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

Tumors of the nasal cavity are relatively rare diseases. Tumors of the paranasal sinuses and, in particular, tumors of the maxillary sinus are diagnosed much more often. Malignant tumors of this area make up, according to various authors, from 0.2 to 1.4% of cancerous tumors of other localizations.

Benign tumors of the nasal cavity and paranasal sinuses are observed much less frequently in adults. At the same time, they make up 9.5% of ENT diseases in children. Over the past 5 years, there has been a tendency for their number to increase from 6.2 to 9.5%.

According to the International Histological Classification of the WHO No. 19, tumors of the nasal cavity and paranasal sinuses can originate from epithelial, connective, muscular, bone, cartilaginous, lymphatic and hematopoietic tissue and can be of mixed genesis. Tumors are classified as benign (papilloma, adenoma, hemangioma, osteoma, chondroma, teratoma, etc.), malignant (cancer, adenocarcinoma, sarcoma, melanoma, etc.), and tumor-like neoplasms (cysts, mucocele, nasal polyps, fibromatosis, fibrous dysplasia, etc.).

ICD-10 code:

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

Papilloma

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

Symptoms of papilloma

Papillomas of the nasal vestibule originate from the skin and have the appearance of a bumpy formation of gray, less often gray-pink color, practically indistinguishable from papillomas of the skin of other localizations. Often they have a narrow stalk, dense consistency and small size, as they are easily diagnosed in the early stages.

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

Differential diagnostics

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

Treatment of papilloma

Traditionally, these formations were removed with a loop and coagulated. In the last decade, cryosurgery and laser removal have been used for these purposes.

Transitional cell papilloma

Synonyms: cylindrical cell papilloma, papilloma of 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, but can be located on the nasal septum and in the maxillary sinus. Clinically, tumor growths on the mucosa differ from common papillomas by a redder color and endophytic growth.

As the tumor grows and spreads to surrounding tissues, the bone walls are destroyed, the tumor grows into the orbit, frontal, sphenoid sinuses, cranial cavity and very rarely into the pterygopalatine fossa.

Differential diagnostics

Given the invasive growth of transitional cell papillomas, differential diagnostics should primarily be performed with squamous cell carcinoma. Malignancy of these tumors is often observed, and in these cases we are talking about transitional cell carcinoma. In the case of small inverted papillomas that do not extend beyond the nasal cavity, they should be differentiated from papillomas, polyps and other benign formations.

Treatment of transitional cell papilloma

Surgical treatment. The scope of surgical interventions is the most diverse in comparison with other benign tumors of the nasal cavity. In case of small transitional cell papillomas, their endonasal removal is possible. In this case, the scope of intervention should be adequate, keeping in mind the high probability of tumor recurrence. In case of tumor invasion of adjacent structures, it is removed using the Caldwell-Luke, Denver, Moore approach. In case of large tumors that significantly affect surrounding tissues, especially when transitional cell cancer cannot be excluded, resection of the nasal walls, upper jaw and adjacent bone structures is performed.

Adenoma

This form of benign tumor is observed rarely and is localized in the area of the nasal conchae, vomer, and posterior parts of the nasal cavity.

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Symptoms of adenoma

The tumor has the shape of a node and is localized under the mucous membrane, which, as a rule, is unchanged.

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

Differential diagnostics

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

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Treatment of adenoma

Intranasal removal is a technically rather complicated manipulation and is possible only for small adenomas. For larger sizes, a Denker-type incision is made, the nasal cavity is opened and the 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 purple-red color have a characteristic clinical picture and are located both on the septum and on the lateral wall of the nose. Often, their first clinical manifestation is bloody discharge from the nasal cavity, especially in case of trauma.

Differential diagnostics

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

Treatment of hemangioma

Surgical. The scope of 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 cartilages, tumor-like formations is surgery. The scope of surgical intervention is determined by the location of the tumor, its prevalence and histological structure. Both endonasal and external approaches can be used.