NEOPLASMS OF NASAL CAVITY

DR. AARYA SERIN

•Both benign and malignant tumours of the nasal cavity per se are uncommon.

•In addition to primary tumours, nasal cavity can be invaded by growths from paranasal sinuses, nasopharynx, cranial or buccal cavity.

•Benign lesions are usually smooth, localised and covered with mucous membrane.

•Malignant ones are usually friable, have a granular surface and tend to bleed easily.

BENIGN MALIGNANTSquamous papilloma Inverted papilloma Pleomorphic adenoma Schwannoma Meningioma Haemangioma Chondroma Angiofibroma Encephalocele Glioma Dermoid

Carcinoma Squamous cell carcinoma Adenocarcinoma Malignant melanoma Olfactory neuroblastoma Haemangiopericytoma Lymphoma Solitary plasmacytoma Various types of sarcoma

BENIGN NEOPLASMS

1. SQUAMOUS PAPILLOMA•Verrucous lesions similar to skin warts

can arise from the nasal vestibule or lower part of nasal septum.

•They may be single or multiple, pedunculated or sessile.

•Treatment is local excision with cauterisation of the base to prevent recurrence. They can also be treated by cryosurgery or laser.

2. INVERTED PAPILLOMA (TRANSITIONAL CELL PAPILLOMA OR RINGERTZ TUMOUR)• It is so-named because microscopically neoplastic

epithelium is seen to grow towards underlying stroma rather than on the surface.

• Mostly seen between 40-70 years with male preponderance (5:1).

• It arises from the lateral wall of nose and is always unilateral.

• It presents as red or grey masses which may be translucent and oedematous, simulating simple nasal polypi.

• Has a marked tendency to recur after surgical removal and may be associated with squamous cell carcinoma in 10-15% of patients.

• Treatment is wide surgical excision by lateral rhinotomy or medial maxillectomy and en bloc ethmoidectomy.

3. PLEOMORPHIC ADENOMA

Rare tumour, usually arises from the nasal septum. Treatment is wide surgical excision.

4. SCHWANNOMA AND MENINGIOMA

They are uncommon tumours which are found intranasally. Treatment is surgical excision by lateral rhinotomy.

5. HaemangiomaIt may be: (a) Capillary haemangioma (Bleeding polypus of

the septum)o It is a soft, dark red, pedunculated or sessile tumour

arising from anterior part of nasal septum. o Usually it is smooth but may become ulcerated and

present with recurrent epistaxis and nasal obstruction. o Treatment is local excision with a cuff of surrounding

mucoperichondrium. (b) Cavernous haemangiomaIt arises from the turbinates on the lateral wall of nose. It is treated by surgical excision with preliminary

cryotherapy. Extensive lesions may require radiotherapy and surgical excision.

6. Chondroma• It can arise from the ethmoid, nasal cavity or

nasal septum. • Pure chondromas are smooth, firm and

lobulated.• Others may be mixed type fibro-, osteo-, or

angiochondromas. • Treatment is surgical excision.• For recurrent or large tumours, wide excision

should be done because of their tendency to malignant transformation after repeated interference.

7. Angiofibroma• It is included in nasal tumours because its primary

site of origin is supposed to be posterior part of nasal cavity near the sphenopalatine foramen

8. Gliomas

• Of all the gliomas, 30% are intranasal and 10% both intra and extranasal. They are seen in infants and children. An intranasal glioma presents as a firm polyp sometimes protruding at the anterior nares.

9. Intranasal meningoencephalocele• It is herniation of brain tissues and meninges

through foramen caecum or cribriform plate.• It presents as a smooth polyp in the upper part of

nose between the septum and middle turbinate.• The mass increases in size on crying or straining.• It may be misdiagnosed as a simple polyp and

mistakenly avulsed, resulting in CSF rhinorrhoea or meningitis.

• For the same reason biopsy should not be taken.• CT scan is essential to demonstrate a defect in the

base of skull. • Treatment is frontal craniotomy, severing the stalk

from the brain, and repair of dural and bony defect. Intranasal mass is removed as secondary procedure after cranial defect has sealed.

10. Nasal dermoid• It presents as widening of upper part of nasal

septum with splaying of nasal bones and hypertelorism.

• A pit or a sinus may be seen in the midline of nasal dorsum with hair protruding from the opening.

MALIGNANT NEOPLASMS

1. Carcinoma of nasal cavity• Primary carcinoma per se is rare. • It may be an extension of maxillary or ethmoid carcinoma.• Squamous cell variety is the most (a) Squamous cell carcinoma

It may arise from the vestibule, anterior part of nasal septum or the lateral wall of nasal cavity. Most of them are seen in men past 50 years of age. (i) Vestibular: • It arises from the lateral wall of nasal vestibule and may

extend into the columella, nasal floor and upper lip with metastases to parotid nodes.

(ii) Septal: • Mostly arises from mucocutaneous junction and causes

burning and soreness in the nose. It has often termed as "nose-picker's cancer". Usually, it is of low grade malignancy.

• (iii) Lateral wall: This is the site most commonly involved. Easily extends into ethmoid or maxillary sinuses.It presents as a polypoid mass in the lateral wall of nose. Treatment is combination of radiotherapy and surgery.

(b) Adenocarcinoma and adenoid cystic carcinoma. They arise from the glands of mucous membrane or minor salivary glands and mostly involve upper part of the lateral wall of nasal cavity

2. Malignant melanoma• Usually seen in persons about 50 years of age. • Both sexes are equally affected.• 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.

• Amelanotic varieties are nonpigmented. • Tumour spreads by lymphatics and blood stream. • Cervical nodal metastases may be present at the

time of initial examination. • Treatment is wide surgical excision• Radiotherapy and chemotherapy suppress the

immune processes and are avoided. • A five-year survival rate of 30% can be expected

after surgical excision.

3. Olfactory neuroblastoma

• It is a tumour of olfactory placode seen in persons of either sex at any age group.

• It presents as a cherry red, polypoidal mass in the upper third of the nasal cavity.

• It is a vascular tumour and bleeds profusely on biopsy.

• Lymph node or systemic metastases can occur. • Presently, favoured treatment is surgical excision

followed by radiation. Craniofacial resection may be required for tumours of the cribriform plate.

4. Haemangiopericytoma• It is a rare tumour of vascular origin. • It arises from the pericyte-a cell surrounding the

capillaries.• It presents with epistaxis. Brisk bleeding may

occur on biopsy. • The tumour may be benign or malignant but it

cannot be distinguished histologically.• Treatment is wide surgical excision.• Radiotherapy is used for inoperable or recurrent

lesions.

5. Lymphoma• Rarely a non-Hodgkin lymphoma presents on the

septum.

6. Plasmacytoma• Solitary plasmacytoma without generalised

osseous disease may be seen in the nasal cavity.• It predominantly affects males over 40 years. • Treatment is by radiotherapy followed three

months later by surgery if total regression does not occur.

• Long-term follow up is essential to exclude development of multiple myeloma.

7. Sarcomas• Osteogenic sarcoma, chondrosarcoma,

rhabdomyosarcoma ,angiosarcoma, malignant histiocytoma are other rare tumours affecting the nose.