Int J Curr Pharm Res, Vol 17, Issue 2, 10-14Original Article

COMPREHENSIVE CLINICOPATHOLOGICAL ANALYSIS OF SINONASAL MASSES: A PROSPECTIVE STUDY OF 100 CASES

T. MAHESWARI RANI1, NIHARIKA THEETLA2, VAISHNAVI BOLLAVARAM1*

1Department of Ent, Gmc, Vikarabad, Telangana, India. 2Department of Ent, Osmania Medical College, Hyderabad, India
*Corresponding author: Vaishnavi Bollavaram; *Email: 212121.vr@gmail.com

Received: 10 Dec 2024, Revised and Accepted: 22 Feb 2025

ABSTRACT

Objective: Sinonasal masses range from benign inflammatory polyps to malignant tumors, often presenting with overlapping clinical features. Accurate diagnosis is essential for effective management and improved patient outcomes. This study aims to evaluate the clinicopathological profile of sinonasal masses in a tertiary care center, emphasizing the correlation between clinical and histopathological diagnoses.

Methods: A prospective study was conducted on 100 patients with sinonasal masses at the Department of Otorhinolaryngology, Osmania Medical College, Hyderabad, over one year. Detailed histories, thorough clinical examinations-including anterior and posterior rhinoscopy-and diagnostic nasal endoscopies were performed. Imaging studies and histopathological examinations were also conducted. Masses were categorized into non-neoplastic and neoplastic types based on histopathology. Data were analyzed for age and sex distribution, clinical presentation, and diagnostic discrepancies.

Results: Out of 100 patients, 58% were male and 42% were female, with the highest incidence in the 31–40 y age group (19%). Non-neoplastic masses accounted for 51% of cases, while neoplastic masses comprised 49%, including 38% benign and 11% malignant tumors. Ethmoidal polyps (22%) and antrochoanal polyps (18%) were the most common non-neoplastic lesions. Capillary hemangioma (12%) was the most frequent benign neoplasm, followed by inverted papilloma (10%). Squamous cell carcinoma (7%) was the predominant malignant tumor. Nasal obstruction was the most common symptom (92%), predominantly unilateral (62%). Discrepancies between clinical and histopathological diagnoses were noted in cases of inverted papilloma and squamous cell carcinoma.

Conclusion: Sinonasal masses present a diverse range of pathologies with overlapping clinical features, highlighting the necessity of histopathological examination for accurate diagnosis. Correlating clinical findings with histopathology is crucial for early detection and optimal management, especially in malignant cases.

Keywords: Sinonasal masses, Clinical diagnosis, Histopathological correlation, Nasal polyps, Neoplastic lesions

© 2025 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)
DOI: https://dx.doi.org/10.22159/ijcpr.2025v17i2.6036 Journal homepage: https://innovareacademics.in/journals/index.php/ijcpr

INTRODUCTION

Sinonasal masses are common entities encountered in otorhinolaryngology, encompassing a wide spectrum from benign inflammatory lesions to aggressive malignant tumors [1]. Patients typically present with nasal obstruction, which may be unilateral or bilateral, along with other symptoms such as nasal discharge, epistaxis, facial swelling, proptosis, diplopia, and visual disturbances [2, 3]. Among these, nasal polyps are the most frequent benign lesions causing nasal obstruction and can significantly impair a patient's quality of life [4].

Differentiating between various sinonasal masses poses a diagnostic challenge due to overlapping clinical presentations and radiological features [5]. Imaging modalities like computed tomography (CT) and magnetic resonance imaging (MRI) provide valuable information regarding the extent and nature of the lesion but are often insufficient for definitive diagnosis [6]. Histopathological examination remains the gold standard for accurate identification, enabling clinicians to distinguish between benign and malignant conditions and to formulate appropriate management strategies [7].

Several studies have emphasized the importance of clinicopathological correlation in the evaluation of sinonasal masses. For instance, Lathi et al. reported that histopathological examination is essential for the definitive diagnosis of these masses, given the limitations of clinical and radiological assessments [8]. Similarly, Bakari et al. highlighted the diverse histopathological spectrum of sinonasal lesions in their study, underscoring the need for meticulous evaluation [9].

Understanding the demographic patterns, clinical presentations, and histopathological characteristics of sinonasal masses is crucial for otorhinolaryngologists. It aids in early detection, accurate diagnosis, and effective treatment planning, ultimately improving patient outcomes [10]. This study aims to investigate the spectrum of sinonasal masses in a tertiary care hospital, emphasizing the correlation between clinical findings and histopathological diagnoses, as well as analyzing potential age and gender variations.

MATERIALS AND METHODS

Study design and population

A prospective study was conducted on 100 patients presenting with sinonasal masses at the ENT Outpatient Department of Osmania Medical College, Hyderabad, during the year 2019. Ethical approval was obtained from the institutional review board, and informed consent was secured from all participants.

Inclusion and exclusion criteria

Clinical evaluation

A comprehensive history was taken for each patient, focusing on symptoms like nasal obstruction, nasal discharge, epistaxis, loss of smell, facial deformity, and other associated complaints. Clinical examinations included:

Diagnostic procedures

Data analysis

Patients were categorized based on age and sex. Sinonasal masses were classified into non-neoplastic and neoplastic (benign and malignant) types based on histopathological findings. Data were analyzed to determine:

RESULTS

Demographic data

Out of 100 patients, 58 were male (58%) and 42 were female (42%), yielding a male-to-female ratio of approximately 1.38:1. The age distribution ranged from 5 to 70 y, with the highest incidence in the 31–40 y age group (19%), followed by the 21–30 y age group (18%). The least number of patients (5%) were in the 1–10 y age group (table 1).

Table 1: Age and gender distribution of patients

Age group (Years) Male Female Total Percentage (%)
1–10 4 1 5 5.0
11–20 7 9 16 16.0
21–30 10 8 18 18.0
31–40 10 9 19 19.0
41–50 11 6 17 17.0
51–60 10 6 16 16.0
61–70 6 3 9 9.0
Total 58 42 100 100

Table 2: Gender-wise distribution of sinonasal masses

Disease Male Female Total
Non-neoplastic
Antrochoanal Polyp 5 13 18
Sphenochoanal Polyp 0 1 1
Ethmoidal Polyp 12 10 22
Maxillary Mucocele 1 0 1
Hamartoma 1 4 5
Pyogenic Granuloma 1 1 2
Wegener's Granulomatosis 1 1 2
Total non-neoplastic 21 30 51
Benign neoplastic
Capillary Hemangioma 6 6 12
Cavernous Hemangioma 2 0 2
Inverted Papilloma 8 2 10
Juvenile Angiofibroma 7 0 7
Schwannoma 0 1 1
Fibrous Dysplasia 2 1 3
Olfactory Neuroblastoma 2 0 2
Chondromyxoid Fibroma 1 0 1
Total benign neoplastic 28 10 38
Malignant neoplastic
Squamous Cell Carcinoma 5 2 7
Adenocarcinoma 1 0 1
Spindle Cell Carcinoma 1 0 1
Chondrosarcoma 1 0 1
Salivary Duct Carcinoma 1 0 1
Total malignant neoplastic 9 2 11
Grand total 58 42 100

Distribution of patients based on age groups

Depicting the age-wise distribution of patients.

Distribution of sinonasal masses

Out of the 100 patients:

Others (adenocarcinoma, spindle cell carcinoma, chondrosarcoma, salivary duct carcinoma): 4%

Side of involvement

Clinical presentation

Watering from eyes: 2%

Table 3: Side-wise distribution of sinonasal masses

Disease Right Left Bilateral
Non-neoplastic
Antrochoanal Polyp 5 13 0
Sphenochoanal Polyp 0 1 0
Ethmoidal Polyp 4 4 14
Maxillary Mucocele 0 1 0
Hamartoma 2 2 1
Pyogenic Granuloma 0 2 0
Wegener's Granulomatosis 0 2 0
Benign Neoplastic
Capillary Hemangioma 6 6 0
Cavernous Hemangioma 2 0 0
Inverted Papilloma 4 6 0
Juvenile Angiofibroma 4 3 0
Schwannoma 1 0 0
Fibrous Dysplasia 2 1 0
Olfactory Neuroblastoma 1 1 0
Chondromyxoid Fibroma 1 0 0
Malignant neoplastic
Squamous Cell Carcinoma 5 2 0
Adenocarcinoma 1 0 0
Spindle Cell Carcinoma 0 1 0
Chondrosarcoma 1 0 0
Salivary Duct Carcinoma 0 1 0
Total 39 46 15

Table 4: Percentage of patients with each symptom

Symptom Percentage (%)
Nasal obstruction 92
Unilateral obstruction 62
Bilateral obstruction 31
Nasal discharge 29
Loss of smell 24
Epistaxis 21
Mouth breathing 20
Sneezing 16
Headache 11
Ear pain 10
Sore throat 5
Double vision 3
Watering from eyes 2

Correlation between clinical and histopathological diagnosis

Discrepancies were noted between pre-operative clinical diagnoses and final histopathological findings:

Table 5: Discrepancy between clinical and histopathological diagnoses

Clinical diagnosis (No. of Patients) Histopathological diagnosis (No. of Patients) Discrepancy (%)
Inverted Papilloma (10) Squamous Cell Carcinoma (1) 10.0
Juvenile Angiofibroma (8) Lymphoma (1) 12.5
Squamous Cell Carcinoma (7) Inverted Papilloma (1) 14.3
Ethmoidal Polyp (24) Hamartoma (2) 8.3

DISCUSSION

Demographics and clinical features

Sinonasal masses affect a wide age range, but in this study, the most frequently affected age group was 31–40 y, with a mean age of 34.86 y. Males were more commonly affected than females, consistent with findings by Lathi et al. [8]. The male predominance may be attributed to higher exposure to risk factors such as smoking and occupational hazards [1]. Nasal obstruction was the most common symptom, emphasizing the need for careful evaluation of patients presenting with this complaint. The majority of masses were unilateral, aligning with the findings of Bakari et al. [9], although some studies, like that of Lathi et al. [8], reported more bilateral cases.

Non-neoplastic lesions

Non-neoplastic lesions constituted 51% of cases in our study, with nasal polyps being the most common. Ethmoidal polyps were more prevalent in males and tended to be bilateral, whereas antrochoanal polyps were more common in females and predominantly unilateral on the left side. These findings are similar to those reported by Pradhananga et al. [2] but contrast with Bakari et al. [9], who found ethmoidal polyps more common in females. The variability in prevalence could be due to geographical and environmental factors influencing the development of nasal polyps [4].

Benign neoplastic lesions

Capillary hemangioma was the most frequent benign neoplasm, occurring equally in males and females. All cases arose from the cartilaginous portion of the nasal septum. Inverted papillomas exhibited a male predominance and are notable for their potential for malignant transformation, occurring in up to 11% of cases [11]. This underscores the importance of histopathological examination, even for lesions that appear benign clinically. Juvenile nasopharyngeal angiofibroma was observed exclusively in males, consistent with its known predilection for adolescent males due to hormonal influences [12].

Malignant neoplastic lesions

Malignant lesions accounted for 11% of cases, with squamous cell carcinoma being the most common. The mean age of presentation was 53.63 y, and there was a male predominance. These findings align with other studies reporting squamous cell carcinoma as the most frequent sinonasal malignancy in older adults [5, 13]. Risk factors such as tobacco use and occupational exposures to wood dust and chemicals may contribute to the development of sinonasal malignancies [14].

Diagnostic challenges and discrepancies

The study revealed discrepancies between clinical and histopathological diagnoses, particularly in cases of inverted papilloma and squamous cell carcinoma. Inverted papillomas can mimic squamous cell carcinoma clinically and radiologically, leading to misdiagnosis [15]. Similarly, juvenile angiofibroma was misdiagnosed as lymphoma in one case. These discrepancies highlight the limitations of relying solely on clinical and radiological assessments. Histopathological examination remains indispensable for accurate diagnosis and appropriate management [6].

Clinical implications

The overlapping symptoms of benign and malignant sinonasal masses necessitate a high index of suspicion and thorough diagnostic workup. Early and accurate diagnosis is crucial for optimal patient outcomes, especially in malignant cases where delayed treatment can significantly impact prognosis [7]. Multidisciplinary collaboration involving otorhinolaryngologists, radiologists, and pathologists is essential for effective management [14].

CONCLUSION

Sinonasal masses present a diverse range of pathologies with overlapping clinical features, making accurate diagnosis challenging. This study emphasizes the necessity of histopathological examination to confirm diagnoses and guide appropriate management. Correlating clinical findings with histopathology is crucial for early detection and optimal treatment, particularly in malignant cases where timely intervention is critical.

ACKNOWLEDGMENT

I would like to extend my heartfelt thanks to M. N. Srisresht, a third-year medical student at PMRIMS, for his invaluable assistance in collecting the materials, including histopathology reports, which greatly facilitated the completion of this work.

FUNDING

Nil

AUTHORS CONTRIBUTIONS

All authors have contributed equally

CONFLICT OF INTERESTS

Declared none

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