Diagnostic challenges in malignant tumors of nasal cavity and paranasal sinuses

Presentation of Rarely Occurring Inverted Squamous Papilloma of Nasal Cavity: A Case Report

This report presents a case of a rarely occurring inverted squamous papilloma, which shows papillary proliferation in squamous epithelium. Inverted papillomas (IPs) are benign epithelial growths that occur in the underlying stroma of the nasal cavity and paranasal sinuses. While viral infections, allergies, and chronic sinusitis have all been proposed as potential causes, the pathophysiology of this lesion is still unknown. Most of the time, IP reflects residual disease, yet the recurrence rates are extremely high. A 60-year-old male patient has chief complaints of right-sided nasal congestion and excessive sneezing and discharge from the nose, which cause discomfort to the patient and make him unable to sleep at night. Computed tomography reveals both the enlargement of the osteomeatal complex and soft-tissue density opacification of the right side of the nasal cavity. The only way to diagnose this type of squamous papilloma is through histopathological examination. In this work, we evaluated the histological characteristics of sinonasal IP and presented a case report of an uncommon instance of inverted squamous papilloma of the nasal cavity.

[Interdisciplinary Management of Orbital Diseases]

Diagnosis and therapy of orbital diseases is an interdisciplinary challenge, in which i.e. otorhinolaryngologists, ophthalmologists, radiologists, radiation therapists, maxillo-facial surgeons, endocrinologists, and pediatricians are involved. This review article describes frequent diseases which both, otolaryngologists and ophthalmologists are concerned with in interdisciplinary settings. In particular the inflammatory diseases of the orbit including orbital complications, autoimmunological diseases of the orbit including Grave´s orbitopathy, and primary and secondary tumors of the orbit are discussed. Beside describing the clinical characteristics and diagnostic steps the article focusses on the interdisciplinary therapy. The review is completed by the presentation of most important surgical approaches to the orbit, their indications and possible complications. The authors tried to highlight the relevant facts despite the shortness of the text.

Understanding frozen section histopathology in Sinonasal and anterior skull base malignancy and proposed reporting guidelines

BACKGROUND

Intraoperative frozen section histopathology (IFSH) in sinonasal and skull base surgery although widely used is not well studied.

METHODS

We reviewed a database of sinonasal and anterior skull base tumors, between 1973 and 2019, and identified 312 suitable operative cases. Clinicopathologic data was collected and analyzed, in addition to descriptive data for histopathological reports classified as "ambiguous," or "limited/insufficient-quality/quantity."

RESULTS

Overall, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for IFSH were 90.2%, 97.5%, 94.2%, 95.6%, and 95.2%, respectively. IFSH for adenocarcinoma, salivary carcinoma, and SCC all demonstrated a better clinical utility with a sensitivity of 90% or greater, while it was less than 90% for esthesioneuroblastoma, melanoma, and sarcoma. Other factors such as unclear reporting, poor quality specimens, or limited quality specimens were shown to lower diagnostic performance. Based on limitations identified, we proposed a novel IFSH reporting algorithm to improve IFSH in sinonasal and skull base surgery.

CONCLUSIONS

IFSH is an accurate and clinically useful technique in sinonasal and skull base surgery patients; however, limitations exist.

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

Background and objective

Nasal 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.

Methods

The 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).

Results

Of 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.

Conclusion

The 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.

Clinical assessment of anatomic origin effect on the clinical outcomes in primary squamous cell carcinomas affecting nasoethmoidal complex

Background:

Sinonasal squamous cell carcinomas (SCCs) present a great challenge in their diagnosis and management owing to their rapid growth, regional recurrence, local recurrence, and aggressive spread locally.

Aims:

The present clinical trial was conducted to evaluate anatomic subsites' impact on the outcomes concerning SCCs affecting ethmoid sinuses and nasal cavity.

Materials and Methods:

Medical records for tumor staging, tumor classification, grading (histologic) clinical features, symptoms, anatomic subsite, p16 results, treatment provided, and the Tumor-related outcomes were obtained for 28 subjects. Following staging and grading, p16 assays were evaluated along with disease-specific survival and disease-free survival. The collected data were subjected to the statistical evaluation and the results were formulated by keeping the level of significance at P < 0.05.

Results:

Origin was seen from nasal septum, nasal floor, lateral wall, ethmoid sinus, and edge of naris to mucocutaneous junction in 21.4% (n = 6), 7.14% (n = 2), 35.71% (n = 10), 7.14% (n = 2), and 28.57% (n = 8) subjects, respectively. For tumor staging, Stages I, II, III, and IV tumors were seen in, respectively, 39.28% (n = 11), 21.42% (n = 6), 10.71% (n = 3), and 28.57% (n = 8) study subjects. Node status was N0, N1, N2, and N3 in 78.57% (n = 22), 3.57% (n = 1), 7.14% (n = 2), and 10.71% (n = 3) subjects. Carcinoma arising from nasal septum had statistically significant worse disease-specific survival compared to carcinomas arising from other sites (P < 0.001).

Conclusion:

The present study concludes that anatomic subsites largely govern the outcomes and tumor behavior. Also, squamous cell carcinoma affecting the nasal septum is an aggressive tumor with more compromised outcomes and more lymph node involvement.

Evaluation and Management of the Nasal Airway

Nasal airway obstruction is a very common phenomenon that can significantly decrease patients' quality of life. This review article summarizes in an evidence-based fashion the diagnosis and treatment of nasal airway obstruction. The nasal airway may be obstructed at the level of the nasal valve, septum, nasal turbinates, sinonasal mucosa, or nasopharynx. Nasal valve obstruction and septal deviations are usually treated surgically depending on the level of valve obstruction. Isolated turbinate hypertrophy is usually managed medically as part of the treatment of rhinitis, with surgery reserved for cases refractory to medical care. Sinonasal and nasopharyngeal conditions are treated according to the diagnosis.

Brachial Plexopathy as an Unusual First Sign of a Head and Neck Cancer: Case Report

Malignancies in the ENT (Ear, Nose, and Throat) area are mostly manifested by dysphagia, dysphonia, dyspnea, throat swelling, and other “traditional” head and neck symptoms. Sporadically, a primary tumor or metastasis can reach such a size and it can be localized in such an area in which it can cause the pathology of the brachial plexus. If this appears first, differential diagnosis may be more difficult.

In this article the authors review current literature knowledge and present the case of this unusual sign of a head and neck cancer at the Clinic of Otorhinolaryngology and Head and Neck Surgery, Jessenius Faculty of Medicine, Comenius University, and Martin University Hospital, Martin, Slovakia.

Septal Nasal Extramedullary Plasmacytoma: A Rare Tumor in an Unusual Area

We present an extreme rare case of extramedullary nasal plasmacitoma that arise from nasal septum. The mass surgically removed was analyzed by a pathologist who diagnosed an extramedullary nasal plasmacytoma. The patient did not present systemic involvement. A short cycle of radiotherapy was performed after the surgery. At 9-month follow-up, the patient is recurrence free.