1. SPECTRUM OF HISTOPATHOLOGICAL LESIONS OF NASAL
CAVITY,NASOPHARYNX AND PARANASAL SINUS
PI: Dr Vandana
Co PI & Corresponding Author :
Dr Reecha Singh
2. INTRODUCTION
• The nose,nasopharynx and paranasal sinuses (PNS) form a
complex system of airway.[1] It comprises of epithelial,
glandular, lymphoid, fibrovascular connective tissue, cartilage
and bony elements.[2]
• The upper respiratory tract gets exposed to a variety of infections and
many other influences in the environment. Due to the effect of these
factors, various infections, tumor like lesions and true neoplasms occur in
the upper respiratory tract.
• The lesions of nasal cavity and PNS were first described by
Hippocrates and Galen.[3] It forms a single functional unit with
common pathological process,most of which are inflammatory.
3. • It is the site of origin of some of the more complex,
histologically diverse group of lesions which causes
problem in their diagnosis, prognosis and
management because of certain unusual
clinicopathological features.[4,5]
• The main lesions of this region are inflammations- both acute
and chronic.Majority of these lesions of the nose and
paranasal sinuses are polypoid.Various pathologies ranging
from benign lesions to malignant nasal tumor may mimic a
simple nasal mass. It is impossible to determine clinically what
pathology lies underneath.[6]
• From the clinical examination of the patient or from the
macroscopic examination of the specimen it is difficult to
comment upon the nature of the lesion-whether neoplastic or
4. • The presenting features and symptomatology and advanced imaging
technique help to reach a presumptive diagnosis. Thus careful
histological workup is essential for a correct diagnosis and timely
intervention. [6,7]
• The histopathological examination of the removed tissue provides
the actual diagnosis of the varied conditions labelled as a nasal mass.
• Benign lesions of sinonasal region are common and lack of
appreciation of these lesions can lead to radical surgeries. They have
long clinical history with frequent local recurrence and thus relatively
significant morbidity.[8]
• Malignant lesions in nasal cavity, paranasal sinuses and nasopharynx
accounts for not more than 3% of head and neck malignancies and
less than 1% of all the malignant tumours.
5. • Due to varieties of histopathological types and grades of
malignancies, it is very important to study their clinical and
pathological aspects.
• A provisional diagnosis can be made after clinical assessment
and radiological investigation but final diagnosis is made
after histopathological examination. So histopathology is
indispensable in the timely diagnosis and treatment of these
lesions.
6. Review of Literature
1. Shikha Ngairangbam et al, [4] found that maximum patients were 51-60 Yrs
age group & most of the patients were male than female and maximum
patients were from urban areas. found that 57.84% were non-neoplastic and
42.16% neoplastic out of which 65.12% were malignant and 34.88% benign..
Among the malignant neoplasms, undifferentiated carcinoma was common
and seen in 78.58% of the cases followed by squamous all carcinoma.
2. Ghosh and Bhattacharya, [5] reported a maximum number of tumor-like
lesions in the second and third decades. And that the majority of malignancies
at this site occur in the fifth to seventh decades.
3. Kalpana et al,[6I found non-neoplastic lesions constituted 65.03% of cases with
inflammatory polyp being the predominant type. There was male
preponderance
4. Narayana Swami et al, [7] also reported 13% incidence of inverted papilloma
amongst all benign tumors. Amongst non-epithelial tumors, 13.34% each of
hemangioma and angiofibroma were seen
7. AIM OF STUDY
• To establish histopathological diagnosis of Inflammatory,
benign and malignant lesions of nasal cavity, paranasal
sinuses and nasopharynx.
8. OBJECTIVES
1. To find out the incidence of non-neoplastic and
neoplastic lesions, mode of presentation and their
histological types
2. To generate awareness about great variety of non-
neoplastic and neoplastic lesions of NC ,NPand PNS.
3. To compare the results with other studies.
9. MATERIALS AND METHODS
• Study design: Both retrospective and prospective study in Department of Pathology,IGIMS PATNA
• Duration of study: 3 years(June2022 to May 2025)after approval.
• Sample Size:
Where:-
(n) is the sample size
(Z) is the Z-score associated with the level of confidence (e.g., 1.96 for 95% confidence)
(p) is the estimated proportion of the population with the condition (in this case, the incidence rate)
(d) is the margin of error (precision)
Given:-
The incidence of masses in nasal cavity, paranasal sinuses and nasopharynx is 34.3 cases per 100,000 population per yearr.
Converting this rate to a proportion, (p = 34.3 / 100,000 = 0.000343).- Let's assume a 95% confidence level, so (Z = 1.96).-
Assuming a desired margin of error of 5% for the proportion (a common choice for preliminary studies), (d = 0.05). –
The calculation resulted in a sample size of approximately 140
• Statistical analysis: Data will be analyzed by appropriate statistics
10. Inclusion criteria-
1. Tissue blocks and slides of cases of lesions of NC,NP and
PNS
2. Biopsy specimens of lesions of NC,NP and PNS
3. All age group.
4. Both Non neoplastic lesion and neoplastic lesion including
primary and metastatic tumors
Exclusion criteria-
5. Requisitions with Incomplete clinical history
6. Poorly preserved tissue blocks and slides
7. Samples not received in 10%formalin.
11. SAMPLE COLLECTON AND DATA COLLECTION
PROCEDURE
• Data for retrospective study will be obtained from departmental records and the
medical records department. Tissue blocks and slides would be retrieved and
reviewed.
• Data for prospective study will be obtained from requisition form which should
include the clinical data after taking informed consent. The biopsies and
the surgical specimens will be received in 10% formalin .. Gross
examination will be carried out on specimens. Tissue bits will be routinely
processed. Three to five micron thick sections will be made from paraffin blocks and
will be stained with H&E stain.
• Special stains like Periodic acid Schiffs ,Grocott’s Methenamine Silver (GMS)
and AFB stains will be done whenever necessary.
• IHC will be performed if required.
12. Implication
The purpose of this study is to provide a representative data on
the incidence of nasal cavity, nasopharynx and paranasal sinus
lesions and also to better understand the epidemiological profile
and etiology of primary tumors and guide research toward those
with the highest mortality and/or incidence.
13. References
1. Stacey E. Mills and Robert E. Fechner. (1999): Diagnostic Surgical Pathology. Ed. Stephen S.
Sternberg., Philadelphia; 885–992
2. Dasgupta A, Ghosh RN, Mukherjee C. Nasal polyps – histopathologic spectrum. Indian J
Otolaymngol Head Neck Surg. 1999;49(1):32-37. 8.
3. Nelson G.Oronez,JuanRosai.Respiratorytract.In:Rosai and Ackerman’s surgical pathology. 11 th
edition. Mosby; 2018,vol.1.p.308-324.
4. Ngairangbam S, Laishram RS. Histopathological patterns of masses in the nasal cavity,
paranasal sinuses and nasopharynx. J Evid Based Med Healthc 2016; 3(2), 99-101 4.
5. Ghosh A, Bhattacharya K. Nasal and nasopharyngeal growth a ten year's survey. J Indian Med
Assoc 2016;47:13-8. 7
6. Kalpana Kumari MK, Mahadeva KC. Polypoidal lesions in the nasal cavity. J ClinDiagn Res. June
2013;7(6):1040-42. 9.
7. Narayana Swami, Apana M Kulkarni, Vishal G Mudholkar, Abhijit S Acharya, et al.
Histopatholgical study of lesions of nose and paranasal sinuses. India J. Otolaryngol Head Neck
Surg. 2012;64:275- 2.
8. Modh SK, Delwadia KN, Gonsai RN. Histopathological spectrum of sinonasal masses- A study of
162 cases. Int J Cur Res Rev. 2018;5(03):83–91.
9. Tondon PL, Gulati J, Mehta N. Histological study of polypoidal lesions in the nasal cavity. Indian J
Otolaryngol 2011;23:3-11. 5.
10. Mysorekar VV, Dandekar CP, Rao SG. Polypoidal lesions in the nasal cavity. Bahrain Med Bull
2007;19:67-69. 10.
11. .Parajuli S, Tuladhar A. Histomorphological spectrum of masses of the nasal cavity, paranasal
sinuses and nasopharynx. Journal of Pathology of Nepal, 2016; 3: 351- 355. 2.
![INTRODUCTION
• The nose,nasopharynx and paranasal sinuses (PNS) form a
complex system of airway.[1] It comprises of epithelial,
glandular, lymphoid, fibrovascular connective tissue, cartilage
and bony elements.[2]
• The upper respiratory tract gets exposed to a variety of infections and
many other influences in the environment. Due to the effect of these
factors, various infections, tumor like lesions and true neoplasms occur in
the upper respiratory tract.
• The lesions of nasal cavity and PNS were first described by
Hippocrates and Galen.[3] It forms a single functional unit with
common pathological process,most of which are inflammatory.](https://image.slidesharecdn.com/drc3nasalmass1-250321010413-28686dac/85/DRC-3-NASAL-njhiuhuyrfrghuyi87jooo98ohMASS-1-pptx-2-320.jpg)
![• It is the site of origin of some of the more complex,
histologically diverse group of lesions which causes
problem in their diagnosis, prognosis and
management because of certain unusual
clinicopathological features.[4,5]
• The main lesions of this region are inflammations- both acute
and chronic.Majority of these lesions of the nose and
paranasal sinuses are polypoid.Various pathologies ranging
from benign lesions to malignant nasal tumor may mimic a
simple nasal mass. It is impossible to determine clinically what
pathology lies underneath.[6]
• From the clinical examination of the patient or from the
macroscopic examination of the specimen it is difficult to
comment upon the nature of the lesion-whether neoplastic or](https://image.slidesharecdn.com/drc3nasalmass1-250321010413-28686dac/85/DRC-3-NASAL-njhiuhuyrfrghuyi87jooo98ohMASS-1-pptx-3-320.jpg)
![• The presenting features and symptomatology and advanced imaging
technique help to reach a presumptive diagnosis. Thus careful
histological workup is essential for a correct diagnosis and timely
intervention. [6,7]
• The histopathological examination of the removed tissue provides
the actual diagnosis of the varied conditions labelled as a nasal mass.
• Benign lesions of sinonasal region are common and lack of
appreciation of these lesions can lead to radical surgeries. They have
long clinical history with frequent local recurrence and thus relatively
significant morbidity.[8]
• Malignant lesions in nasal cavity, paranasal sinuses and nasopharynx
accounts for not more than 3% of head and neck malignancies and
less than 1% of all the malignant tumours.](https://image.slidesharecdn.com/drc3nasalmass1-250321010413-28686dac/85/DRC-3-NASAL-njhiuhuyrfrghuyi87jooo98ohMASS-1-pptx-4-320.jpg)
![Review of Literature
1. Shikha Ngairangbam et al, [4] found that maximum patients were 51-60 Yrs
age group & most of the patients were male than female and maximum
patients were from urban areas. found that 57.84% were non-neoplastic and
42.16% neoplastic out of which 65.12% were malignant and 34.88% benign..
Among the malignant neoplasms, undifferentiated carcinoma was common
and seen in 78.58% of the cases followed by squamous all carcinoma.
2. Ghosh and Bhattacharya, [5] reported a maximum number of tumor-like
lesions in the second and third decades. And that the majority of malignancies
at this site occur in the fifth to seventh decades.
3. Kalpana et al,[6I found non-neoplastic lesions constituted 65.03% of cases with
inflammatory polyp being the predominant type. There was male
preponderance
4. Narayana Swami et al, [7] also reported 13% incidence of inverted papilloma
amongst all benign tumors. Amongst non-epithelial tumors, 13.34% each of
hemangioma and angiofibroma were seen](https://image.slidesharecdn.com/drc3nasalmass1-250321010413-28686dac/85/DRC-3-NASAL-njhiuhuyrfrghuyi87jooo98ohMASS-1-pptx-6-320.jpg)
