Clinical Profile and Histopathological Patterns of Unilateral Nasal Masses

Abstract

Background: Unilateral nasal masses are common finding in an ENT outpatient department. Most patients present with complaints of nasal obstruction. Other symptoms include nasal discharge, epistaxis and disturbances of smell. A sinonasal mass can have various differential diagnoses. They may be congenital, inflammatory, neoplastic (benign or malignant) or traumatic in nature.
Aims of Study: To evaluate the specific age and gender of presentation, associated symptoms, histopathological results and frequency of lesions in patients with established unilateral nasal mass.
Patients and Methods: A prospective study of 50 selected adult patients presented with a unilateral nasal mass were seen in ENT department in Baghdad teaching medical city over a period of 12 months (Oct.2015- Sep.2016).A full history, ENT examination including nasoendoscopy, and head and neck examination were done for all patients. CT scan of nose and paranasal sinuses was done for all patients to identify the site of lesion, it's extension, and a probable diagnosis. MRI was done in selected patients for better soft tissue differentiation and for those with a possible intracranial or intraorbital extension. Biopsy from the lesion was taken under either local or general anesthesia. Those who were fit for GA underwent endoscopic sinus surgery as a definitive management for possible inflammatory lesions, or for biopsy and tumor debulking of neoplastic lesions. Some patients required no further management; others required additional management in the form of surgery, radiotherapy, chemotherapy or combination of any.
Results: Most of our patients were males (56%). The most common age of presentation was between 20-30 years and the mean ± standard deviation was (42.3 ± 18) years. Clinical presentations were nasal obstruction in 78%, rhinorrhea in 44% and smell change in 34% of patients. Histopathological results showed that 62% of patients presented with non-neoplastic lesion and 38% presented with neoplastic lesions (26% benign and 12% malignant). Inflammatory polyp (38%), inverted papllioma (16%) and squamous cell carcinoma (6%) were the highest findings representing non-neoplastic, benign and malignant lesions respectively. There was no significant association between the gender and type of lesion as the P value was 0.16. There was significant association between the age of the patients and the type of lesion as non-neoplastic lesions were found more common in the 3rd decade (the P value was 0.02) and neoplastic lesions were more common in the 6th decade (the P value was 0.006).
Conclusions: Unilateral sinonasal masses have male predilection. The mean age is oldest for neoplastic lesions and youngest for non-neoplastic lesions. Unilateral Nasal obstruction is the most common presentation in all types of unilateral sinonasal masses. Non-neoplastic lesions are commoner than neoplastic ones. Inflammatory polyp, inverted papllioma and squamous cell carcinoma are the most common findings representing non-neoplastic, benign and malignant lesions respectively.