JCDR - Register at Journal of Clinical and Diagnostic Research
Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X
Original Article DOI : 10.7860/JCDR/2013/4718.3025
Year : 2013 | Month : Jun | Volume : 7 | Issue : 6 Full Version Page : 1040 - 1042

Polypoidal Lesions in the Nasal Cavity

Kalpana Kumari M.K.1, Mahadeva K.C.2

1 Associate Professor, Department of Pathology, M.S. Ramaiah Medical College, Karnataka, India.
2 Professor, Department of Pathology, M.S. Ramaiah Medical College, Karnataka, India.

NAME, ADRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Kalpana Kumari M.K, Flat No 710, C Block, Sterling Residency, Dollors Colony, RMV IInd Stage, Bangalore-560094, Karnataka, India.
Phone: 9886392301
E-mail: kalpank@gmail.com

Introduction: Nasal polyps are polypoidal masses arising from mucous membranes of nose and paranasal sinuses. They are overgrowths of the mucosa that frequently accompany allergic rhinitis. They are freely movable and nontender.

Aims and Objectives: The purpose of this study was to study the histopathologic spectrum of polypoidal lesions of the nasal cavity.

Materials and Methods: The study comprised of 100 condivutive cases of polypoidal lesions in the nasal cavity, received in the department of pathology. The age and sex of the patients were recorded. The tissues were routinely processed for histopathologic divtions and stained with haematoxylin and eosin stains. Special stains like Periodic acid Schiff (PAS) was done wherever applicable. The cases were classified into neoplastic and nonneoplastic lesions. The neoplastic lesions were further classified according to WHO classification on histopathologic examination.

Results: Analysis of 100 polypoidal lesions in the nose and paranasal sinuses with clinical diagnosis of nasal polyps, revealed 66 cases were nonneoplastic and 34 were neoplastic;17 (50%)were benign and 17(50%) were malignant. True nasal polyps both inflammatory and allergic together comprised 44 cases of the 100 polypoidal lesions in the nasal cavity. Angiofibroma and inverted papilloma were the most frequent benign tumour accounting for 12/17(0.7%). The most common malignant tumour was anaplastic carcinoma 7/17(0.4%). Nonneoplastic and benign tumours were common in younger age groups whereas malignant tumours were most common in older males.

Conclusion: The majority of polypoidal lesions in the nasal cavity are nonneoplastic.



Nasal polyps are recognized as projections of the mucous membranes which develop in association with chronic rhinitis and sinusitis. Clinically, polyps are smooth, shiny and movable swellings. It is quite impossible to distinguish clinically between simple nasal polyps, polypoidal lesions which are caused by specific granulomatous diseases and polypoidal neoplasms [1].

The clinical features and imaging techniques help us in reaching a provisional diagnosis, but a histopathologic examination remains the mainstay for making a final, definitive diagnosis [2]. The present study analyzed the histopathological spectrum of the polypoidal lesions of the nasal cavity.


This study included 100 consecutive cases of polypoidal lesions in the nasal cavity, which were received in the department of pathology. The age and sex of the patients were recorded. The tissues were routinely processed as histopathologic sections and they were stained with the haematoxylin and eosin stain. Special stains like Periodic Acid Schiff (PAS) were done wherever they were applicable. The cases were classified into neoplastic and nonneoplastic lesions. The neoplastic lesions were further classified according to the WHO classification, based on the histopathologic examination results [3].


The histopathological analysis of the 100 consecutive cases which were clinically diagnosed as nasal polyps revealed that 66 cases were nonneoplastic lesions and that 34 were neoplastic lesions. Among the 34 neoplastic lesions, 17(50%) were benign and 17(50%) were malignant in nature. [Table/Figs-1,2and3] give the demographic details of the study population.

Distribution of Various Lesions in Males and Females

Type of lesionMalesFemalesToatal number of cases
1.Non neoplastic lesions
Inflammatory polyps231235
Allergic polyps639
Granulomatous lesions404
Inflammatory pseudotumor101
Fibrous dysplasia011
Chronic hypertrophic rhinitis011
Non-specific inflammation628
a. Benign tumours
Inverted papilloma426
Capillary haemangioma101
Microcystic papillary adenoma101
Spindle cell lesion101
b. Malignant tumours
Anaplastic carcinoma527
Squamous cell carcinoma426
Non-Hodgkin lymphoma213

Distribution of Nonneoplastic Lesions in the Various Age Groups (years)

Nonneoplastic lesions0-1011-2021-3031-4041-5051-6061-7071-80Total no.
Inflammatory polyp4684553035
Allergic polyp022021209
Granulomatous lesions003000104
Inflammatory pseudotumour010000001
Fibrous dysplasia010000001
Chronic hypertrophic rhinitis000100001
Nonspecific lesions021030118

Distribution of the Neoplastic Lesions in Various Age Groups (years)

Tumour0-1011-2021-3031-4041-5051-6061-7071-80Total no.
Benign tumours
Inverted papilloma001202106
Microcystic papillary adenoma000001001
Malignant tumours
Anaplastic carcinoma010015007
Squamous cell carcinoma011002206
Non-Hodgkin lymphoma000003003

The Non Neoplastic Lesions

True nasal polyps (44) were the commonest non neoplastic lesions which were encountered in this study, followed by four cases of granulomatous inflammations and mucormycosis each. Two cases of rhinosporidiosis and one each of an inflammatory pseudotumour, fibrous dysplasia, chronic hypertrophic rhinitis and rhinoscleroma were seen.

The true nasal polyps were further subdivided into allergic nasal polyps and inflammatory polyps. The allergic nasal polyps have eosinophils infiltrating the stroma, whereas the inflammatory polyps have an oedematous fibrous stroma with a pseudocyst formation and infiltration with lymphocytes and plasma cells. There were 23 males and 12 females with inflammatory nasal polyps and 6 males and 3 females with allergic nasal polyps. These were common in younger patients (22/35), who were in the age range of 11-45 years. On taking all the cases of nonneoplastic lesions together, it was seen that there were 46 males against 20 females and the average age was 39 years (7-71 years).

The Neoplastic Lesions

Seventeen cases each of benign and malignant tumours were seen. Angiofibroma and inverted papilloma were the most common benign tumours. There were 6 cases of each 18% (6/34). Angiofibromas were seen in the younger age group (11-40 years). Inverted papilloma was also predominantly seen in men (4/6) who were in the age group of 30-70 years. Next in frequency were three cases of schwannomas; these cases were seen in elderly females who were aged 54, 50 and 62 years. The other important benign tumours were one case each of a capillary haemangioma and a microcystic papillary adenoma.

Malignant tumours were seen in 50% (17/34) of the neoplastic cases. A majority were sinonasal undifferentiated carcinomas 41% (7/17), followed by squamous cell carcinomas 35% (6/17). Sinonasal undifferentiated carcinomas were predominantly seen in the age group of 40-50 years. This was followed by three cases of non-Hodgkin's lymphoma in elderly patients (50-60 years). One interesting case of a sinonasal adenocarcinoma was seen in a 60 years old male.


In a similar study which was carried out on 345 cases, Dasgupta et al., [4] found 175 (50.7%) non neoplastic lesions and 170 (49.3%) neoplastic lesions. In their study, among the nonneoplastic lesions, true nasal polyps accounted for 110(63.8%) cases; 74(63.3%) being allergic and 36(32.7%) being inflammatory ones. Among 129 benign neoplasms, they found that a majority were hemangiomas which were seen in 59(45.7%) cases and among the 41 malignant neoplasms, 15(36.6%) were squamous cell carcinomas.

In a study which was done by Mysorekar et al., [5] of the 145 lesions which were examined, 102(70.3%) were nonneoplastic and 43(29.7%) were neoplastic; 21(48.8%) were benign and 22 (51.2%) were malignant. True nasal polyps, both inflammatory and allergic, together comprised 86(59.2%) of the polypoidal lesions in the nasal cavity. Angiofibroma was most frequently seen in the benign tumour category, which accounted for 15/22(71.5%) cases. Squamous cell carcinoma was the most frequent tumour which was encountered.

In a study which was done by Dafale et al., [6] simple polyps accounted for 88.57% of total cases and neoplastic polyps accounted for 11.42% cases.

As in other studies, in this study also, the noneoplastic polyps were common as compared to the neoplastic ones. The true nasal polyps, both inflammatory and allergic, comprised 44(44%) of the polypoidal lesions in the nasal cavity.

Rhinosporidiosis is a chronic granulomatous disease which is caused by Rhinosporidium seeberi. Although a variety of sites may be affected, the principal site of infection is the nasal mucosa; this disease is endemic in India and Sri Lanka. It is more prevalent in males and in the second decade of life [7]. The only curative approach is surgical excision, combined with electrocoagulation. No efficacy has been demonstrated in using antifungal and or antimicrobial drugs. Recurrence, dissemination in the anatomically close sites and local bacterial infections are the most frequent complications [8].

We came across one case of rhinoscleroma in a male who was aged 50 years. Rhinoscleroma is a chronic, slowly progressive inflammatory disease of the upper respiratory tract. It is associated with the Klebsiella rhinoscleromatis infection. Without treatment, this condition can result in significant complications which includes the involvement of the lower airways [9].

In the present study, angiofibroma was the commonest benign tumour. All the six cases were males who were in the age group of 10-40 years. Juvenile angiofibroma is a rare tumour which comprises 0.05% of the head and neck tumours, which is histologically benign and locally invasive and it has a specific predilection for the nasopharynx and adolescent males. A study which was done by Madhavan et al also showed an unusual case of nasopharyngeal angiofibroma in a 45 years old male [10].

Microcystic papillary adenoma is rarely seen in the nose [11]. There was one case in our study, who was a 58 years old male.

In the present study, majority of the malignancies were sinonasal undifferentiated carcinomas (7/17) and the remaining were squamous cell carcinomas, adenocarcinomas and non Hodgkin's lymphomas.

In some of the studies which were done by Lathi A et al., [12] and Svane Knudsen et al., [13] they have reported squamous cell carcinoma to be the most commonly encountered malignancy in the sinonasal tract in India and Denmark respectively.

Nasopharyngeal carcinoma has an average age of onset of about 50 years and it has been reported to be unusual in children [14]. However it was seen in a 13 year old girl in this study. A study which was done by Abdulai et al., on head and neck tumours in Ghanaian children, reported that nasopharyngeal carcinoma accounted for 19(9%) of the 613 cases which were studied [15].

The treatment of nasal polyps includes a combination of observation and medical and surgical treatments, depending on the individual clinical assessment. Initially, the patients are treated medically and they are later considered for surgery. The main aims of the treatment are to eliminate or to significantly reduce the size of the nasal polyps to relieve the nasal obstruction, improvement in the sinus drainage and restoration of the olfaction. With both the treatments, recurrences are common, particularly in patients with asthma [16].


Nasal polyps can result from a wide variety of pathologic entities which range from infective granulomatous to polypoidal neoplasms, which include malignant ones. The malignancies should be distinguished from the nonmalignant conditions. Inflammatory and allergic polyps are the most common lesions which present as polypoidal lesions in the nasal cavity. This study helped us to know the prevalence and the distribution of the polypoidal lesions in the nasal cavity and it emphasises that nasal polyps should be subjected for histopathological test, a failure to do so will delay the appropriate treatment.


[1]Friedmann I, Inflammatory conditions of the nose. In: Symmers WSTC, ed Nose, throat and ears 1986 3rd edEdinburghChurchill Livingstone:19-23.  [Google Scholar]

[2]Zafar U, Khan N, Afroz N, Hasan SA, Clinicopathological study of non-neoplastic lesions of nasal cavity and paranasal sinuses Indian J Pathol Microbiol 2008 51(1):26-29.  [Google Scholar]

[3]Wright HN, Lewis SJ Jr, Nasal cavity, paranasal sinuses In The Washington manual of surgical pathology 2012 2nd editionLippincott Williams and Wilkins:34-50.  [Google Scholar]

[4]Dasgupta A, Ghosh RN, Mukherjee C, Nasal polyps-histopathological spectrum Indian J Otolaryngol 1997 49:32-37.  [Google Scholar]

[5]Mysorekar VV, Dandekar CP, Rao SG, Polypoidal lesions in the nasal cavity Bahrain Med Bull 1997 19:67-69.  [Google Scholar]

[6]Dafale SR, Yenni VV, Bannur HB, Malur PR, Hundgund BR, Patil SY, Histopathological study of polypoidal lesions of the nasal cavity - A cross sectional study Al Ameen J Med Sci 2012 5(4):403-06.  [Google Scholar]

[7]Samaddar RR, Sen MK, Rhinosporidiosis in Bhankura Indian J Pathol Microbiol 1990 33:129-36.  [Google Scholar]

[8]Bhargava S, Grover M, Maheshwari V, Rhinosporidiosis: intraoperative cytological diagnosis in an unsuspected lesion Case Report Pathol 2012 2012:101832  [Google Scholar]

[9]Tan SL, Neoh CY, Tan HH, Rhinoscleroma:a case series Singapore Med J 2012 53(2):e24-7.  [Google Scholar]

[10]Madhavan NR, Veervarmal V, Santha Devy, Ramachandran CR, Unusual presentation of nasopharyngeal (juvenile) angiofibroma in a 45 year old female Indian J Dent Res 2004 15:145-48.  [Google Scholar]

[11]Sinha AK, Agrawal A, Lakhey M, Mishra A, Shah SP, Microcystic papillary adenoma of the nose: A case report Indian J Pathol Microbiol 2003 46:76-77.  [Google Scholar]

[12]Lathi A, Syed MMA, Kalakoti P, Qutub D, Kishve SP, Clinico-pathological profile of sinonasal masses: a study from a tertiary care hospital of India Acta Otorhinolaryngol Ital 2011 31(6):372-77.  [Google Scholar]

[13]Svane-Knudsen V, Jorgensen KE, Hansen O, Lindgren A, Marker P, Cancer of the nasal cavity and paranasal sinuses: a series of 115 patients Rhinology 1998 Mar 36(1):12-14.  [Google Scholar]

[14]Taxy JB, Upper respiratory tract. In: Damjanov I, Linder J, eds Andersons pathology 1996 10th edSt. LouisMosby year book inc:1446-69.  [Google Scholar]

[15]Abdulai AE, Nuamah IK, Gyasi R, Head and neck tumours in Ghanaian children. A 20 year review Int J Oral Maxillofac Surg 2012 41(11):1378-82.  [Google Scholar]

[16]Newton Jonathan Ray, Ah-See Kim Wong, A review of nasal polyposis Ther Clin Risk Manag 2008 4(2):507-12.  [Google Scholar]