Nose is the most prominent part of face having great aesthetic value and functional significance.^[1] Filtering, humidifying the temperature of inspired air are done by the functional unit of nose named as the nasal cavity and the paranasal sinuses.^[2]It comprises of epithelial, glandular, lymphoid, fibrovascular connective tissue, cartilage and bony elements. ^[3]

Sino nasal area is exposed to various infective agents, chemicals, antigens, mechanical, and many other influences. As a result of these multifaceted exposures, various inflammatory conditions, infections and neoplasms can occur in the Sino nasal tract.^[4]

The incidence of Sino nasal masses is 1-4% in the total population.^[5] Many of these lesions present as nasal mass with obstruction.Nasal polyps have a prevalence of 4%.^[6] Their pathogenesis is unknown but they have association with allergy, asthma, infections and aspirin sensitivity.^[7].

In the neoplastic lesions, benign tumors were more frequent than malignant tumors.^[8] Malignant lesions of the nose and PNS account for less than 1% of all malignancies and about 3 % of all head and neck malignancies^.[9]

AIMS AND OBJECTIVES OF THE STUDY

1. To study the histomorphological features and clinical correlation of various lesions in nasal cavity, nasopharynx and paranasal sinuses.
2. To study the frequency and distribution of various lesions in nasal cavity, nasopharynx and paranasal sinuses.
3. To categorize neoplastic and non-neoplastic lesions in reference to age and sex differences.

MATERIALS AND METHODS

Retrospective and prospective study done for a period of 3 years from October 2020 to 0ctober 2023 in the department of Pathology, Raichur Institute of Medical Sciences, Raichur.Clinical and radiological details were obtained from histopathology requisition forms and medical records section, RIMS, Raichur. Institutional Ethical Committee approval was obtained for study.

10% formalin fixed tissue were processed and stained with Haematoxylin& Eosin(H&E) for histomorphological evaluation. Periodic acid Schiff (PAS) and Grocott’s methenamine silver stain(GMS) were done where ever required.

182 cases were analysedhistomorphologically and the lesions were categorized. Statistical analysis was done by using SPSS 30 (IBM) software.

RESULTS

In the present study of total 182 cases, non-neoplastic lesions were 165cases which account for 90.66% and neoplastic lesions were 17cases which account for 9.34%(Table 1).

TABLE 1: DISTRIBUTION OF TOTAL CASES

In the present study age of presentation ranges from 1-80years. A maximumof 82 cases (45.05%) were observedin individual aged 21-40years followed by 56 cases (30.76%) in 41-60years, 33 cases (18.13%) in 1-20years and 11cases (6.04%) in 60-80years of age group respectively. The highest number of non-neoplastic cases were seen in the age group of 21-40yrs and neoplastic cases were seen between 41-60 yrs as depicted in (Figure 1).

Fig1: Distribution of cases according to age.

In the present study out of 182 cases, males were 97(53.29%) and females were 85(46.71%) with a ratio of 1.14:1. Male preponderance was seen in non-neoplastic cases and a slight female preponderance was seen in neoplastic cases (Table2).

Table 2: DISTRIBUTION OF CASES BASED ON GENDER

Among 182 cases, 101(55.5%) cases were located in paranasal sinuses, followed by 78 (42.86%) cases in nasal cavity and 3 (1.64%) cases in nasopharynx respectively.

Themost common symptom wasnasal obstruction 75 (41.2%) followed by headache 46 (25.27%). Facial pain/eye pain 27 (14.83%) and nasal discharge 6 (3.29%) were exclusively associated with non-neoplastic lesions. Nasal bleed 4 (2.19%) was more common in neoplastic lesions. Other symptoms like cheek swelling and black discharge were also observed (Table 3).

Table 3: CLINICAL PRESENTATION OF CASES

A total of 165non-neoplastic lesions of which 100 cases (60.6%) wereof inflammatory lesions and 65 (39.4%) cases were of nasal polyp. Among inflammatory lesions chronic inflammation accounts for 97 cases (58.8%) and 3cases (1.8%) were of acute inflammation.

Chronic inflammatory lesions include 62 cases (37.8%) of chronic nonspecific lesions and 35cases (21.2%) of chronic specific inflammatory lesions (mucormycosis).65 cases of Nasal polyps were found of which 49cases (75.4%) were inflammatory and 16cases (24.6%) were allergic nasal polyps

(Table 4& Figure 2).

TABLE 4: DISTRIBUTION OF NON-NEOPLASTIC LESIONS

Figure 2) A: Showing allergic polyp covered by respiratory epithelium with underlying oedematous stroma (H&E 10X).

B:  Inflammatory Polyp showing squamous metaplasia &Stroma showing dense mixed inflammatory cell infiltrate (H&E 10x).C:Chronic specific inflammation- mucormycosis showing broad aseptate ribbon like hyphae (H&E 40X). D: PAS stain highlighting the fungal elements of mucormycosis.

As depicted in table 5 maximum number of non- neoplastic both inflammatory lesions (47 cases) and nasal polyp (32 cases) were seen in 21-40yrs age group followed by 41-60yrs for inflammatory lesions (37 cases) and 1-20yrs for nasal polyp (21 cases).

Table 5: DISTRIBUTION OF NON-NEOPLASTIC LESIONS IN DIFFERENT AGE GROUPS

In our study17 cases were neoplastic lesions, out of which 16 cases (94.12%) were benign and 1 case(8.8%) was malignant(Table 6).

Table 6:DISTRIBUTION OF NEOPLASTIC LESIONS

In our studymaximum cases of benign neoplastic lesions which include Inverted papilloma 5 cases (2.8%) followed by, haemangioma 3 cases (1.7%), Angiofibroma 3 cases (1.7%), osteoma 2 cases (1.1%), 1 case (0.5%) of each fibroepithelial polyp, chondroma and schwannoma respectively were seen in age group of 1-20yrs and 41-60yrs. Malignant case was seen in 4^th to 6^th decade. Maximum preponderance was seen in females among neoplastic lesions(Table 7& Figure 3).

TABLE 7: AGE WISE AND SEX WISE DISTRIBUTION OF NEOPLSTIC LESIONS

Figure 3) A: Inverted papilloma with typical inverted pattern of growth (H&E10X)

.B: Osteoma showing admixture of woven and lamellar bone with haversian canal (H&E 10X).

C:  Chondroma showing closely packed lobules of chondroid tissue separated by fibromyxoid stroma (H&E 10X).D: Chondrosarcoma showing lobules of chondrocytes showing mild pleomorphism, enlarged, mild hyperchromatic nuclei and some showing binucleation (H&E 10X).

In present studymaximum correlation was found for haemangioma (100%) and osteoma (100%) where 3 cases were reported as haemangioma and 2 cases reported as osteoma both clinically and histomorphologically. Chondrosarcoma was reported as clinical diagnosis in 2 cases which show correlation of 50% of which one case was diagnosed as chondrosarcoma and other as chondroma on histopathology. Clinical and histomorphological correlation was found to be statistically significant (P value 0.000014) as depicted in the(Table8).

TABLE 8: CLINICAL AND HISTOMORPHOLOGICAL CORRELATION

DISCUSSION

Masses in nasal cavity form a heterogeneous group of lesions with a broad spectrum of histopathological features. The lack of differentiation between neoplastic and non-neoplastic lesions clinically will delay the diagnosis and treatment. ^[1]

Histopathologic categorization is essential in the management of these lesions because of different treatment modality and emotional burden on the patient.

In the present study a total of 182 cases were studied of which 165(90.66%) were non neoplastic lesion and 17(9.34%) were neoplastic lesions. Similar findings were seen in study done by Aparna M et al ^[10], Hemant chopra et al ^[11], Seema et al ^[12] and Bistel al ^[13](Table 9).

TABLE 9: COMPARISION OF TOTAL CASE DISTRIBUTION WITH PRESENT STUDY

In the present study, the age range of the patient varied from 1 to 80 years. Majority of the patients were in the age group of 21-40 years (45.05%), followed by 41-60 years (30.76%), which was consistent with study done by Vijaya v mysorekar et al ^[14], T. Dinesh singh et al ^[15](table 10).

TABLE 10: COMPARISON OF AGE WISE DISTRIBUTION OF NASAL LESIONS WITH PRESENT STUDY

A slight male predominance was observed in present study with a male to female ratio of 1.14:1. Similar findings observed with study done by Vijaya v mysorekar et al ^[14]  and T. Dinesh singh et al ^[15],. S. R. Dafale et al ^[17] and Harshad’s ^[18]study(Table 11).

TABLE 11: COMPARISON OF SEX WISE DISTRIBUTION WITH PRESENT STUDY

Nasal obstruction was the most common clinical presentation in 75 cases (41.20%) out of 182   and similar results were observed in the studies done by Lathi A et al ^[18], Maheshwari et al ^[19] with nasal obstruction as the most common clinical presentation with 108 (97.3%) cases, 71 (88.75%) cases respectively.

In present study nasal polyp constitutes 65 cases (39.4%) among non-neoplastic cases out of total 180 cases (35.72%). Similar findings with more cases of nasal polyp was observed in the study done by Vijaya v mysorekar et al ^[14] and Dafale SR et al ^[17](Table 12).

TABLE 12: NON-NEOPLASTIC LESION COMPARISION WITH PRESENT STUDY

 Inverted papilloma 5 cases (2.8%) were the commonest benign neoplastic lesion in our study followed by haemangioma and angiofibroma similar most common benign lesions was reported by Hemant chopra et al ^[11], Parajuli &Tuladar’s^[16].Karansinh et al ^[20]. Nepal A. et al ^[21] and Seema et al ^[12] in their study found hemangioma as most common benign lesion followed by inverted papilloma(Table 13).

TABLE 13: COMPARISION OF TYPES OF NEOPLASTIC- BENIGN LESIONS WITH PRESENT STUDY

Chondrosarcoma constitutes approximately 15% of all primary malignant bone tumors. Chondrosarcoma of the nasal septum is rare and is sometimes difficult to suspect on physical examination and differentiating low grade chondrosarcomas from chondromas is also difficult radiologically.

The malignant lesions were predominant in the sixth decades in our study, similar findings were observed in the study by Frazell& Lewis ^[22] and Ghosh & Bhattacharya ^[23] who reported a maximum number of malignant cases in the fifth to seventh decades.

CONCLUSION

In clinical practice lesions of the Nasal Cavity, Nasopharynx and Paranasal sinuses are commonly encountered and it affects any age group. Histopathology plays an integral role in diagnosing and categorizing the lesions as well as it aids in identifying the host response to various lesions. Though histopathology is gold standard but Multidisciplinary approach (clinical, radiological and histopathological examination) aids in appropriate management of the lesions of nasal Cavity, nasopharynx and paranasal sinuses at the earliest.

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