Benign tumors of the nasal cavity and paranasal sinuses: causes, symptoms, diagnosis, treatment

Tumors of the nasal cavity are relatively rare diseases. Much more often diagnosed tumors of the paranasal sinuses and, in particular, tumors of the maxillary sinus. Malignant tumors of this region make, according to different authors, from 0.2 to 1.4% of cancer tumors of other localizations.

Benign tumors of the nasal cavity and paranasal sinuses in adults are observed much less often. At the same time, in the structure of diseases of the ENT organs in children, they constitute 9.5%. Over the past 5 years, there has been a trend towards an increase in their number from 6.2 to 9.5%.

According to the International Histological Classification of WHO No. 19, tumors of the nasal cavity and paranasal sinuses may come from the epithelial, connective, muscular, bone, cartilaginous, lymphatic and hematopoietic tissues and may be of a mixed origin. There are benign tumors (papilloma, adenoma, hemangioma, osteoma, chondroma, teratoma, etc.), malignant (cancer, adenocarcinoma, sarcoma, melanoma, etc.), and tumorous neoplasms (cysts, mucocele, nasal polyps, fibromatosis, fibrous dysplasia and etc.).

ICD-10 code:

• D10.6 Benign neoplasm of the nasopharynx.
• D14.0 Benign neoplasm of middle ear, nasal cavity and paranasal sinuses.

Papilloma

There are two types of papillomas: the papilloma of the vestibule and the nasal cavity.

Symptoms of papilloma

Papillomas of the nasal artery emanate from the skin and have the appearance of a hilly formation of gray, less often of a gray-pink color, practically not differing from the papillomas of the skin of other localizations. Often they have a narrow foot, a dense consistency and small dimensions, as they are easily diagnosed in the early stages.

Papillomas of the nasal cavity proper are both single and multiple, localized mainly in the area of the inferior nasal cavity or nasal septum, often have a wide base, easily bleed. The latter is often the first clinical sign, with further growth there is difficulty in breathing through the corresponding half of the nasal passage, less often bleeding.

Differential diagnostics

Papillomas of the vestibule of the nose should be differentiated with basalomas (rarely localized in this area), as well as with the initial forms of squamous cell carcinoma. Papillomas of the nasal cavity are differentiated, especially with persistent recurrence with the initial forms of cancer of the nasal cavity.

Treatment of papilloma

Traditionally, these formations were removed by a loop and coagulated. In the last decade for these purposes, cryosurgical method and laser removal are used.

Transitional cell papilloma

Synonyms: cylindrical papilloma, papilloma from the respiratory epithelium.

Symptoms of transitional cell papilloma

Transitional cell papilloma usually grows on the lateral wall, at the level of the upper or middle part of the nasal cavity, however it can be located on the septum of the nose and in the maxillary sinus. Clinically, tumor growths on the mucosa differ from banal papillomas with a more red color and endophytic growth.

As the tumor grows and spread to the surrounding tissues, the bone walls are destroyed, the tumor grows into the orbit, the frontal, the wedge-shaped sinuses, the cranial cavity and very rarely into the pterygo-palatine fossa.

Differential diagnostics

Given the invasive growth of transitional cell papillomas, differential diagnosis should primarily be carried out with squamous cell carcinoma. Often there is malignancy of these tumors, and in these cases it is a transitional cell cancer. With inverted papillomas of small size that do not extend beyond the nasal cavity, they should be differentiated with papillomas, polyps and other benign lesions.

Treatment of transitional cell papilloma

Surgery. The volume of surgical interventions is most diverse in comparison with other benign tumors of the nasal cavity. At small sizes of transitional cell papillomas, their endonasal removal is possible. At the same time, the amount of intervention should be adequate, bearing in mind the high probability of tumor recurrence. When the tumor is invaded by neighboring structures, it is removed by access via Caldwell-Luc, Denver, Moore. For tumors of large size, significantly affecting surrounding tissues, especially when it is impossible to exclude transitional cell cancer, resection of the walls of the nose, upper jaw and adjacent bone structures is performed.

Adenoma

This form of benign tumor is rare, and localize in the region of nasal concha, vomer, and posterior sections of the nasal cavity.

[1], [2]

Symptoms of adenoma

The tumor has the form of a node and is localized under the mucous membrane, which, as a rule, is not changed.

It is characterized by slow growth and can reach large sizes. One of the first clinical signs is the difficulty of nasal breathing.

Differential diagnostics

It is performed with the initial forms of infiltrative cancer, in some cases with inverted papilloma.

[3], [4], [5], [6]

Treatment of adenoma

Intranasal removal is technically quite complex manipulation and is possible only with small adenoma sizes. For larger sizes, a Denker type cut is performed, the nasal cavity is opened and tumor is removed, often with resection of surrounding tissues.

Hemangiomas

There are three types of hemangiomas: capillary, cavernous and mixed (with capillary, venous and arterial vessels).

Symptoms of hemangioma

Tumors of red, sometimes crimson-red have a characteristic clinical picture and are located both on the septum and on the side wall of the nose. Often the first clinical manifestation of them are the sanguinary discharge from the nasal cavity, especially with trauma.

Differential diagnostics

The characteristic clinical picture of this form of a benign tumor does not present difficulties for diagnosis.

Treatment of hemangioma

Surgical. The extent of the intervention depends on the location and volume of the tumor.

Other benign tumors of the nasal cavity and paranasal sinuses

The main method of treating other benign tumors of the nasal cavity, as well as neoplasms of soft tissues, bones and cartilage, tumor-like formations is surgical. The volume of surgical intervention is determined by the localization of the tumor, its prevalence and histological structure. Both endonasal and external accesses can be used.