Nasal polyps

From Libre Pathology
(Redirected from Sinonasal papilloma)
Jump to: navigation, search

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

Overview

DDx (benign - multiple):[1]

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]

Microscopic

Features:

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

Sign out

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.

Microscopic

Features:[6]

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

DDx:

Sign out

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

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

Fungiform Schneiderian papilloma

Features:

  • Exophytic growth pattern - key feature.

Oncocytic Schneiderian papilloma

Features:

  • Oncocytes - key feature.
  • Exophytic or endophytic growth pattern.

See also

References

  1. 1.0 1.1 URL: http://emedicine.medscape.com/article/994274-overview. Accessed on: 16 March 2011.
  2. http://emedicine.medscape.com/article/333492-overview
  3. URL: http://emedicine.medscape.com/article/994274-diagnosis. Accessed on: 16 March 2011.
  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.
  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.
  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.
  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.