Introducing 

Prezi AI.

Your new presentation assistant.

Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.

Loading…
Transcript

Papilloma of nasal septum & nostril

SCHNEIDERIAN PAPILLOMAS

The fungiform papilloma

The ectodermally derived ciliated respiratory mucosa.

32%

Inverted papilloma

47–78%

Oncocytic papillomas

2–26%

Clinical features

  • 1-Site: nasal septum,only 4–21% originate in or involve the lateral nasal wall.
  • 2-Involvement of the paranasal sinuses is unusual.
  • 3-There is no significant lateralization to either side of the nose.
  • 4-Generally solitary and discrete, they may be multifocal.
  • 5-bilaterality is rare.
  • 6-Epistaxis.
  • 7-unilateral nasal obstruction.
  • 8-the presence of an asymptomatic mass are the typical presenting symptoms.

On physical examination, FPs appear as exophytic, papillary, or warty; gray, pink, or tan; non translucent growths attached to the nasal septum by a relatively broad base

Oncocytic Schneiderian Papilloma

  • is the rarest of the three morphologic variants of Schneiderian papillomas.
  • it shows many features in common with the inverted papilloma.
  • Incidence:1-Oncosytic Schneiderian Papilloma is equally distributed between the sexes,
  • 2-the majority of the patients are >50 years of age at the time of diagnosis.
  • 3-The youngest patient reported thus far in the literature has been a 33-year-old woman.

Pathology

  • Microscopically, exhibits both exophytic and endophytic patterns of growth.
  • epithelium is multilayered.
  • granular cytoplasm reminiscent of oncocytes
  • Observe the multilayered oncocytic epithelium and intraepithelial mucin-filled cysts and microabscesses.

Radiography

The radiographic features are identical to those of the Invetred papilloma.

CLINICAL PICTURE

Treatment & Prognosis

  • occurs exclusively on the lateral nasal wall or in the sinuses, usually the maxillary or ethmoid,
  • a fleshy pink, tan, red-brown, or gray papillary or polypoid growth.
  • Unilateral nasal obstruction and intermittent epistaxis (most common)

The clinical behavior parallels that of the inverted papilloma

.

Effective treatment consists of a lateral rhinotomy and medial maxillectomy.

If inadequately excised, at least 25–35% will recur, usually within 5 years of treatment. Smaller tumors may be treated endoscopically.

Carcinoma &Inverted Papilloma

INVERTED Papilloma occasionally complicated by carcinomas, especially squamous cell carcinoma , verrucous,mucoepidermoid,spindle and clear cell carcinomas, as well as adenocarcinoma

INCIDENCE :from 2 to 27%.

three groups: (1) those who have primarily an IP with only a small focus of carcinoma,

(2) those who have primarily a carcinoma with only a small focus of IP

(3) those who have an IP and then years later develop a carcinoma in the area in which the papilloma arose

Differential Diagnosis

Treatment and Prognosis

  • atypical mitoses
  • keratin pearls,
  • loss of basement membranes,
  • unequivocal invasion associated with an inflammatory-desmoplastic stromal response

1-if neglected, can cause considerable morbidity or even death by extending into contiguous structures

2-The preferred treatment for a lateral rhinotomy and medial maxillectomy with removal of all mucosa in the ipsilateral paranasal sinuses.

3-Radiation therapy should also be considered as an adjunct in patients who have carcinomas arising in IPs.

Radiography

Differential Diagnosis

Must be distinguished from the much more common, keratinizing cutaneous papillomas (e.g., verruca vulgaris) occurring in the nasal vestibule.

The lack of extensive surface keratinization and the presence of mucous cells (accentuated by mucin stains) and ciliated and/or 'transitional' epithelium

,

the presence of minor salivary glands and septal cartilage further indicate that the lesion is of mucosal rather than cutaneous origin.

Treatment and Prognosis

Complete surgical excision is the treatment of choice.

Inadequate excision rather than multiplicity of lesions probably accounts for the 22–50% incidence of local recurrence

Radiography

physical examination, IPs present as pink, tan, or gray; nontranslucent; soft to moderately firm polypoid growths with a convoluted or wrinkled surface

  • Early on, there may be only a soft tissue density within the nasal cavity and/or paranasal sinuses.

Later, with more extensive disease, unilateral opacification and thickening of one or more of the sinuses is common.

Pressure erosion of bone may also be apparent.

Differential diagnosis

  • 1- Invasive carcinoma:loss of basement membrane, atypical mitotic figures.
  • 2-inverted ductal papilloma of minor salivary glands: is confined by duct.
  • 3-Polyps with squamous metaplasia: thickening prominent minor salivary glands, eosinophils and other inflammatory cells, no multilayered epithelium
  • 4-Respiratory epithelial adenomatoid hyperplasia

Extensive bone destruction should always raise the possibility of a carcinoma arising in and/or associated with an inverted papilloma .

  • Incidence : two to five times more common in males,found primarily in the 40–70-year age group.
  • Etiology: HPV 6 and 11, sometimes HPV 16 and 18, and exceptionally, HPV 57,the Epstein-Barr virus (EBV).

Pathology

Clinical Features

  • hyperplastic ribbons of basement membrane
  • enclosed epithelium that grow. endophytically into the underlying stroma
  • epithelium is multilayered.
  • squamous or ciliated, columnar (respiratory epithelial) cells admixed with goblet cells.
  • Nonkeratinizing squamous epithelium tends to predominate.
  • Mitoses are not numerous
  • These are not necessarily signs of malignancy.
  • Arise from: lateral nasal wall in the region of the middle turbinate or ethmoid recesses
  • about 8% arise from the nasal septum.
  • bilateral in 0–10% of cases
  • arouse the suspicion of septal erosion and perforation from unilateral disease.
  • Unilateral nasal obstruction is the most common presenting symptom.
  • nasal drainage.
  • epistaxis
  • anosmia
  • headaches (especially frontal)
  • pain

arouse suspicion of secondary infection even a malignant change.

Inverted Papilloma

Schneiderian membrane in which the epithelium invaginates into and proliferates in the underlying stroma.

Inverted papilloma composed of 'glycogenated' squamous cells. Basement membrane is thin and delicate

Note the endophytic growth and that the epithelial islands are well demarcated from the stroma.

  • Radiological evaluation isn't indicated.
  • Soft tissue along nasal septum.

  • septal erosion.

the exophytic growth, absence of surface keratinization, and presence of a few scattered intraepithelial mucous cells (clear cells)

  • pathology
  • Microscopical: papillary fronds with delicate fibrovascular cores covered by epithelium.
  • Scattered mucin-containing cells&goblet cells.
  • Surface keratinization is absent or scant.
  • Mitoses are rare and never atypical.
  • The stroma contains few inflammatory cells.

Fungiform papilloma

  • Definition: composed of papillary fronds with delicate fibrovascular cores covered by multiple layers of epithelial cells.
  • Incidence :more common in men, between 20 and 50 years of age.
  • Etiology: related to the human papilloma virus, especially types 6 and 11, rarely Types 16 and 57b.
  • are not associated with an increased incidence of carcinoma.
Learn more about creating dynamic, engaging presentations with Prezi