d/d of nasal polyp in pathology

1. D/D OF
NASAL POLYP
MODERATED BY- DR.JAYANTI MALA
PRESENTED BY-DR.SHIVANI MEENA

4. Lateral wall of nasal cavity

5. NASAL POLYPS
 Abnormal lesions that originate from any portion of
nasal mucosa or paranasal sinuses.
 Polyps are an end result of varying disease processes
in the nasal cavities.
 The most commonly discussed polyps are benign
semitransparent nasal lesions.

7. Classification:
 Bilateral Ethmoidal polyps
 Antrochoanal polyps
 Neoplastic

8. Bilateral ethmoidal polyp

11. Pathogenesis:

12. Pathology:

20. SIGNS

25. Although all nasal and paranasal
polyp share morphologic
similiarties,there are 3 clinically
and to a lesser
extent,microscopically distinctive
subtype.

26. A. Inflammatory polyps
 Clinical feature:
 it is by far the most common subtype.
 They are multiple and bilateral.
 They involve both nasal and paranasal sinuses.
 They find mainly in >=30 yr old pt.
• Morphologic feature:
 on gross inspection
 Polyp have a translucent,moist,or edematous cut surface.
 Most have broad base of attachment.

27. On microscopic level;
Nasal polyp are localized outgrowth of lamina propria resulting
from the accumulation of edema like fluid with varying degree of
fibroblastic proliferation and inflammation.
Mucous glands are embedded in the stroma,particulary in distal
portion of polyp.
There may be predominance of neutrophillic,eosinophillic,or
lymphoplasmacytic elements.

28. Inflammatory nasal polyp. The
edematous stroma
contains capillaries and a mixed
inflammatoryinfiltrate with prominent
eosinophils.

29. D/d of inflammatory polyp
I. Inverted papilloma
• In inverted papilloma stroma is edematous much like an inflammatory
polyp but the epithelial invagination are clearly evident.

30. •In microscopic level of inverted papilloma
 Nonkeratinizing squamous epithelium is most common followed by
intermediate epithelium.
 All epithelial types present in single papilloma.
 Mitotic figures are ususally few in number and are located in basal or
parabasal region.
 Neutrophills scattered through out the epithelial layer as single cell or
microabcess
 Stroma is fibrous,edematous and vascular.inflammatory cells can be
absent/abundent.plasma cell,lymphocyte and neutrophills
predominantely.
 Unlike inflammatory polyp seromucinous glands are not present except
at the base of lesion where it arise from mucosa.

31. This inverted papilloma consists
of deeply invaginated
nests of benign, predominantly
squamous epithelium

32. Ahigher-power viewof the epithelium
seen in inverted papilloma shows mildly
pleomorphic, hyperchromatic, and
somewhat disorganized
squamous cells. A suprabasal mitotic
figure is present.

33. II. Oncocytic papilloma
 When there are many neutrophills in the epithelium and stroma of
oncocytic papilloma ,the resemblence to an inflammatory polyp is
enhanced.
 Inflammatory polyp do not have oncocytic epithelial cells or mucous
inclusions.
Oncocytic schneiderian papilloma
has irregularly distributed
strips of eosinophilic cells with
interspersed mucous cells and
acute inflammation.

34. Inspissated mucin lies within the clear
spaces of the
mucous cells.

35. III. Respiratory epithelial adenomatoid hamartoma
 Often polypoid mass
 Increased glands composed of bland psuedostratified ciliated
epithelium surrounded by a thick basement membrane separated by
stroma
 Glands and ducts often connect to surface.
 Glands are situated in stroma.background resembling inflammatory
polyp replete with edema and chronic inflammatory cells.
 Rare: males affected more than females, in sixth decade
 It is also differentiate from papillomas and adenocarcinomas.
 The lesion arise most commonly from posterior nasal septum but may
occur from lateral nasal mucosa.

36. Respiratory epithelial adenomatoid hamartoma has
the low-power appearance of an inflammatory polyp but
contains large
numbers of irregular glands.

37. Respiratory epithelial adenomatoid
hamartoma. At
higher magnification, the glands
resemble respiratory bronchial mucosa,
complete with cilia (inset) .

38. IV. Rhinosporiodiosis
 Hyperplastic polypoid lesion in nasal cavity
 Numerous globular cysts measuring up to 300 micro m in diameter
containing numerous endospores (2 to 9 um) of Rhinosporidium
seeberi highlighted by silver stain,PAS,or mucicarmine
 Marked lymphoplasmacytic infiltrate

39. A large, thick-walled sporangium
of rhinosporidiosis
contains hundreds of spores.

40. V. Rhabdomyosarcoma
 Usually more cellular with small primitive cells
 Botryoid variant may be polypoid
 Atypical spindle cells;positive for desmin,myogenin,and MyoD1
VI. Angiofibroma
 Almost exclusively found in males aged 10 to 25 years
 Arise in nasopharynx
 Haphazardly arranged small,thin-walled blood vessels of varying sizes
 Stroma frequently collagenous with stellate fibroblasts

41. B. Nasal polyp in cystic fibrosis
 Clinical feature
 Inflammatory polyps are rare in childhood except in children with
cystic fibrosis.
 They are seen in 20% of children.
 It is important to suspect cystic fibrosis in any child with an
inflammatory nasal polyp.
• Morphologic feature
 Nasal polyp in cystic fibrosis resemble inflammatory polyps but they
lack basement membrane and submucosal hyalinzation.
 They usually contain few stromal eosinophills.

42.  More important the mucous glands,cysts and blanket contain
predominantely acid mucin.manifested as a blue/purple blue
coloration with combined alcian blue/PAS stain.
 In contrast,neutral mucin in inflammatory polyp stain red/purple red.
 Goblet cells in both condition contain acid mucin.
The predominantly acid mucin
in a nasal polyp of
cystic fibrosis stains blue to
purple-blue with the Alcian
blue/ periodic
acid –Schiff stain ( left) . The
neutral mucin in an
inflammatory nasal
polyp stains red to purple-red
with the Alcian blue/ periodic
acid–Schiff
stain ( right).

43. C. Stromal atypia in polyps
 Most,if not all polyps of nasal cavity and paranasal
sinuses have scattered,mild atypical stromal cells.
 Such polyps contain sufficient number of pleomorphic
or overtly bizzare stromal cells to lead confusion with a
sarcoma.
 Atypical cells are most numerous in polyp from
younger indivisuals or in polyp with a fibrous stroma.

44. Scattered, atypical stromal cellswith hyperchromatic,
enlarged nuclei and prominent cytoplasm may be seen
in nasal polyps
of all types. The atypical cells resemble ‘‘radiation
fibroblasts’’ and must
not be confused with a sarcoma.

45. Thank you
Thank you