Nasal Tumor

Benign and malignant

• Benign is classified into epithelial (adenoma and
papilloma)
• mesenchymal :(hemangioma, osteoma, chondroma,
angiofibroma)
• Malignant :epithelial(TCC,SCC)
• Mesenchymal:(osteosarcoma,fibrosarcoma and
chondrosarcoma
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• 1.papilloma:
• Def:These are benign neoplasms of the sinonasal mucosa.

• They fall into three groups: (exophytic,inverted and oncocytic)

• 1.exophytic or fungiform papillomas: this type accounts for

about 50% of the total2. They most commonly involve the
anterior nasal septum. They may contain HPV 6 or 11.
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• 2.inverted papillomas: are benign finger-like growths
in the soft epithelial tissues lining the nasal cavities that
extend into the underlying bone.

• They can be fast growing and may become malignant.

• Site: usually in the lateral nasal wall or middle meatus and

may extend into paranasal sinuses.

• They may contain HPV 6 or 11 and possibly with EBV.

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• Inverted papilloma:
• Gross :pink-gray, soft to moderately firm polypoid growth
with convoluted or wrinkled surface

• Microscopic:There is a thickened non-keratinising

epithelium with a prominent basement membrane.
• A layer of ciliated columnar cells may cover the surface.
• Frequently, there are numerous mucous cells and mucous
cysts. Large clear cells contain abundant glycogen.
• There may be a chronic inflammatory cell infiltrate.
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• Exophytic papilloma
• gross: usually mushroom shaped and exophytic with
papillary appearance

• microscopic: There is an exophytic architecture, with

thick non-keratinising squamous ("transitional")
epithelium covering fibrovascular cores.
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Oncocytic papilloma
• gross: fleshy polypoid growth of variable color
• microscpice:show the same anatomic distribution s
inverted papillomas.
• The architecture may be exophytic or endophytic.
• The multilayered epithelial cells have eosinophilic
granular cytoplasm.
• Mucous cells with intra-epithelial mucous cysts
contain neutrophils
Inverted papilloma
Exophytic papilloma
Oncocytic papilloma
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• Prognosis:
• Multiple recurrences are common, unless extensive
resection is performed.
• Carcinomatous transformation may occur in inverted
and oncocyticpapillomas, most commonly to
squamous cell but less often clear cell, sarcomatoid
or mucoepidermoid carcinoma, carcinoma with
endodermal sinus tumour-like features, small cell
carcinoma or undifferentiated sinonasal carcinoma
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• 2.Adenoma
• Def:Pleomorphic tumor and It is most common tumor
of salivary glands.
• Painless, slow growing tumor, composed of biphasic
population of epithelial and mesenchymal cells. It is
also called benign mixed tumor of salivary gland
• Clinical features:Often women in 30s but any age
• 90% occur in parotid gland, 10% in submandibular
gland, rare in sublingual gland
• Represents 50% of salivary gland tumors of palate
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• Adenoma
• Gross description:
• Well demarcated, partially encapsulated, gray-
white, myxoid, rubbery mass with solid cut
surface, often 6 cm or less, tumor extensions
into adjacent tissue may be subtle
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• Adenoma
• microscopic:
• Biphasic population of epithelial and
mesenchymal cells
• Epithelial cells are glandular or occasionally
squamous; may be spindled or oval, have large
hyperchromatic nuclei
• Stroma is myxoid, hyaline, chondroid, rarely
adipose tissue or osseous; mucin often present
• No mitotic figures, no necrosis
Pleomorphic adenoma
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• 2. malignant tumor:

• A. Transitional cell carcinoma

• known as nonkeratinizing squamous cell carcinoma
• rarely arises from preexisting inverted papilloma
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• Sites
• Maxillary antrum is most common site, followed by
lateral nasal wall and ethmoid sinus

• Clinical features:
• Nasal obstruction, rhinorrhea and epistaxis are common
• Advanced cases may present with diplopia or lacrimation

• Prognosis:
• Better prognosis than keratinizing squamous cell carcinoma
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• gross description:
• May be an exophytic, fungating or papillary mass

• Microscopic (histologic) description:

• Resembles urothelial (transitional) carcinoma
• Usually invades underlying tissue with a pushing
margin
• marked nuclear atypia and mitotic activity
• Squamous differentiated cells are frequently seen but
tumor is devoid of significant keratinization
• Occasional mucus containing cells can be seen
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• B.squamus cell carcinoma
• Def: Epithelial malignancy originating from sinonasal
surface epithelium
• types: keratinizing and nonkeratinizing
• Incidence: More common in Japan than in the West
• More common in adult men Average age at
presentation is 55 - 65 years Rare in patients < 40
years old
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• Sites: Maxillary sinus (60 - 70%), nasal cavity
(12 - 25%), ethmoid sinus (10 - 15%), ethmoid
and frontal sinuses (1%)
• associated with HPV Clinical features Nasal
fullness, epistaxis, rhinorrhea
• Gross: exophytic, fungating or papillary;
friable, hemorrhagic or necrotic mass
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• Microscopic:
• Two broad microscopic subtypes: Keratinizing
squamous cell carcinoma: 80 - 85%
• Non keratinizing