Benign sinonasal
neoplasms and tumor-like
lesions
Prof.Alena Skálová, MD,PhD
Charles University, Faculty of
Medicine, Plzen, Czech Republic
EScoP Belgrade 2011, 7-9th April, 2011, Belgrade, Serbia
Anatomy of nasal cavity and sinonasal region
Benign lesions of sinonasal region
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Sinonasal polyps
Sinonasal hamartomatous and teratoid
lesions
Benign epithelial neoplasms
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Papillomas
Salivary gland-type adenomas
Benign sinonasal soft tissue neoplasms
Sinonasal polyps
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Most sinonasal polyps are of allergic origin
consist largely of myxoid edematous tissue with
pseudocysts containing eosinophilic
proteinaceous material and inflammatory cells
heavy infiltration by eosinophils
marked thickening of basement membranes
goblet cell metaplasia
Antrochoanal angiomatoid polyp
Antrochoanal angiomatoid polyp
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3-6% of all patients with nasal polyps
Usually solitary, at any age, most in young
adults
Removed by curretage, recurrences- 25%
Clinical symptoms
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nasal obstruction, epistaxis
susceptible to vascular injury
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Origin within sinus, passage through constrictive
ostia- characteristic vascular changes
Angiomatoid nasal polyps
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arising from inflammatory nasal polyps are
benign lesions with frequent recurrences
may become partially or extensively infarcted
which results in hemorrhage, necrosis and
erosion of the surrounding tissues including the
skeletal bones
histological resemblance to various benign and
malignant tumors
Heffner DK. Sinonasal angiosarcoma? Not likely (a brief description
of infarcted nasal polyps). Ann Diagnostic Pathology 2010: 14: 233-234.
Histology
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Early angiomatoid vascular changes
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Late angiomatoid vascular changes
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Hyperemia, congestion, early hemorhagic
necrosis, interstitial edema
Congestion with organizing vascular thrombi,
neovascularization (granulation tissue),
fibrosis, ulcerations, necrosis
Pseudosarcomatous stromal cell changepitfall
Ulceration, granulation tissue, bood vessel proliferation
Dilated blood vessels, granulation tissue
Increased cellularity around blood vessels
Thrombosis with organisation
Hemorrhage, extravasation of RBCs
ASMA
Angiomatoid nasal polyps (ANP)
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45 cases of ANP were retrieved from
consultation registry in Pilsen
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32 men and 13 women
Sites included
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nasal septum (14/41)
antrum Highmori (12/41), ethmoid sinuses (5/41)
lateral wall of nasal cavity (5/41), sphenoid sinus
(1/41), and non-specific nasal cavity (4/41)
Hadravsky L, Skalova A, Michal M. Angiomatoid nasal polyp: often misdiagnosed
and little known lesion. Report of 45 cases.
Modern Pathology 2011: 24: 278A (Abstract).
Angiomatoid nasal polyps (ANP)
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X-ray or computed tomography scans were performed in
19 cases and bone erosions/deviations occurred in 4
cases of them
Initial diagnoses submitted by referring pathologists
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angiofibroma 32%, hemangioma 24%, hemangiopericytoma
16%, angiosarcoma 12%, pyogenic granuloma and hemangioendotelioma, both at 8%
None of the patients died of the disease and there has
been no progression in any patient
Recurrence was recorded in 30% (9/30)
Hadravsky L, Skalova A, Michal M. Angiomatoid nasal polyp: often misdiagnosed
and little known lesion. Report of 45 cases.
Modern Pathology 2011: 24: 278A (Abstract).
Sinonasal hamartomatous and
teratoid lesions
Hamartomas of respiratory tract
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Rare tumor like lesions of sinonasal
mucosa and nasopharynx
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Respiratory epithelial adenomatoid
hamartoma (REAH)
Seromucinous hamartoma
nasal chondromesenchymal hamartoma
Mixed chondro-osseous REAH
Wenig BM, Heffner DK. Respiratory epithelial adenomatoid hamartomas
of the sinonasal tract and nasopharynx: a clinicopathologic study of 31 cases.
Ann Otol Rhinol Laryngol 1995:104:639-645.
Seromucinous (glandular)
hamartomas
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polypoid lesions characterized by
epithelial proliferations of small glands,
acini, and tubules growing haphazaradly
in clusters and lobules
devoid of myoepithelial cells
Weinreb I, et al. Seromucinous hamartomas: a clinicopathological study
of a sinonasal glandular lesion lacking myoepithelial cells.
Histopathology 2009:54:205-213.
Seromucinous hamartoma of sinonasal
tract
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Uncommon, under-reported entity
Residual lobular architecture, bland morphology
Absence of epithelial tufting, papillae, back-to
back glands
Absence of invasion
Spectrum with REAH and low-grade sinonasal
adenocarcinoma
Jo VY, Mills SE, Cathro HP, Carlson DL, Stelow EB. Low-grade sinonasal
adenocarcinomas. The association with and distinction from respiratory
epithelial adenomatoid hamartomas and other glandular lesions.
Am J Surg Pathol 2009:33:401-408.
Spectrum from seromucinous
hamartoma to REAH
Weinreb et al: Histopathology 2009
Respiratory epithelial adenomatoid hamartoma (REAH)
Differential diagnosis of sinonasal
hamartomas
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Low-grade sinonasal adenocarcinoma
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Schneiderian benign papilloma
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LG tubulo-papillary adenocarcinoma
Oncocytic variant
Salivary gland type adenoma
Sinonasal adenocarcinomas (SNAC)
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uncommon malignancies that show a
variety of growth patterns
classified as intestinal and non-intestinal
types, the latter subclassified as low grade
and high grade
Low grade tubulopapillary adenocarcinoma of the nasal cavity in 72-y old man,
slowly growing tumour- of nasal mucosa, filling the middle meatus,
Presented with nasal obstruction and recurrent attacks of chronic hyperplastic
rhinitis for at least 5 years
Sinonasal adenocarcinomas (SNAC)
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Recently, some cases of low-grade
sinonasal adenocarcinomas associated
with REAH were reported
possibly implicating REAH as a precursor
lesion for at least a subset of SNAC
Jo, et al. Low-grade sinonasal adenocarcinomas. The association with and distinction
from respiratory epithelial adenomatoid hamartomas and other glandular lesions.
Am J Surg Pathol 2009:33:401-408.
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29 LG sinonasal adenocarcinoma reviwed
6 of them associated with REAH
REAH may be precursor of LG sinonasal
adenoca
Benign epithelial neoplasms
Papillomas
Salivary gland-type adenomas
Sinonasal papillomas
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Squamous cell papilloma
Schneiderian papilloma
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Exophytic
Inverted
oncocytic
Benign sinonasal soft tissue
neoplasms