Dr. sharath chandra

1. Differential diagnosis
of nasal mass
Dr. Sharath Chandra,
JR ENT,
AIIMS RISHIKESH.

2. Reason for detecting various nasal mass

3. Symptoms and its frequency
nasal onstruction
41%
Rhinorrhea
20%
congestion
13%
hyposmia
7%
epistaxis
7%
headache
7%
facial swelling
5%
nasal onstruction Rhinorrhea congestion hyposmia epistaxis headache facial swelling

4. In extreme cases

5. Physical examination
Nasal examination

6. Oral cavity examination

7. Face and orbit examination
• Facial swelling , cheek and nose skin thickening indicates tumor involved soft tissue
through anterior wall.
• Proptosis indicates lamina papyracea involvement.
• Diplopia present along with proptosis in most cases.
• Vision loss indicates to involvement of O.N.

8. Can be divided as..
Anatomical Inflammation/infect
Congn../developmental neoplasms
Nasal mass

9. Normal anatomical variants appearing as
nasal mass
Concha bullosaDNS & SPUR

10. Congenital / developmental

11. Congenital / developmental
Glioma
• Ectopic rests of glial tissue.
• Some visible out side the nasal vault.
• some completely present in nasal cavity.
• No expansion on crying.

12. Meningocele and Encephalocele.
• Meninges out side cranial vault .
• Located in area of foramen caecum.
• Expand on crying.
• Brain tissue along with meninges
protrude out the cranial vault.

13. Inflammatory and infectious
▪ Nasal polyps
▪ Sarcoidosis
▪ Wegner's granulomatosis
▪ Rhinoscleroma

14. Nasal polyp
▪ Non –neoplastic masses .
▪ Edematous nasal or sinus mucosa.
▪ chronic inflammation leading to stromal
edema and variable cellular infiltrate .
▪ watery rhinorrhea , postnasal drip, hyposmia.
▪ A/R reveals single or multiple pale, grey
polypoid masses arising most middle meatus
and prolapsing into the nasal cavity.

15. Continue…
• X ray wont help, except for
opacification.
• CT scan will show the extent
of NP and anatomical
variations and is essential
if surgical treatment is to
be implemented.

16. Sarcoidosis
▪ Classic non caseating granuloma .
▪ Ext. nose and face – lupus pernio
▪ Thickened nasal septum due to
granulomatous infiltration
▪ Yellowish , nodular appearing
lesion.
▪ DNE: classic sarcoid submucosal
nodules.
▪ HPE: classic, non caseating pattern
asteroid bodies.

17. Rhinoscleroma
▪ Chronic
granulomatous
condition
▪ Involves URT
▪ Begins in
mucocutaneous
junction(vestibule)
▪ Females > males;
10-30 yrs. age
group.
▪ Presents as nasal
obstruction,
rhinorrhea ,
deformity,
anosmia.
• Initial nodule small size
• CT: homogenous and
non enhancing
• Include calcification.

18. Wegner's granulomatosis
▪ Sino nasal involvement in
80% cases
▪ nasal obst, rhinorrhea ,
ulceration, crusting
epistaxis .
▪ Osseocartilaginous frame
work damage (saddle
nose).
▪ Kidney and joint
involvement
▪ ANCA C associated .

19. Who classification of benign nasal mass
Epithelial Soft tissue tumor Bone and cartilage Miscellaneous
Papilloma Myxoma Giant cell tumor Juvenile angio fibroma
Salivary gland
adenomas
Leiomyoma Chondroma
Hemangioma osteoma
Schwannoma Osteoid osteoma
Meningioma
neurofibroma

20. Incidence of various mass
400
120
50
109
50
26
11
10
Cap
9
7
0 50 100 150 200 250 300 350 400 450
inverted papilloma
JAF
LCH
Data from a series of 931 patients treated at the University
Hospitals of Brescia and Varese (Italy) from 1994 to 2013.

21. Inverted papilloma(Schneiderian
papilloma)
• 0.5 to 7 % of all nasal tumors
• a/c HPV
• From lateral nasal wall (middle meatus mostly + any one
sinus)
• Some times involve septum and involve C/L cavity

22. Inverted papilloma
Cerebriform appearance

23. Juvenile angiofibroma
• Vascular endothelium lined spaces embedded in fibrous
stroma
• Exclusively male adolescent
• Pterygoid palatine fossa – epicenter

24. Lobular capillary hemangioma
▪ vascular tumor involving nasal vestibule and nasal septum.
▪ m/c seen pregnant females , 20 – 30yr
▪ Recurrent nasal trauma.
▪ Presents as red to purple mass.
▪ Spontaneous epistaxis and nasal obstruction.
▪ On CT U/L mass with soft tissue density.

25. Schwannoma
• 25-55yr of age
• Arise from
Schwann cells
• Trigeminal nerve
,Carotid plexus
and
parasympathetic
fibers of
pterygopalatine
ganglion
• Well delineated ,
unencapuslated
• Globular
• Firm to rubbery
yellow tumor
• Antoni A and B
bodies
• Endoscopy shows
network of fine
capillaries giving
image of vascular
tumor.

26. Schwannoma
lesions with a prevalent Antoni A component have
an intermediate signal on both T1- and T2-
weighted images, whereas in those with a
predominant Antoni B pattern, which is related to
a loose myxoid stroma, hyper intensity is observed
onT2-weighted images.
MRI showing ..A large hyper intense mass obliterates the nasal
fossa and protrudes into the sphenoid and frontal sinus. The
ethmoid roof is eroded, and the crista galli cannot be recognized.

27. Hamartomas
▪ Hamartomas are defined as benign masses of disorganized mature
cells of any tissue type.

28. Malignant nasal mass
 Carcioma
 Squamous cell Ca
 Adenocarcinoma
 Malignant melanoma
 Olfactory neuroblastoma
 Haemangiopericytoma
 Lymphoma
 Solitary plasmacytoma
 Various types of sarcoma

29. Squamous cell CA
▪ m/c malignant tumor
▪ Arise from lateral nasal wall and septum
▪ Grow insidiously with little symptoms.
▪ Pain in maxillary teeth
▪ Palatal erosion.
▪ Proptosis .
▪ Cheek paresthesia's

30. Adenocarcinoma / adenocystic carcinoma
▪ 4-8 % of Sino nasal tumors
▪ Nasal cavity and ethmoid sinus.
▪ a/c with hardwood workers
▪ 3 types- papillary, sessile, alveolar
▪ Adenocystic CA m/c minor salivary gland tumor
in Sino nasal tract
▪ m/c in women
▪ 3 types – cribriform ,tubular , solid
▪ Swiss cheese app,
▪ Perineural invasion .

31. Mucosal melanoma
▪ Rapidly lethal
neoplasm.
▪ m/c nasal septum , inf
turbinate.
▪ Spread submucosally
with little erosion of
bone and cart.
▪ Varies from normal to
heavy pigmentation.
▪ IHC s-100 and HMB
45.

32. Esthesioneuroblastoma
▪ From olfactory epith. in
superior nasal vault.
▪ Sup to middle turbinate.
▪ Tumor made of round cells
arranged in to rosettes , pseudo
rosettes and sheets.
▪ Express – NSE , chromogranin
,synaptophysin.
▪ Snow man appearance on CT
scan.

33. Miscellaneous
▪ Rhinolith: Forms when an intranasal foreign body acts as a nidus
upon
▪ which salts from inspissated mucus precipitate; symptoms include
purulent secretions, recurrent infections, fetid odor, and nasal
obstruction;
▪ can appear as bone-density on CT.

34. Meningocele/encephalocele Expands with crying
Dermoid Fistulous tract
Rhinoscleroma Klebsiella rhinosderomatis
Mikulicz cells
Sarcoidosis Noncaseating granulomas
Wegener disease Pulmonary and renal disease
Unilatera I nasal polyposis Allergic fungal sinusitis
Antrochoanal polyp
Inverting papilloma
Malignancy
Inverting papilloma HPV infection
Juvenile nasopharyngeal angiofibroma Adolescent males

35. Thank you