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Abstract：
Background and objective Nasal and paranasal lesions are one of the most common otorhinolaryngological presentations encountered in clinical practice. Common presenting symptoms of these lesion range from nasal blockades, facial swellings, pain, nasal discharge, and epistaxis to orbital and ear symptoms. Diagnosis can be tricky as these symptoms are common in inflammatory conditions and tumors. The aim of our study was to observe the epidemiology and clinical pathological findings in patients with nasal and paranasal masses presenting to our institute and discuss the challenges in proper diagnosis and management due to similar presentations, and the role of histopathological examination (HPE) and immunohistochemistry (IHC) in overcoming these challenges. Methods The IPD records of 396 patients were taken up for the study. All the specimens were sent in 10% neutral buffered formalin for examination as biopsy for diagnosis or after surgical excision. After adequate fixation, the biopsy specimen was submitted for routine processing, followed by paraffin embedding, and stained with hematoxylin and eosin (H&E). Special stains like periodic acid-Schiff (PAS) and Ziehl-Neelsen (ZN) stains for acid-fast bacilli (AFB) were used as required. IHC was performed in the required samples. IHC markers were performed on representative paraffin-embedded sections according to the streptavidin-biotin immunoperoxidase technique as needed. The findings were noted, and histology was correlated with clinical presentations and investigations, tabulated, and statistically analyzed using SPSS Statistics (IBM, Armonk, NY). Results Of note, 67.92%% were non-neoplastic lesions whereas 18.18% came out to be benign neoplasms and 13.88% were malignant lesions on HPE. Nasal obstruction was the most common presenting symptom (73.23% of patients) followed by nasal mass (64.14% of cases). Inflammatory sinonasal polyps were the most prominent cases in our study, accounting for 41.16% of all lesions; 18.68% fungal RS (mucormycosis) were seen in our study and 4.54% were cases of juvenile nasopharyngeal angiofibroma (JNA). The majority of benign neoplasms encountered were Schneiderian papilloma or inverted papilloma (06.81%). Eighteen (4.54%) cases of squamous cell carcinomas (SCC) were seen in our study and 2.77% (n=11) cases were of adenoid cystic carcinoma. Of 18 cases of SCC, moderately differentiated SCC carcinoma accounted for 10 cases followed by poorly differentiated SCC (5/18) and nonkeratinizing SCC (3/18). IHC for p40 was performed in all the cases of nonkeratinizing SCC, which showed strong and diffuse nuclear positivity. Conclusion The nasal cavity is the site of the most varied presentation of tumors in the upper respiratory tract. Mass in the nose and paranasal sinus (PNS) form a heterogeneous group of lesions with varied histopathological features. The proximity of the area to the eyes and brain warrants early definitive diagnosis so that the lesion is treated before it can involve important and vital centers. Even though malignant nasal tumors have a very low incidence, they cause a lot of morbidity due to their long course and frequent local recurrences. Nasal tumors tend to become polypoidal. Epithelioid papilloma of the nasal cavity often resembles a nasal polyp. Clinical diagnosis can be challenging due to similar presentations and appearances, and hence histological examination is a vital tool for the timely diagnosis of such patients.
摘要：
背景与目的鼻和鼻旁病变是临床上最常见的耳鼻咽喉科表现之一。这些病变的常见症状包括鼻塞，面部肿胀,疼痛,鼻腔分泌物,和鼻出血到眼眶和耳部的症状。诊断可能很棘手，因为这些症状在炎症和肿瘤中很常见。我们的研究的目的是观察患者的流行病学和临床病理发现鼻和鼻旁肿块呈现给我们的研究所，并讨论在适当的诊断和管理的挑战，由于类似的介绍，以及组织病理学检查（HPE）和免疫组织化学（IHC）在克服这些挑战中的作用。方法对396例患者的IPD记录进行研究。所有标本均在10％中性缓冲福尔马林中进行检查，作为活检诊断或手术切除后进行检查。充分固定后,活检标本提交常规处理，然后是石蜡包埋,并用苏木精和伊红(H&E)染色。根据需要使用特殊的染色剂，例如高碘酸希夫（PAS）和Ziehl-Neelsen（ZN）染色剂用于抗酸杆菌（AFB）。在所需样品中进行IHC。根据需要,根据链霉亲和素-生物素免疫过氧化物酶技术在代表性的石蜡包埋切片上进行IHC标记。发现被注意到，组织学与临床表现和调查相关，列表，并使用SPSS统计进行统计分析(IBM，Armonk,NY).结果值得注意，67.92%为非肿瘤性病变，18.18%为良性肿瘤，13.88%为恶性病变。鼻塞是最常见的症状（73.23％的患者），其次是鼻肿块（64.14％的病例）。炎症性鼻窦息肉是我们研究中最突出的病例，占所有病变的41.16％；在我们的研究中发现了18.68％的真菌RS（毛霉菌病）和4.54％的青少年鼻咽血管纤维瘤（JNA）。遇到的大多数良性肿瘤是Schneiderian乳头状瘤或内翻性乳头状瘤（06.81％）。在我们的研究中发现了18例（4.54％）鳞状细胞癌（SCC），而2.77％（n=11）的腺样囊性癌。在18例SCC中，中分化SCC癌占10例，其次是低分化SCC（5/18）和非角化SCC（3/18）。在所有非角化性SCC病例中进行p40的IHC，表现出强烈和弥漫性的核阳性。结论鼻腔是上呼吸道肿瘤表现最多样的部位。鼻和鼻旁窦（PNS）中的肿块形成一组具有不同组织病理学特征的异质病变。该区域与眼睛和大脑的接近度保证了早期明确的诊断，以便在病变涉及重要和重要的中心之前对其进行治疗。尽管恶性鼻腔肿瘤的发病率非常低，由于病程长，局部复发频繁，发病率高。鼻腔肿瘤倾向于变成息肉状。鼻腔上皮样乳头状瘤通常类似于鼻息肉。由于相似的表现和外观，临床诊断可能具有挑战性。因此，组织学检查是及时诊断此类患者的重要工具。
