causes of nasal mass- joe

7/27/2019 Causes of Nasal Mass- Joe

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CAUSES OF NASALMASS

Joseph Lim071303503

Group A1 Batch 22


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Causes of Nasal Mass

Congenital

Dermoid cysts

Glioma

Encephalocele

Acquired

Neoplastic Non-neoplastic

Benign Malignant

Invertedpapilloma

Juvenilenasopharyngeal

angiofibroma Squamous

papilloma Chondroma Haemangioma Rhinophyma

Ca of nasal cavity Malignant melanoma Lymphoma Sarcoma Olfactory

neuroblastoma Hemangiopericytom

a Plasmacytoma

Nasal polyps Granulomas Traumatic Rhinolith


Congenital

Dermoid cysts

Glioma

Encephalocele

Acquired


Benign Malignant

Invertedpapilloma






a Plasmacytoma

Nasal polyps Granulomas

Rhinolith


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Congenital

Dermoid cysto Simple dermoid: Midline swelling under the skin in front of the

nasal bone

o Associated with sinus: Midline swelling on the dorsum of nose

with an external opening (sinus). Hair may seen protruding

through the sinus. Sinus track can go under nasal bone orintracranial dural - meningitis


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Gliomaso Firm subcutaneous swelling on bridge, side of nose or near

inner canthuso Nipped off portion of encephalocele during embryonic

development

o Occur in infants & children - 60% are extranasal

o

Firm, non compressible and size does not increase on crying,no transillumination and telangiectasis on skin


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Extranasal Encephalocele/ Meningoencephaloceleo Subcutaneous pulsatile swelling in the midline at the root of the

nose (nasofrontal), side of nose (nasoethmoid) or on theanteromedial aspect of orbit (naso-orbital)

o Herniation of brain tissue & meninges through a congenital bony

defect

o Smooth, mobile, easily compressible, enlarges on crying, shows

cough impulse and may be reducibleo Contains CSF and sometimes cerebral tissue


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Congenital

Dermoid cysts

Glioma

Encephalocele

Acquired


Benign Malignant

Invertedpapilloma






a Plasmacytoma


Rhinolith


Congenital

Dermoid cysts

Glioma

Encephalocele

Acquired


Benign Malignant

Invertedpapilloma






a Plasmacytoma

Nasal polyps Granulomas Traumatic Rhinolith

Foreign

bodies


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Non-Neoplastic

1. Nasal polyp

o Non neoplastic masses of edematous, prolapsedmucosa of paranasal sinus/nasal cavity

o Round, pedunculated, fleshy , grape-like mass which is

greyish/bluish white translucent in colour with smooth

glistening surfaceo Soft, mobile, insensitive, and does not bleed on touch


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Aetiology

o Chronic rhinosinusitis

o Asthmao Aspirin intolerance

o

Cystic fibrosiso Allergic fungal sinusitis

o Kartageners syndrome

o Youngs syndrome

o Churg-Strauss syndromeo Nasal mastocytosis


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Pathology

o End product of prolonged odemao Submucosa especially around middle meatus is lax

and is easily water logged

o

Increase vascular permeability fluid retention(odema) prolapse of mucosa


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Antrochoanal v/s Ethmoidal

Pathology

o Arises frommaxillary antrum

o Usually unilateraland solitary

o Arises fromethmoid sinuses

o Bilateral due toallergy

o Multiple due to

multiple ethmoidair cells (8-20)


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Antrochoanal v/s ethmoidal

Clinical features- Symptomso Childreno Unilateral nasal

obstruction Valvular

o Bilateral if opposite

choana is blocked in

nasopharynx

o Unilateral nasaldischarge-mucoid/mucopurulent

o No allergy symptoms

o Middle aged

Exception: in cystic

fibrosis/ mucovisidosisoccurs in children

o Allergy symptoms+

o Bilateral nasal

obstruction/dischargeo Anosmia

o Asthma/ aspirinintolerence


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Antrochoanal v/s ethmoidalClinical features: Signs

o Solitary and unilateralo Seen more postnasally

than anteriorly

o External: Frog-facedeformity +/-(intercanthal widening)

o Multiple and bilateralo Seen more anteriorly


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Tuberculosis

Lupus vulgaris

Sarcoidosis

Leprosy

Rhinoscleroma

Foreign bodyoreosinophilicgranuloma

Idiopathic

Wegenersgranulomatosis

Stewarts

granuloma

Fungal

Rhinosporidiosis

Spirochetal

Syphilis

Bacterial

Granulomatous


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Rhinoscleroma Caused by Klebsiella rhinoscleromatis

(gram negative bacilli)

Starts in the nose, extends tonasopharynx, oropharynx, larynx,

trachea, and bronchi. 3 stages :

Atrophic stage: foul smellingpurulent discharge

Granulomatous stage: painless andnon-ulcerative nodules form in nasal

mucosa, lips and external nose

Hebra nose, woody feeling

Cicatricial stage: Stenosis of nares,

distortion of upper lip, adhesion in

the nose, nasopharynx, and

oropharynx.


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Rhinosporidiosis

Caused by yeast like fungi

Rhinosporidium seeberi A leafy, polypoidal mass, pink

to purple in colour, attached to

nasal septum and lateral wall

Surface is studded with whitedots sporangia of fungus

Strawberry appearance

Vascular and bleeds on touch

May extend to nasopharynx

and hang behind soft palate

Nasal discharge blood

tinged, epistaxis


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3. Traumatic:

Septal haematoma Collection of blood under the perichondrium or periosteum

of the nasal septum Smooth soft rounded swelling of the septum in both the

nasal fossae Bilateral nasal obstruction, frontal headache


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Septal abscess

Results from secondary infection of septal haematoma/

follows furuncle of nose/upper lip Smooth bilateral swelling of the nasal septum

Severe bilateral nasal obstruction Pain and tenderness over the bridge of nose.

May associated with fever with chills, frontal headache Congested septal mucosa Enlarged submandibular lymph nodes


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4. Rhinolith Stone formation in the nasal

cavity Deposition of Ca and Mg salts

around the nucleus of a small

exogenous foreign body,

blood clot or inspissatedsecretion.

Pressure necrosis of

septum/lateral wall.

Unilateral nasal obstruction,foul smelling and blood-

stained discharge.

Grey /greenishmassirregular surfacestony hard


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Foreign bodies

If a child presents with unilateral, foul smelling nasaldischarge, foreign bodies must be excludedAetiology:

pieces of paper, chalk, button, pebbles, seed


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Congenital

Dermoid cysts

Glioma

Encephalocele

Acquired


Benign Malignant

Invertedpapilloma




Ca of nasal cavity Malignant melanoma Lymphoma Sarcoma

Olfactoryneuroblastoma

Hemangiopericytoma

Plasmacytoma


Rhinolith


Congenital

Dermoid cysts

Glioma

Encephalocele

Acquired


Benign Malignant

Invertedpapilloma






Hemangiopericytoma

Plasmacytoma

Nasal polyps Granulomas Traumatic


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Benign Neoplastic

Inverted papilloma

Benign but locally aggressive premalignant tumor of thenasal cavity

Pedunculated grey or reddish mass arise from the lateral

nasal wall, usually in the region of the middle meatus and

turbinate


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Symptoms Elderly males, 4070 years old

Unilateral nasal obstruction

Blood stained nasal discharge

Epistaxis

Pain, epiphora, proptosis +/-

H/O multiple previous nasal polypectomy+/-

Signs Reddish, vascular, firm, mobile, insensitive

pedunculated mass from lateral nasal wall

Looks like unilateral infected polyp May bleed on probing

Proptosis, facial swelling especially if associated with

malignancy


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Histologically benign yet locally

aggressive tumour ofnasopharynx seen in adolescentboys

Exact cause is unknown

testosterone dependent? Site: posterior part of nasal cavity

close to sphenopalatine foramen

Made of vascular and fibrous

tissue The vessels have a single endothelial cell lining without a

muscle coat, which probably explains the tumor's

propensity for hemorrhage; no muscle, cant contract.

Juvenile Nasopharyngeal Angiofibroma (JNA)


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Symptoms Adolescent males; 14-18 years

Nasal obstruction, nasal discharge (80%)

Profuse, painless, unprovoked paroxysms of epistaxis (60%) Less common symptoms include hearing loss, anosmia,

mouth breathing, diplopia and blindness

Signs Lobulated, firm, non-encapsulated mass, pink-gray or

purple-red in colour, Sessile or pedunculated

Probe test: CONTRAINDICATED

Proptosis, palatal bulge, or swelling of the cheek or over the

zygoma- Ominous indications of extensive tumor spread -tumor extension well beyond the nasopharynx.

Otitis media


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Intranasal meningoencephalocoele

o Herniation of brain tissue and meninges through

foramen caecum or cribriform plate

o Present as smooth polyp in upper part of nose

between septum and middle turbinateo Usually in infant and young children

o Misdiagnosed as simple polyp excise

meningealand brain damage


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Squamous papilloma Similar to skin wart Can arise from nasal vestibule or

lower part of nasal septum Maybe single /multiple,

pedunculated/sessile

Rhinophyma Slow-growing tumour, due to

hypertrophy of the sebaceousglands of the tip of external nose

Pink, lobulated mass over thenose with superficial vasculardilation.

seen in the long standing case ofacne rosacea


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Haemangioma

Soft, dark red, pedunculated orsessile tumour

Chondroma Arise from ethmoid, nasal cavity or

nasal septum. Pure chondromas are smooth, firm

and lobulated.


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Congenital

Dermoid cysts

Glioma

Encephalocele

Acquired


Benign Malignant

Invertedpapilloma






Hemangiopericytoma

Plasmacytoma


Rhinolith


Congenital

Dermoid cysts

Glioma

Encephalocele

Acquired


Benign Malignant

Invertedpapilloma






Hemangiopericytoma

Plasmacytoma

Nasal polyps Granulomas Traumatic


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Malignant neoplastic

Carcinoma of nasal cavity

Squamous cell carcinoma (80%) Vestibular Septal Lateral wall

Adenocarcinoma and Adenoid cystic carcinoma

Gland of mucous membrane or minor salivary glandsMalignant melanoma

Malignant tumor of melanocytes, >50 years old Slate grey or bluish black polypoid mass

Site usually at anterior part of nasal septum followed bymiddle and inferior turbinates

Early signs are changes to the shape or color of existingmoles. The mole may itch, ulcerate or bleed.

Spread is by lymphatics and blood


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THANK YOU

causes of nasal mass- joe

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