Nasal cavity and paranasal sinuses: Difference between revisions

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{{Comprehensiveness}}
==Nasal polyps==
==Nasal or sinonasal polyps==
Look for signs of malignancy.
Look for signs of malignancy.
{{Further|Evaluation of suspected malignancies}}
{{Further|Evaluation of suspected malignancies}}
[[File:Histopathology of a nasal polyp.jpg|thumb|'''Benign nasal polyp''' (not otherwise specified), consisting of hyperplastic edematous connective tissue with some seromucous glands and cells representing inflammation (mostly neutrophils and eosinophils). In early stages, the surface of the nasal polyp is covered by normal respiratory epithelium, but later it undergoes metaplastic change to squamous type epithelium (because of the constant irritation and inflammation). The submucosa shows large intercellular spaces filled with serous fluid.<ref>{{Cite book|url=https://books.google.com/books?id=Zm3jBwAAQBAJ&pg=PA168|title=Ear, Nose and Throat Histopathology|last=Michaels|first=Leslie|date=2012-12-06|publisher=Springer Science & Business Media|isbn=9781447133322|language=en|page=168}}</ref>]]
[[File:Histopathology of a nasal polyp.jpg|thumb|'''Benign nasal/sinonasal polyp''' (not otherwise specified), consisting of hyperplastic edematous connective tissue with some seromucous glands and inflammation (mostly neutrophils and eosinophils), surrounded by respiratory or squamous epithelium.<ref>{{Cite book|url=https://books.google.com/books?id=Zm3jBwAAQBAJ&pg=PA168|title=Ear, Nose and Throat Histopathology|last=Michaels|first=Leslie|date=2012-12-06|publisher=Springer Science & Business Media|isbn=9781447133322|language=en|page=168}}</ref> It can be termed '''inflammatory nasal/sinonasal polyp''' when inflammation is more pronounced.]]


Main differential diagnoses:
Main differential diagnoses:
<gallery mode=packed heights=200>
<gallery mode=packed heights=210>
File:Histopathology of inverted papilloma.jpg|'''Inverted papilloma''', wherein the surface epithelial cells grow downward into the underlying supportive tissue.
File:Histopathology of inverted papilloma.jpg|'''Inverted papilloma''', wherein the surface epithelial cells grow downward into the underlying supportive tissue.
File:Histopathology of nasal squamous papilloma.jpg|'''Squamous papilloma'''.
File:Histopathology of nasal squamous papilloma.jpg|'''Squamous papilloma''', with acanthosis and hyperkerratosis.
</gallery>
</gallery>
In case of significant '''inflammation''':
*Take at least one high magnification look to confirm that it is mixed and that lymphocytes are not atypical (otherwise, consult hematopathology, particularly whether it could be a lymphoma, notably extranodal NK/T cell lymphoma, nasal type.
*{{Moderate-begin}}Classify as '''acute''' (with neutrophils) versus '''chronic''' (lymphocytes, eosinophils and/or plasma cells). Also look at any bone fragments for osteomyelitis.{{Moderate-end}} {{further|Osteomyelitis}}
<gallery mode=packed heights=210>
File:Histopathology of sinonasal inflammatory polyp with mixed inflammation, annotated.jpg|'''Benign chronic mixed inflammation''' of an inflammatory sinonasal polyp.
File:Histopathology of acute sinusitis.png|'''Acute inflammation''' characterized by neutrophils.
File:Histopathology of extranodal NK-T cell lymphoma, nasal type.png|'''Extranodal NK/T cell lymphoma, nasal type'''.<ref>{{cite journal| author=Takahara M, Kumai T, Kishibe K, Nagato T, Harabuchi Y| title=Extranodal NK/T-Cell Lymphoma, Nasal Type: Genetic, Biologic, and Clinical Aspects with a Central Focus on Epstein-Barr Virus Relation. | journal=Microorganisms | year= 2021 | volume= 9 | issue= 7 | pages=  | pmid=34202088 | doi=10.3390/microorganisms9071381 | pmc=8304202 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34202088  }}<br>- "This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)."</ref> These lymphoma cells are typically monotonous, with folded nuclei, indistinct nucleoli and moderate amount of cytoplasm.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/lymphomanonBnasal.html|title=Extranodal NK / T cell lymphoma, nasal type|author=Mario L. Marques-Piubelli, M.D., Carlos A. Torres-Cabala, M.D., Roberto N. Miranda, M.D.|website=Pathology Outlines}} Last author update: 5 January 2021. Last staff update: 14 October 2021</ref>
</gallery>
==Reporting==
Example:
{|class=wikitable
| [[File:Histopathology of nasal contents with chronic inflammation.jpg|210px|left]] Right and left sinus contents, excisions:<br>Benign respiratory mucosa with chronic inflammation.<br>Bone without significant histopathologic changes.
|}
{{Bottom}}
{{Bottom}}

Latest revision as of 15:17, 14 June 2024

Author: Mikael Häggström [note 1]

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Nasal or sinonasal polyps

Look for signs of malignancy. Further information: Evaluation of suspected malignancies

Benign nasal/sinonasal polyp (not otherwise specified), consisting of hyperplastic edematous connective tissue with some seromucous glands and inflammation (mostly neutrophils and eosinophils), surrounded by respiratory or squamous epithelium.[1] It can be termed inflammatory nasal/sinonasal polyp when inflammation is more pronounced.

Main differential diagnoses:

  • Inverted papilloma, wherein the surface epithelial cells grow downward into the underlying supportive tissue.
    Inverted papilloma, wherein the surface epithelial cells grow downward into the underlying supportive tissue.
  • Squamous papilloma, with acanthosis and hyperkerratosis.
    Squamous papilloma, with acanthosis and hyperkerratosis.

In case of significant inflammation:

  • Take at least one high magnification look to confirm that it is mixed and that lymphocytes are not atypical (otherwise, consult hematopathology, particularly whether it could be a lymphoma, notably extranodal NK/T cell lymphoma, nasal type.
  • (Classify as acute (with neutrophils) versus chronic (lymphocytes, eosinophils and/or plasma cells). Also look at any bone fragments for osteomyelitis.) Further information: Osteomyelitis
  • Benign chronic mixed inflammation of an inflammatory sinonasal polyp.
    Benign chronic mixed inflammation of an inflammatory sinonasal polyp.
  • Acute inflammation characterized by neutrophils.
    Acute inflammation characterized by neutrophils.
  • Extranodal NK/T cell lymphoma, nasal type.[2] These lymphoma cells are typically monotonous, with folded nuclei, indistinct nucleoli and moderate amount of cytoplasm.[3]
    Extranodal NK/T cell lymphoma, nasal type.[2] These lymphoma cells are typically monotonous, with folded nuclei, indistinct nucleoli and moderate amount of cytoplasm.[3]

Reporting

Example:

Right and left sinus contents, excisions:
Benign respiratory mucosa with chronic inflammation.
Bone without significant histopathologic changes.

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ Michaels, Leslie (2012-12-06) (in en). Ear, Nose and Throat Histopathology . Springer Science & Business Media. p. 168. ISBN 9781447133322. 
  2. ↑ Takahara M, Kumai T, Kishibe K, Nagato T, Harabuchi Y (2021). "Extranodal NK/T-Cell Lymphoma, Nasal Type: Genetic, Biologic, and Clinical Aspects with a Central Focus on Epstein-Barr Virus Relation. ". Microorganisms 9 (7). doi:10.3390/microorganisms9071381. PMID 34202088. PMC: 8304202. Archived from the original. . 
    - "This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)."
  3. ↑ Mario L. Marques-Piubelli, M.D., Carlos A. Torres-Cabala, M.D., Roberto N. Miranda, M.D.. Extranodal NK / T cell lymphoma, nasal type. Pathology Outlines. Last author update: 5 January 2021. Last staff update: 14 October 2021

Image sources


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