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Sinonasal Tract – Benign

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Textbook of Head and Neck Pathology

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Abstract

This chapter covers some common, benign sinonasal entities (Schneiderian papillomas) and uncommon, emerging entities (respiratory epithelial adenomatoid hamartoma and sinonasal serous hamartoma). The latter likely represent benign adenosis-like tumor processes rather than hamartomas. Benign peripheral nerve sheath tumors and ectopic central nervous system entities are also discussed.

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Author information

Authors and Affiliations

  1. Erie County Medical Center, State University of New York at Buffalo, Buffalo, NY, USA

    Margaret S. Brandwein

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  1. Margaret S. Brandwein
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Appendices

Self Study

  1. 1.

    Which statement is true regarding Fig. 3.19?

    Fig. 3.19
    figure 19

    Self study

    Full size image
    1. (a)

      This represents a benign hamartomatous process.

    2. (b)

      This is worrisome for carcinoma – ex-inverted papilloma.

    3. (c)

      These lesions appear red and ragged on gross examination.

    4. (d)

      This lesion must arise from the nasal septum.

  2. 2.

    Which statement is true regarding Fig. 3.20?

    Fig. 3.20
    figure 20

    Self study

    Full size image
    1. (a)

      The mature, keratinized squamous epithelium is typical for exophytic papilloma.

    2. (b)

      This lesion must arise from the nasal septum.

    3. (c)

      The epithelium of this inverted papilloma is bland and benign.

    4. (d)

      The architectural changes are worrisome for carcinoma-ex-inverted papilloma.

  3. 3.

    Which statement/statements is/are true regarding Fig. 3.21?

    Fig. 3.21
    figure 21

    Self study

    Full size image
    1. (a)

      This represents a benign hamartomatous process.

    2. (b)

      The proliferating ductules are single-layered with little or no basal cell lining.

    3. (c)

      There is a propensity for the olfactory cleft.

    4. (d)

      a + b.

    5. (e)

      a, b, c.

Answers

  1. 1.

    Which statement is true regarding Fig. 3.19?

    This is an oncocytic Schneiderian papilloma. Stratified columnar oncocytes are appreciated in the bottom panel. The goblet cell hyperplasia here is somewhat unusual.

    1. (a)

      This represents a benign hamartomatous process. No.

    2. (b)

      This is worrisome for carcinoma – ex-inverted papilloma. No.

    3. (c)

      These lesions appear red and ragged on gross examination CORRECT.

    4. (d)

      This lesion must arise from the nasal septum. These typically arise from the antrum or lateral nasal wall.

  2. 2.

    Which statement is true regarding Fig. 3.20?

    1. (a)

      The mature, keratinized squamous epithelium is typical for exophytic papilloma. No papillary structures are seen.

    2. (b)

      This lesion must arise from the nasal septum. The upper left panel demonstrates the typical mucosa of antrum/lateral nasal wall.

    3. (c)

      The epithelium of this inverted papilloma is bland and benign. Bland yes, but see below.

    4. (d)

      The architectural changes are worrisome for carcinoma-ex-inverted papilloma. CORRECT This represents a well-differentiated keratinizing squamous carcinoma-ex-inverted papilloma. As with other well-differentiated keratinizing squamous carcinomas, the lack of pleomorphism can cause some diagnostic confusion. More commonly, carcinoma-ex-inverted papilloma is cytologically pleomorphic.

  3. 3.

    Which statement/statements is/are true regarding Fig. 3.21?

    1. (a)

      This represents a benign hamartomatous process. No. This is an example of respiratory epithelial adenomatoid “hamartoma” (REAH) which represents a clonal proliferation rather than a hamartoma.

    2. (b)

      The proliferating ductules are single-layered with little or no basal cell lining. No. The ductal elements here are surrounded by p63+ basal cells.

    3. (c)

      There is a propensity for the olfactory cleft. CORRECT. There is a propensity for superior nasal cavity REAH to arise from the posterior nasal septum (vomer) and the olfactory cleft.

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Brandwein, M.S. (2016). Sinonasal Tract – Benign. In: Textbook of Head and Neck Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-33323-6_3

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  • DOI: https://doi.org/10.1007/978-3-319-33323-6_3

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  • Online ISBN: 978-3-319-33323-6

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