Sinonasal tumors

Tumors of the nasal cavity and paranasal sinuses are not common in the general population, but are commonly encountered in a rhinology practice.  When unilateral symptoms such as nasal obstruction, smell loss and epistaxis are present then evaluation by an otolaryngologist would be prudent.

The most common sinonasal tumor is an inverted papilloma.  These are also known as Schneiderian papillomas.  Fortunately these are benign tumors, but they can turn into squamous cell carcinoma eventually if not excised.  They can occur throughout the nasal cavity and paranasal sinuses.    Inverted papillomas can be quite large, but usually will have a distinct attachment site that can be identified on CT imaging by looking for an area of hyperostosis.  MRI imaging is helpful to further define the extent of tumor and to distinguish between tumor and blocked secretions.  Most tumors can be excised using traditional endoscopic sinus surgery techniques, and extended endoscopic approaches such as frontal sinus drillout and endoscopic medial maxillectomy can be used to remove tumors without external incisions.  Treatment of the attachment site should be treated with excision, drilling or cauterization to ensure complete removal of all of the tendrils of tumor to prevent recurrence.

Allergic fungal sinusitis can mimic a tumor with its unilaterality, however it is uncommon in the West.

Sinonasal malignancies are thankfully rare (1:500,000 to 1:1,000,000), but prompt diagnosis and management are key to ensure survival.  Squamous cell carcinoma, melanoma, sinonasal undifferentiated carcinoma, esthesioneuroblastoma, lymphoma and adenocarcinoma are the most common sinonasal malignancies.  For most sinonasal malignancies, except lymphoma, treatment is usually surgical resection, and depending on the tumor pathology, post operative radiation and chemotherapy.

 

Josh Meier, M.D. F.A.R.S.