Nasal Cavity and Paranasal Sinus Lesions: A Frequent Diagnostic Problem

Background: The lesions of the nasal cavity and the paranasal sinuses present with nonspecific symptoms and often pose an interesting challenge to the clinician. This is due to the wide range of pathological entities, the local anatomy, and the potential for functional and cosmetic deficits.

Aim: The aim of the present paper is to assess the rate of malignancies in biopsies from the nasal cavity and the paranasal sinuses.

Material and Methods: During the last 20 months we took 164 biopsies from the nasal cavity and the paranasal sinuses. There were 104 men (63.4%) and 60 women (36.6%). The average age was 48.5 years, with a median age of 48 years. The range of ages was 17 to 84.

Results: From the 164 histological diagnoses, 154 patients (94%) had benign lesions, 10 (6%) had malignant lesions, and in 1 case there was a lesion with undefined behavior. The benign lesions were: (1) inflammatory polyps in 36 cases (22%); (2) allergic polyps in 57 cases (37.5%); (3) benign cysts in 6 cases (3.65%); (4) hemangioma in 6 cases (3.65%); (5) other polyps in 5 cases (3%); (6) inverted papilloma in 12 cases (7.32%); (7) hemagiomyolipoma in 1 case (0.6%); (8) papilloma in 1 case (0.6%); (9) osteoma in 1 case (0.6%); (10) Wegener's disease in 1 case (0.6%); (11) mucocele in 1 case (0.6%); (12) sarcoidosis in 1 case (0.6%); (13) meningocele in 1 case (0.6%); (14) fungal infection in 1 case (0.6%); (15) granulomatous inflammation (0,6%); (16) Moyamoya disease lesions (0,6%); and (17) other in 22 cases (13.2%). The malignant lesions were: (1) undifferentiated carcinoma in 1 case (0.6%); (2) squamous cell carcinoma in 2 cases (1.2%); (3) one metastatic carcinoma from kidneys (0.6%); (4) one B lymphoma; (5) adenocarcinoma in 3 cases (1.8%);(6) malignant melanoma in 1 case (0.6%); (7) low-grade endocrine malignancy in 1 case (0.6%). We also found 1 patient with sinonasal ameloblastoma (0.6%), a neoplasm with uncertain biological behavior.

Conclusions: Although nasal polyps are the predominant lesions in the nasal cavity and paranasal sinuses, there are a significant percentage of malignancies and an unexpected wide variation of neoplasms and pathological disorders. Therefore excision biopsies should be undertaken in all lesions and in certain cases there will be a need for multidisciplinary assessment and management.