melanoma :
Seen in persons about 50 years of age. Both
sexes equally affected. Grossly, it presents as a
slaty-grey or bluish black polypoid mass. Within
the nasal cavity, most frequent site is anterior
part of nasal septum followed by middle and
inferior turbinate.
Tumour spreads by lymphatics and blood
stream.
Treatment : Wide surgical excision.
3) Olfactory neuroblastoma :
Tumour of olfactory placode. Either sex at any
age group. Cherry red, polypoidal mass in the
upper third of the nasal cavity.
Lymph node or systemic metastases can occur.
Treatment : Surgical excision followed by
radiation.
12. 4) Haemangiopericytoma :
Tumour of vascular origin. Arises from the
pericyte. Age group of 60-70 presents with
epistaxis.
Treatment : Wide surgical excision.
5) Lymphoma :
Rarely a non-Hodgkin lymphoma presents on
the septum.
6) Plasmacytoma :
Males over 40 years.
Treatment : Radiotherapy followed three months
later by surgery if total regression does not
occur.
7) Sarcomas
14. Nasal polypi are non –neopalstic masses
of oedematous nasal or sinus mucosa.
Two main varieties
a) Bilateral ethmoidal polypi
b) Antrochoanal polyp.
15. Bilateral ethmoidal polypi
Etiology : Arise in inflammatory conditions of
nasal mucosa (Rhinosinusitis), disorders of
ciliary motility or abnormal composition of
nasal mucus (cystic fibrosis).
Diseases associated with nasal polypi
i. Chronic rhinosinusitis : Both allergic and non-
allergic origin.
ii. Asthma
iii. Aspirin intolerance : Sampter’s triad-nasal
polypi, asthma and aspirine intolerance.
17. iv. Cystic fibrosis : Due to abnormal mucus.
v. Allergic fungal sinusitis.
vi. Kartagener’s syndrome : Bronchiectasis
sinusitis, situs inversus and ciliary dyskinesis.
vii. Young’s syndrome : Sinopulmonary disease
and azoospermia.
viii. Churg-Strauss syndrome : Asthma, fever,
eosinophilia, vasculitis and granuloma.
ix. Nasal mastocytosis : Chronic rhinitis in which
nasal mucosa is infiltrated with mast cells.
18. Pathogenesis : Nasal mucosa, particularly in the
region of middle meatus and turbinate becomes
oedematous due to collection of extracellular fluid
causing polypoidal change.
Polypi, sessile in the beginning become
pedunculated due to gravity and the excessive
sneezing.
Pathology : Surface of nasal polypi is covered by
ciliated columnar epihtelium.
Later it undergoes a metaplastic change to
transitional and squamous type on exposure to
atmospheric irritation.
Submucosa: large intercellular spaces filled with
serous fluid. Infiltration with esoinophils and round
cells.
Site of origin :
Lateral wall of nose, usually from the middle
meatus.
20. MIGRATION OF EOSINOPHILS (ARROWS) THROUGH THE EPITHELIUM
OF A NASAL POLYP. THE EOSINOPHILS ARE CONCENTRATED
MAINLY BENEATH THE BASAL MEMBRANE
21. Symptoms : Signs :
Mostly seen in adults Anterior rhinoscopy –
Nasal suffiness, total
polypi appear as smooth,
nasal obstruction. glistering, grape-like
masses often pale in
Loss of sense of smell colour.
Headache, sinusitis. Sessile or pedunculated
Sneezing and watery Insensitive to probing, do
nasal discharge due to not bleed on touch.
associated allergy. Multiple and bilateral.
Mass protruding from the
Broadening of nose and
nostril. increased intercanthal
distance.
Nasal cavity may show
purulent discharge due to
associated sinusitis.
22. Diagnosis :
Clinical examination
CT scan of paranasal sinuses to exclude
the bony erosion and expansion
suggestive of neoplasia.
Histological examination of the tissue.
23. Treatment
Conservative :
1. Antihistaminics and control of allergy.
2. A short course of steroids may also be used to prevent
recurrence after surgery.
Surgical :
1. Polypectomy using a Snare, Multiple and sessile polypi
require special forceps.
2. Intranasal ethmoidectomy – when polypi are multiple and
sessile. Uncapping of the ethmoidal air cells by intranasal
route.
3. Extranasal ethmoidectomy – when polypi recur after
intranasal procedures. Approach is through the medial wall
of the orbit by an external incision, medial to medial
canthus.
4. Transantral ethmoidectomy – This is indicated when
infection and polypoidal changes are also seen in the
maxillary antrum.
5. Endoscopic sinus surgery – FESS done with variuos
endoscopes of 0°, 30° and 70° angulation.
24. Antrochoanal polyp ( Killian’s
Polyp)
This polyp arises form the mucosa of
maxillary antrum near its accessory
ostium, comes out of it and grows in the
choana and nasal cavity. Three parts.
i) Antral: Which is a thin stalk.
ii) Choanal : Which is round and globular
iii) Nasal : Which is flat from side to side.
25. Aetiology :
Unknown
Nasal allergy coupled with sinus infection.
Seen in children and young adults.
Usually they are single and unilateral.
Symptoms :
Unilateral nasal obstruction.
Obstruction, bilateral when polyp grows
into the nasopharynx.
Voice thick and dull due to hyponasality.
Nasal discharge, mostly mucoid.
26. Signs :
Anterior rhinoscopy: A smooth greyish
mass covered with nasal discharge. Soft
and can be moved up and down. A large
polyp may protrude from the nostril and
show a pink congested look on its
exposed part.
Posterior rhinoscopy: globular mass filling
choana or the nasopharynx. May hang
down behind the soft palate and present in
the oropharynx.
28. X-rays of paranasal sinuses.
Opacity of the involved antrum.
X-ray, (lateral view) soft tissue nasopharynx a
globular swelling in the postnasal space.
Treatment :
Removed by avulsion either through the nasal or
oral route.
In cases which do recur, Caldwell-Luc operation
may be required to remove the polyp completely
from the site of its origin and to deal with co-existing
maxillary sinusitis.
Endoscopic sinus surgery.
29. Differential diagnosis :
1. A blob of mucus
2. Hypertrophied middle turbinate is
differentiated by its pink appearance and
hard feel of bone on probe testing.
3. Angiofibroma has history of profuse
recurrent epistaxis. Firm in consistency
easily bleeds on probing.
4. Other neoplasms may be differentiated
by their fleshy pink appearance, friable
nature and their tendency to bleed.
30. Differences between antrochoanal and
ethmoidal polypi
Antrochoanal polypi Ethmoidal polypi
Age Common in children Common in adults
Aetiology Infection Allergy or multifactorial
Number Solitary Multiple
Laterality Unilateral Bilateral
Origin Max.sinus near the ostium Ethmoidal sinuses,
uncinate process, middle
turbiante and middle
meatus.
Growth Grows backwards to the Mostly grow anteriorly and
choana may present at the nares
Size & shape Trilobed Usually small and grape
like masses.
31. Antrochoanal Ethmoidal
Polyp Polyp
Trilobed in shape Usually small and grape-
like masses
Recurrence is uncommon Recurrence is common
if removed completely
Treatment: Polypectomy; Treatment: Polypectomy,
endoscopic removal or Endoscopic surgery or
Caldwell-Luc Operation Ethmoidectomy
