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    Benign Tumors of Nose and Nasopharynx

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    manoj kumar
    This document discusses benign tumors of the nose and nasopharynx, including inverted papillomas, fibrous dysplasia, and juvenile nasopharyngeal angiofibroma. Inverted papillomas are locally aggressive epithelial tumors that commonly arise from the lateral nasal wall and have high recurrence rates without complete surgical excision. Fibrous dysplasia is a benign bone tumor that causes facial deformity and occurs more often in young females involving the maxilla. Juvenile nasopharyngeal angiofibroma is a benign but locally aggressive vascular tumor seen exclusively in adolescent boys that presents with nasal obstruction and epistaxis.

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    Benign Tumors of Nose and Nasopharynx

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    manoj kumar
    26 views39 pages
    This document discusses benign tumors of the nose and nasopharynx, including inverted papillomas, fibrous dysplasia, and juvenile nasopharyngeal angiofibroma. Inverted papillomas are locally aggressive epithelial tumors that commonly arise from the lateral nasal wall and have high recurrence rates without complete surgical excision. Fibrous dysplasia is a benign bone tumor that causes facial deformity and occurs more often in young females involving the maxilla. Juvenile nasopharyngeal angiofibroma is a benign but locally aggressive vascular tumor seen exclusively in adolescent boys that presents with nasal obstruction and epistaxis.

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    This document discusses benign tumors of the nose and nasopharynx, including inverted papillomas, fibrous dysplasia, and juvenile nasopharyngeal angiofibroma. Inverted papillomas are locally aggressive epithelial tumors that commonly arise from the lateral nasal wall and have high recurrence rates without complete surgical excision. Fibrous dysplasia is a benign bone tumor that causes facial deformity and occurs more often in young females involving the maxilla. Juvenile nasopharyngeal angiofibroma is a benign but locally aggressive vascular tumor seen exclusively in adolescent boys that presents with nasal obstruction and epistaxis.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    26 views39 pages

    Benign Tumors of Nose and Nasopharynx

    Uploaded by

    manoj kumar
    This document discusses benign tumors of the nose and nasopharynx, including inverted papillomas, fibrous dysplasia, and juvenile nasopharyngeal angiofibroma. Inverted papillomas are locally aggressive epithelial tumors that commonly arise from the lateral nasal wall and have high recurrence rates without complete surgical excision. Fibrous dysplasia is a benign bone tumor that causes facial deformity and occurs more often in young females involving the maxilla. Juvenile nasopharyngeal angiofibroma is a benign but locally aggressive vascular tumor seen exclusively in adolescent boys that presents with nasal obstruction and epistaxis.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    of 39

    Benign tumors of Nose and

    Nasopharynx
    Classification
    Epithelial
    • Odontogenic
    • Non-odontogenic
    Non-epithelial (connective tissue)
    • Odontogenic
    • Non-odontogenic
    • Epithelial: • Dental/ dentigerous cyst
    Odontogenic
    • Epithelial: • Inverted Papilloma, adenoma,
    Non-odontogenic accessory salivary tumors
    • Non-epithelial: • Dentinoma, cementinoma
    Odontogenic
    • Non-epithelial: • Angiofibroma, Fibro-osseous
    Non-odontogenic dysplasia, hemangioma,
    chondroma, osteoma,
    Inverted papilloma
    • Benign but locally aggressive premalignant
    tumor of the nasal cavity with histologically
    inverted epithelial tumor cells into the
    stroma and usually presents as a
    pedunculated reddish mass from the lateral
    nasal wall
    • Transitional cell papilloma
    • Schneiderian cell papilloma
    Incidence
    • 4% of all primary nasal tumors
    • >5-6 decade
    • M:F :: 3:1
    • > Caucasians
    Etiology
    • Unknown
    • ? Genetic predisposition
    • ? Human papilloma virus (type 11/ 16)
    • ? Human papilloma virus type 16: more
    chances of associated malignancy
    • ? Environmental carcinogens
    Pathology: Gross
    • Firm, polypoidal and more vascular than
    inflammatory polyps
    • Commonly arises from the lateral nasal
    wall, usually in the region of the middle
    meatus and middle turbinate
    • Extension into the maxillary and ethmoid
    sinuses and orbit is common.
    Pathology: Microscopy
    • Inversion of the neoplastic epithelium into
    the underlying stroma
    • The neoplastic epithelium
    – Commonly stratified squamous type with
    minimal mitosis and atypia
    – Occasionally the respiratory or transitional
    epithelium can be found
    • Malignant transformation/ associated
    malignancy in about 30%
    Inverted papilloma
    Inverted papilloma with malignancy
    Clinical features: Symptoms
    • Elderly males commonly affected
    • Unilateral nasal obstruction
    • Blood stained nasal discharge
    • Epistaxis
    • Pain, epiphora, proptosis +/-
    • H/O multiple previous nasal polypectomy+/-
    Clinical features: Signs
    • Reddish, vascular, firm, mobile, insensitive
    pedunculated mass from lateral nasal wall
    • Looks like unilateral infected polyp
    • May bleed on probing
    • Proptosis, facial swelling may be present
    especially if associated with malignancy
    Investigations
    • Biopsy
    • CT scan of nose and paranasal sinuses
    – Mass involving maxillo-ethmoid region and
    nasal cavity
    – Bone destruction, orbital and cheek extension
    should raise suspicion of associated
    malignancy
    • Frozen section biopsy (intra-operative) if
    malignancy is suspected
    Treatment: Surgery
    • Medial maxillectomy with total
    ethmoidectomy (Lateral rhinotomy/
    midfacial degloving approach)
    • Endoscopic excision/ intranasal
    sphenoethmoidectomy in small lesions on
    CT scan
    • If associated malignancy is present
    – Total maxilloethmoidectomy +/- orbital
    exenteration
    Prognosis
    • Recurrence rates
    – Limited excision: 40% to 80%
    – Medial maxillectomy/ethmoidectomy: <10%
    • Malignant transformation/ association: 30%
    FIBROUS DYSPLASIA
    • Benign bony tumor (dysplasia) of the
    craniofacial bones usually involving
    maxilla and rarely the mandible, causing
    cosmetic/ functional deformity and occurs
    commonly in young females
    Variants
    Depends on the proportion of the fibrous and
    osseous components
    • Fibrous dysplasia
    • Fibro-osseous dysplasia
    • Ossifying fibroma
    Typical microscopic appearance of trabecular bone in fibrous
    dysplasia. There is fibrous replacement of the marrow spaces,
    and the bone spicules are composed of woven rather than
    lamellar bone.
    Clinical features
    • Common in females
    • Infancy or childhood
    • Painless, slow growing swelling of the
    maxilla. Rarely the mandible is involved
    • Cosmetic deformity
    • Functional deformity
    – Orbit: Diplopia, proptosis, blindness, etc..
    – Oral cavity: Malocclusion, dysarthria, difficulty
    in mastication
    • Growth usually ceases after puberty
    Investigations
    • X-ray PNS: Homogenous opacity (ground
    glass appearance) of the maxilla with
    expansion
    • CT scan
    Treatment- Surgical
    • Cosmetic or functional shaving/ trimming
    • Sub-labial approach preferred
    •
    •
     
    NO RADICAL RESECTIONS
                                   
    Spontaneous regression after puberty can
    occur
    Juvenile nasopharyngeal
    angiofibroma

    • Juvenile nasopharyngeal angiofibroma


    (JNA) is a histologically benign yet
    locally aggressive vascular head and neck
    tumor exclusively seen in adolescent
    boys
    Incidence
    • Most common benign neoplasm of the
    nasopharynx (0.5% of all head and neck
    neoplasms)
    • Varies between 1 in 5000 and 1 in 60,000
    otolaryngology patients
    Etiopathology
    • The histogenesis and pathogenesis of JNA are unclear.
    Popular theories
    • Abnormal growth of embryonal chondrocartilage
    • Testosterone acting on a hamartomatous nidus of
    inferior turbinate tissue mislocated in the nasopharynx
    • Tumor growth from normal nasopharyngeal
    fibrovascular stroma.
    • Other suggested etiologies include trauma,
    inflammation, infection, allergy, and heredity.
    Origin
    • Around sphenopalatine
    foramen in the posterior
    part of nasal cavity
    Pathology
    • Gross:
    – Lobulated, firm, non-encapsulated mass
    – Usually pink-gray or purple-red
    – Sessile or pedunculated
    – Secondary attachments usually, complicating resection in
    continuity.
    • Histopathology:
    – Tumor composed of thin-walled vessels of varying caliber in a
    mature connective tissue stroma
    – The vessels typically have a single endothelial cell lining without
    a muscularis layer, which probably explains the tumor's
    propensity for hemorrhage.
    Clinical features- Symptoms
    • Adolescent males
    • Average age of onset of symptoms:14-18 years
    • Nasal obstruction, nasal discharge (80%)
    • Profuse, painless, unprovoked paroxysms of
    epistaxis (60%)
    • Less common symptoms include diplopia,
    blindness, hearing loss, otitis media, rhinorrhea,
    anosmia, nasal speech, noisy sleep, mouth
    breathing, eye pain, and headache
    Clinical features: Signs
    • Nasopharyngeal mass, usually pink-to-
    purple and nodular
    • Probe test: CONTRAINDICATED
    • Proptosis, palatal bulge, or swelling of the
    cheek or over the zygoma- Ominous
    indications of extensive tumor spread -tumor
    extension well beyond the nasopharynx.
    • Otitis media
    Investigations
    • Diagnosis by clinical suspicion
    • Biopsy CONTRAINDICATED
    • Radiology
    – Plain radiographs
    – CT scan/ MRI
    – Digital subtraction angiography
    CT Scan
    • Vascular ‘dumb-bell’ shaped mass
    in nasal cavity/ nasopharynx and
    pterygopalatine fossa with
    constriction at pterygopalatine
    foramen
    • Anterior bowing of maxilla and
    posterior bowing of pterygoids
    (Holman-Miller sign)
    • Other extensions: Intracranial and
    extracranial
    Angiography:
    Feeding vessels usually
    ipsilateral internal
    maxillary- may be
    embolised pre-
    operatively

    DSA: Pre and post embolization


    Treatment
    • Excision of the tumor- Treatment of choice
    • Adequate blood should be kept ready
    • Preoperative embolization or external
    carotid clamping before excision to reduce
    bleeding
    • Approach depends on the extent
    • Complete excision to prevent recurrence
    Approaches
    • Trans-palatal
    • Lateral rhinotomy
    • Combined transpalatal and lateral rhinotomy
    • Mid-facial degloving approach
    • Endoscopic endonasal approach for small
    tumors
    • Infratemporal fossa approaches
    • Craniotomy if intracranial extension+
    Other modalities
    • Radiotherapy, chemotherapy and hormonal
    therapy have been tried- none curative
    • For extensive unresectable tumors
    • Tumors with extensive intracranial
    extensions
    Prognosis
    • Depends on the stage
    • Early diagnosis favor complete resection
    • Prognosis good if completely excised

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