Monday, September 26, 2022

Nasal Polyps In Sinus Cavity

Types Of Nasal Cavity And Paranasal Sinus Cancers

Causes of Nasal Polyps

Cancer can start from any type of cell that makes up the mucosa, and each type of cancer acts and grows differently.

Each of these types of cancer has a distinct behavior and outlook. They cannot all be treated the same way. Many of them rarely affect the nasal cavity and paranasal sinuses, so they’ve been hard to study. Because of this, doctors must base treatment decisions on their experience with similar cancers in other parts of the head and neck.

What To Expect Before Surgery

A nasal polypectomy is an outpatient procedure. This means that you will go home on the day of your surgery.

Your pre-operative CT scan will let your surgeon know whether your polyps are isolated to only the nasal passages, or if you have polyps in any of your sinus cavities. This will be important for surgical planning.

Before your surgery, you will likely be instructed on the following things:

  • Do not eat or drink anything after midnight the night before surgery.
  • You may be asked to stop taking any blood thinners.
  • Arrive around an hour to an hour and a half before your scheduled procedure, or whenever you are told to arrive.
  • Typically, younger children are scheduled in the morning, and adults are often scheduled afterward. If you have any questions regarding the procedure, you should reach out to your surgeon’s office.

    Medications For Nasal Polyp Removal

    While medications cant physically get rid of nasal polyps, they are used to treat these benign growths. Depending on the type of medication you take, your polyps may shrink or stop growing.

    A medical professional may recommend you try medications, such as steroid sprays and saline irrigation, for at least before considering surgery.

    Medications used for nasal polyp treatment include:

    • Nasal corticosteroid sprays. Often considered the most effective treatment for nasal polyps, these are safe for long-term use. They can also help shrink polyps and reduce inflammation in the nasal passages.
    • Oral steroids. For severe symptoms, your doctor may prescribe oral steroids for a short period of time only. These also help reduce inflammation and shrink nasal growths, but long-term use can lead to side effects.

    Your healthcare professional may also recommend other medications to help alleviate nasal polyp symptoms, such as:

    If medications arent enough to manage your symptoms, your doctor may recommend surgery for nasal polyp removal. This type of surgery is also called a nasal polypectomy.

    You can expect the following during surgery:

  • Prior to your procedure, you may be asked to fast for a certain amount of time before you arrive.
  • Sometimes, a specimen of the tissue will be sent to pathology. A stent that gradually releases steroids may also be put in place to help with healing.
  • You will spend some time in post-surgery recovery, where medical staff will monitor your condition.
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    What Are My Nasal Polyp Treatment Options

    The first step to determining the appropriate nasal polyps treatment is to be evaluated by an experienced sinus surgeon. Dr. Yeung will examine you and may recommend that you have a CT scan of your sinuses taken . This will allow Dr. Yeung to determine if there are any structural abnormalities or another condition thats causing your nasal polyps.

    Conservative treatment options are always tried first and may include the following:

    • Nasal steroid sprays used to shrink polyps, help clear blocked nasal passages and temporarily alleviate runny nose symptoms
    • Antihistamines used to help reduce symptoms like runny nose while decreasing inflammation, particularly if inflammation is caused by allergies
    • Antibiotics used to help treat polyps caused by a bacterial sinus infection
    • Oral steroid pills used to reduce swelling and other symptoms, but they shouldnt be taken long-term because of possible side effects

    Ewings Sarcoma/primitive Neuroectodermal Tumor

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    Definition

    An exceedingly rare sinonasal tumor composed of poorly differentiated small round cells that shows varying degrees of neuroectodermal differentiation and originates from a pluripotential neuroectodermal cell progenitor .

    Epidemiology

    Approximately 9 % of extraosseous EWS/PNETs arise in the head and neck region , and about 20 % of them develop in the sinonasal tract, being the most common site the maxillary sinus, followed by the nasal cavity .

    Primitive neuroectodermal tumor: MRI displaying a destructive mass involving the right maxillary sinus, expanding to the orbit and to both sides of the nasal cavity

    Etiology

    EWS/PNET has been reported following radiotherapy for retinoblastoma .

    Macroscopy

    Sinonasal EWS/PNET may present as a soft polypoid mass.

    Microscopy

    EWS/PNET is composed of uniform, small, undifferentiated, primitive neuroectodermal cells . Unusually, pseudorosettes and true rosettes may be found in these tumors.

    Primitive neuroectodermal tumor: monotonous proliferation of small, round, undifferentiated cells requiring immunohistochemistry for correct typing

    Electron microscopy

    EWS/PNET displays rudimentary neuritic differentiation, as well as scanty microtubule formation dense-core granules are much less abundant than in olfactory neuroblastoma .

    Primitive neuroectodermal tumor: ultrastructurally, a rudimentary neuritic differentiation is seen with scanty microtubule formation. Dense core granules are much less abundant than in olfactory neuroblastoma

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    When To See A Healthcare Provider

    If you find that it’s more difficult to breathe through your nose than usualespecially if you aren’t dealing with a cold or allergiesit’s a good idea to schedule an appointment with your healthcare provider. Similarly, if you lose your sense of taste and/or smell, or have what feels like a head cold or sinus infection that never goes away, it’s time to seek medical treatment.

    At the appointment, your healthcare provider will look in your nose and may have to do a nasal endoscopy to get a good look at the full extent of the polyps.

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    Keratinizing Squamous Cell Carcinoma

    Definition

    Keratinizing squamous cell carcinoma is a malignant epithelial neoplasm originating from the mucosal epithelium of the nasal cavities or paranasal sinuses with histological evidence of squamous differentiation and keratin production.

    Synonyms

    Conventional squamous cell carcinoma and squamous cell carcinoma NOS

    Epidemiology

    At the nasal vestibule, KSCC is the most common malignancy . Due to early recognition and easy access to treatment, they usually have more favorable prognosis than their counterpart of the sinonasal region.

    Sinonasal KSCC comprises up to 4550 % of the malignant tumors of this region in several series . They predominate in males and the great majority are seen in patients aged over 50 years. The maxillary antrum, the lateral nasal wall, and the ethmoid sinuses are the most common sites . Other locations such as the nasal septum and the nasal floor are less usual the frontal and sphenoid sinuses are rarely involved. These tumors grow by local extension, infiltrating the neighboring structures, but lymph node metastases are rare .

    Main locations of sinonasal malignant tumors: 1 maxillary sinus, 2 ethmoid and lateral wall, 3 nasopalatine septum, 4 nasal septum, and 5 roof of the nasal cavity

    Etiology and pathogenesis

    Macroscopy

    Sinonasal KSCCs display gross features similar to those of other upper aerodigestive tract territories.

    Microscopy

    Keratinizing squamous cell carcinoma: proliferation of malignant squamous cells with keratin pearls

    Surgery Is Not The First Solution

    Learning About Nasal Polyps

    Nasal polyps are usually treated conservatively before we suggest surgery. Non-surgical treatment protocols include saline sprays to keep the lining of the nostrils moist or steroid treatments to reduce inflammation. Steroids may be administered into the nostrils in spray form or taken orally to work on the systemic level. Treatment may also center around managing allergy or asthma symptoms since polyps often coincide with these conditions.

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    What To Expect With Surgery For Nasal Polyps

    Nasal polypectomy is the surgical removal of nasal polyps, which are abnormal noncancerous growths that can form from inflammatory materials in your nasal passages or your sinus cavities. They can cause symptoms, including difficulty breathing and congestion. While not all polyps need to be surgically removed, in some cases you and your healthcare provider may decide that surgery is the best option for you.

    When visualized, polyps are a semi-translucent gray color. A nasal polypectomy is not always a cure for nasal polyps. They can grow back if the underlying cause is not treated.

    Sinus Tumors & Csf Leaks

    Tumors within the nasal or sinus cavities can be benign or malignant . Their treatment varies greatly based on type of tumor, location and size.

    A tear in the brain lining and the bone separating the sinuses from the brain can result in a drainage of fluid called cerebrospinal fluid or CSF. A CSF leak can occur from many different sources.

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    Malignant Soft Tissue Tumors

    Malignant soft tissues tumors of the sinonasal tract are very rare neoplasms and account for about 5 % of all the malignancies in this territory . Only the most salient of these entities are covered here. For a detailed discussion of soft tissue tumors, the reader is referred to Chap. 10.1007/978-3-662-49672-5_12.

    Fibrosarcoma

    Definition

    A malignant mesenchymal tumor composed of fibroblast with variable collagen production and in prototypical cases a herringbone pattern .

    Synonym

    Adult fibrosarcoma.

    Epidemiology

    Most of head and neck fibrosarcomas occur in the sinonasal tract and are seen across a wide age range . They are considered the second most common soft tissue sarcoma after rhabdomyosarcoma in the head and neck .

    Clinical aspects

    Fibrosarcomas most commonly cause obstruction and epistaxis . An ethmoid sinus fibrosarcoma arising as a frontal sinus mucocele has been reported .

    Microscopy

    The histological appearance is that of a spindle cell lesion, with fascicles or bundles of neoplastic cells intersecting at various angles, sometimes with a herringbone pattern. Most sinonasal fibrosarcomas have a low-grade appearance, with moderate cellularity and low mitotic rate . In accordance, the behavior is more often characterized by repeated local recurrences, while distant metastases are rare.

    Differential diagnosis

    It includes desmoid-type fibromatosis, leiomyosarcoma, nerve sheath tumors, spindle cell carcinoma, and desmoplastic melanoma.

    Treatment and prognosis
    Definition

    Advanced Sinus Surgery Relieves Nasal Polyp Symptoms Without A Long Recovery

    Nasal polyps

    Most of us have experienced the temporary misery of a stuffy nose or sinuses, especially during cold and allergy season. It can be hard to breathe, smell, and your head may feel as if it weighs a ton. But at least its temporary.

    For people with chronic rhinosinusitis and nasal polyps, this is their life.

    Nasal polyps are noncancerous growths that dangle like grapes from the linings of the nasal passages or sinuses. They can develop in anyone, but approximately 25-30 percent of patients with chronic rhinosinusitis a persistent, long-term sinus inflammation disorder develop nasal polyps.

    Despite their name, these annoying growths dont always originate in the nose. Polyps can form in any part of the sinuses, often appearing where the sinuses drain into the nose near the eyes, base of the brain, and cheekbones.

    Small nasal polyps may not cause any symptoms, but if they grow large enough, they can block your nasal passages and lead to a host of symptoms, including:

    • Runny or stuffy nose
    • Reduced sense of smell
    • Pressure in your face or forehead

    Approximately 4% of adults have nasal polyps, which affect twice as many men as women. The growths can make you more susceptible to sinus infections, asthma flare-ups, and sleep apnea.

    From personalized medications to state-of-the-art procedures, we have all the tools and are dedicated to finding the best treatment for each patient.

    A close-up look at the results of functional endoscopic sinus surgery

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    How Nasal Polyps Are Removed

    Nasal polyps refer to small growths of tissue inside your nasal passages. While usually not cancerous , polyps can gradually grow and lead to problems with smell, congestion, and recurring sinusitis. These symptoms may occur when polyps grow to full size, which is about the same size as a grape.

    Medications are the first line of treatment for nasal polyps to help prevent them from growing larger. However, surgery is the only method that actually removes them.

    Contrary to information found online, theres nosafe or proven way to remove nasal polyps on your own at home.

    Learn what nasal polyp removal entails, and what you can expect.

    The only way to physically remove nasal polyps is through an in-office procedure. However, medications are recommended as a first-line treatment for small growths, to help prevent them from getting larger.

    Talk with a doctor about which option may be right for you.

    Malignant Peripheral Nerve Sheath Tumors

    Definition

    A malignant tumor of nerve sheath phenotype .

    Synonyms

    Neurofibrosarcoma, malignant schwannoma, and neurogenic sarcoma

    Epidemiology

    The head and neck is one of the more common anatomic areas to be affected by malignant peripheral nerve sheath tumors . MPNST of the sinonasal tract is a very rare neoplasm . Most arise de novo or less often in the context of neurofibromatosis type 1 . There is female predominance for the novo sinonasal MPNST and male predominance in NF1-associated MPNST .

    Etiology

    Radiation and immunosuppression may be causative agents of MPNSTs .

    Microscopy

    Epithelioid MPNST marked S-100 protein positivity in a large cell malignant neoplasm, mimicking amelanotic melanoma. Additional immunohistochemistry and electron microscopy resulted confirmatory

    Immunohistochemistry

    In MPNSTs the nerve sheath markers S100 and SOX10 are positive, but usually have focal distribution in contrast, epithelioid MPNSTs stain diffusely for S-100.

    Genetics

    Both NF1 alleles are inactivated in MPNSTs ex neurofibroma associated with NF1.

    Differential diagnosis

    It includes fibrosarcoma, leiomyosarcoma, synovial sarcoma, spindle cell carcinoma, and malignant melanoma. Furthermore, positivity for S-100 in a spindle cell sarcoma as present in MPNST may also be shown by the recently described sinonasal biphenotypic sarcoma, a low grade sarcoma that shows immunohistochemically demonstrable neurogenic and myogenic differentiation .

    Treatment and prognosis

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    What To Expect Long

    Still, despite surgical removal, nasal polyps will likely return. While the exact timeline isnt certain, research suggests that recurrence may be expected within a decade . Symptoms, though, will often remain improved.

    If you experience new symptoms of nasal polyps, discuss next steps with your doctor. This may include repeat surgery or medications, depending on how large the polyps are.

    Nasal corticosteroids and nasal saline irrigations are still recommended long-term to help stop polyps from coming back even after surgery.

    While you cant prevent nasal polyps from occurring, medications may help reduce their growth. In some cases, nasal steroid treatment may help shrink polyps to help prevent the need for surgery or a repeated operation.

    Treating underlying conditions, such as allergies and aspirin sensitivity, may also be important.

    During your treatment plan, take note of any symptoms, and whether they have gotten better or worsened during medication use.

    If you experience frequent nasal symptoms such as congestion or loss of smell, see a medical professional for an evaluation. Even if youve already had nasal polyp surgery, remember that these growths may come back.

    Your healthcare professional will diagnose nasal polyps and make treatment recommendations based on the following:

    • a history of your symptoms
    • a physical exam, including your nasal passages
    • imaging tests

    Teratoma With Malignant Transformation

    Causes for Nasal Polyps – Dr. Sreenivasa Murthy T M

    Definition

    Teratoma with malignant transformation is a neoplasm containing benign tissue elements of all three germinal layers and, in addition, a specific type of malignant tumor .

    Synonym

    Malignant teratoma

    Epidemiology

    In the head and neck, malignant transformation of a teratoma is a distinctly uncommon observation. Involvement of the sinonasal tract by such a lesion is extremely rare. Kuhn et al. reported of a case of squamous cell carcinoma arising in a benign teratoma of the maxilla of a 13-month-old boy . Petrovich et al. reported a nasal malignant teratoma in a 63-year-old man .

    Clinical features

    A fluctuating left facial swelling occurred during a period of 9 months prior to the diagnosis. On computed tomography scans, thickened left maxillary sinus mucoperiostium and a soft tissue defect were observed over the alveolar ridge. Metastatic disease was not found.

    Macroscopy

    A soft tissue mass of 2.0-cm diameter in the left maxillary alveolar ridge with displacement of unerupted teeth has been noted .

    Microscopy

    The tumor was composed of variable mature tissue elements of ectodermal, mesodermal, and endodermal derivation consistent with extragonadal teratoma. An additional finding was the presence of an atypical squamous proliferation with the features of squamous cell carcinoma .

    Differential diagnosis

    It includes immature teratoma with pseudocarcinomatous proliferation of the squamous epithelium and odontogenic cyst.

    Treatment and prognosis

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    Recommendation For Information To Be Obtained To Determine The Phenotype

    When evaluating patients for CRSwNP, it is important to evaluate for the presence of the 4 cardinal symptoms: rhinorrhea, nasal congestion, facial pressure/pain, and hyposmia. While not definitive, hyposmia is more classically associated with CRSwNP while facial pain/pressure is more suggestive of CRSsNP , . It remains difficult to distinguish eosinophilic and non-eosinophilic nasal polyps by clinical symptoms alone. A recent study examining 57 CRS patients who underwent surgery at a tertiary care facility found that ear pain, sneezing, severe difficulty breathing through the nose, severe nasal congestion, and bothersome loss of taste/smell were significantly more likely to be reported in patients with eosinophilic compared to non-eosinophilic nasal polyps . The duration of sinus symptoms is also critical to ascertain, as symptoms lasting greater than 12 weeks are consistent with chronic rhinosinusitis while those lasting less than 4 weeks are more concerning for an acute infectious process.

    In addition to addressing sinonasal complaints, a detailed clinical history should be obtained to establish the presence of an underlying lower respiratory disease such as asthma. Past reactions to any COX-1 inhibitors should be documented so as to not miss the diagnosis of AERD. Finally, symptoms such as sneezing, itching, and ocular involvement are suggestive for underlying allergic rhinitis and should be evaluated given the association with CRSwNP.

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