Squamous papilloma case report and review of literature


Malignancies in this region present a variety of pathologies, each with distinct prop- erties.

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These tumors have different levels of involvement with the surrounding critical structures, including the brain and orbit. Sinonasal malignancies have diverse pathologies, with the most common being epithelial tumors [4]. Squamous cell car- cinoma SCC is the most common neoplasm in this category, followed by minor salivary gland tumors squamous papilloma case report and review of literature undifferentiated carcinomas [5].

Malignant Primary Neoplasms of the Nasal Cavity and Paranasal Sinus

Because these symptoms are not specific to sinonasal malignancies, and are seen more com- monly in benign inflammatory conditions, workup for malig- nancy is often delayed. Symptoms and signs more likely to arouse suspicion of malignancy include tooth pain, facial defor- mity, cranial neuropathies, trismus, diplopia, and visual loss [7]. In the majority of cases, sinonasal malignancies present in an advanced stage; by contrast, malignancy in the nasal cavity most commonly presents at the T1 stage The high T-stage at initial presentation can be attributed to the non- specific signs and symptoms of these malignancies, as well as poor education of patients and their health care providers.

While the definitive diagno- sis needs to be made with biopsy, magnetic resonance imaging MRI Fig. This manuscript reviews and describes the unique aspects of the epidemiology, histopathologic and clinicopathologic charac- teristics, as well as treatment options for some of different sinonasal malignancies encountered.

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In a review of 13, cases of sinonasal malignancies, the mean age of patients was The highest proportion of cases was seen in white patients Environmental toxins such as cigarette smoke are recognized as risk factors [8]. Smoking leads to a two- to threefold increase in the risk of developing sinonasal malignancies [9,10].

Industrial agents associated with sinonasal malignancies include thorium dioxide, isopropyl oils, lacquer paints, solder and welding ma- terials, wood dust, as well as radium watch dial paint squamous papilloma case report and review of literature. These lesions classically present in the 6th to 7th decades of life.

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Smoking is the predominant modifiable risk factor, but this lesion has also been associated with other environmental exposures such as nickel, arsenic, chromium, and aflatoxin [13]. Histologically, these malignancies are characterized by the presence of sheets of epithelial cells, containing various amounts of keratin. Staging of the disease at presentation is recorded using the TNM system [16].

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They are similar to conventional SCC in their race, age, and gender breakdowns. However, the primary an- atomic site distribution differs slightly between conventional SCC and some of the variants of SCC.

Differences in survival are also seen between SCC and its variants. Most of these malignancies originate from salivary gland tissues, but less commonly they can have histological patterns resembling intestinal adenocarcinomas [20].

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These lesions are more com- mon in those who worked in the hardware and shoe-leather industry or a history of exposure to wood dust [12]. Prognosis in sinonasal adenocarcinomas is poor, but 5-year DSS rates are higher in adenocarcinoma compared with SCC According to a recent population-based analysis of the SEER database, the incidence is 0.

Interestingly, the incidence in women has been steadily declining squamous papilloma case report and review of literature the past three decades while the incidence in men has been stable [21].

SNACC is believed to originate from the minor mucoserous glands in the mucosa, which are below the respiratory-type epithelium of the nasal cavity and paranasal sinuses. There are three morphologic patterns which are cribriform, tubular, and solid.

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Cribriform and tubular-type adenoid cystic carcinoma ACC tend to be lower grade, whereas solid-type ACC tend to be higher grade [23]. A unique aspect of ACCs is that they have a high propensity to undergo perineural spread.

The most common nerves affected by this process are the maxillary, mandibular, and vidian nerves [24]. However, they tend to have better short-term prognosis at 5 years than SCCs.

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Their incidence is estimated to be 0. These malignancies are thought to arise from the nasal ecto- derm of the paranasal sinuses or from the Schneiderian epi- thelium [27].

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Immunohistochemical staining is critical in dif- ferentiating SNUC from other epithelial malignancies; SNUC usually stains positive for neuron-specific enolase, chromogranin, cytokeratins 7, 8, and 19, and negative for S- and vimentin [28].

Similar to other sinonasal malignan- cies, presenting signs and symptoms may include nasal ob- struction, proptosis, cranial nerve palsies, and visual distur- bances.

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Radiographic studies will usually demonstrate mass lesions in multiple anatomic sites with invasion into surrounding structures [27]. Gross pathologic evaluation usually reveals large tumors, often greater than 4 cm, with poorly defined margins.

squamous papilloma case report and review of literature

Histologically, there is hypercellular proliferation with varied patterns including trabecular, satellite, ribbon, lob- ular, and organoid [28]. Cellular infiltrate includes polygonal cells with large round, hyperchromatic nuclei, with a high nuclear to cytoplasm ratio.

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Often, there is invasive growth, with extension into lymphatics, blood vessels, or soft tissue Fig.