Bilateral antrochoanal polyp: report of a new case and systematic review of the literature

Journal of Surgical Case Reports, 2019;3, 1–3 doi: 10.1093/jscr/rjz074 Case Report CASE REPORT and systematic review of the literature Omar Iziki*, Sami Rouadi, Redallah Larbi Abada, Mohamed Roubal, and Mohamed Mahtar Department of Otorhinolaryngology, Head and Neck Surgery, King Hassan II University & Ibn Rochd Hospital, Morocco *Correspondence address. Department of Otorhinolaryngology, Head and Neck Surgery, King Hassan II University, Ibn Rochd Hospital, Casablanca, Morocco. Tel.: +212-0613953181; Fax: +212-05 22 92 80 21; E-mail: Abstract Antrochonal polyp (ACP) is a benign, rare, and generally unilateral tumor which originates from the maxillary sinus mucosa. Bilateral ACP is extremely rare. Only few cases have been documented in the literature until 2018. The authors report the case of a 44-yearold women, who presented with a bilateral progressive nasal obstruction for the past 2 years, slight headache and a decreased sense of smell has been started in last four months. Nasal endoscopy revealed pale polypoidal masses in nasal cavities, arising from each middle meatus and extending to the nasopharynx. Computed tomography of the paranasal sinuses revealed the presence of softtissue masses in the maxillary sinuses, passing through the maxillary ostium, and extending into the corresponding nasal cavities, and posteriorly upto the nasopharynx. The other sinuses were normally aerated. The tumors were removed surgically with a nasal endoscopy technique. Histopathology examination the two lesions revealed benign inflammatory nasal polyps. INTRODUCTION Antrochonal polyp is a benign tumor that originates from the maxillary sinus mucosa, prolapses into the nasal cavity through the maxillary ostium, and may reaching the choana and nasopharynx. It was described for the first time by Professor Gustav Killian, in 1906 [1]. Antrochoanal polyps are generally unilateral in occurrence and seen mostly in children and adolescents, bilateral antrochonal polyp are extremly rare [2]. Only 11 cases have been reported in the English scientific literature until April 2017. In this article, we presented a new rare case of bilateral antrochoanal polyp. CASE REPORT We report the case of a 44-year-old female patient, without important pathological antecedents (no history of associated asthma or allergy), who was referred to our ENT clinic with a 2-year history of bilateral progressive nasal obstruction, slight headache and a decreased sense of smell has been started in last four months.She denied other nasal symptoms such as rhinorrhea, epistaxis, sternutation crises, itching, and no otologique or pharyngolaryngeal symptoms. Anterior rhinoscopy and nasofibroscopique revealed pale polypoidal masses in both nasal cavities, arising from each middle meatus and extending to the nasopharynx (Fig. 1). Computed tomography of the paranasal sinuses disclosed an almost complete opacification of the maxillary sinuses and the presence of a soft-tissue masses passing through the maxillary ostium and extending into the corresponding nasal cavities and posteriorly upto the nasopharynx. The other sinuses were normally aerated (Fig. 2). Received: February 5, 2019. Accepted: February 22, 2019 Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2019. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact 1 Bilateral antrochoanal polyp: report of a new case 2 | O. Iziki et al. Surgery was performed exclusively by nasal endoscopy, and the polyps were removed under general anesthetic using functional endoscopic sinus surgery (FESS) with bilateral uncinectomy, middle meatal antrostomy and bilateral polypectomy. Histopathologic examination the two lesions revealed benign inflammatory nasal polyps. The patient experienced a complete recovery with resolution of complaints and no recurrence one year postoperatively. DISCUSSION Figure 2: CT scan showing bilateral antrochoanal polyp. Table 1 Summary of published cases of bilateral antrochoanal polyp. Authors Age(years)/sex Clinical presentation Surgical approach Histology Recurence Time of follow-up Myatt and Cabrera [2] 12/F FESS Benign No 3 months Basu [4] 12/F nasal obstruction + rhinorrhoea nasal obstruction Caldwell-Luc operation Benign No 6 months Jmeian [5] Konstantinidis [6] Yilmaz et al. [7] 6/F 49/F 24/F Benign Benign Benign No No No 6 months 12 months Sousa et al. [3] 37/M Singhal and Gupta [8] Sabino et al. [9] 32/F 48/M Chodankar and Tiwari [1] Oner et al. 57/M 20/M Iziki et al. 44/F Nasal obstruction Nasal obstruction Nasal Obstruction rhinorrhea Nasal obstruction Nasal obstruction Nasal obstruction rhinorrhea, hyposmia Nasal obstruction headache rhinorrhea, hyposmia Nasal obstruction headache, hyposmia FESS FESS Caldwell-Luc Approach and FESS FESS FESS Benign No 6 months Benign Benign No No 4 months FESS FESS Benign Benign No No — — FESS Benign No 12 months Figure 1: Endoscopic view of the left antrochoanal polyp. Antrochoanal polyps are infrequent benign nasal masses, it’s a unilateral condition mainly affecting young people, representing between four to six per cent of all nasal polyps [3]. The pathogenesis and etiology of ACPs are still unknown [4]. In 1988, Berg et al. hypothesized that ACP could arise from an antral cyst [5]. Recently, Frosini et al., in the largest study of 200 cases, suggested that, in a patient with a pre-existing silent antral cyst, an association of inflammatory-anatomical alteration at ostio-meatal complex/middle meatus level, can forced the polyp to herniate outside, through the accessory ostium [1]. It is important to note that ACP can be associated with same chronic inflammatory condition (allergic or infectious), but the factors of cause and effect remain controversial [3]. Macroscopically, the antrochoanal polyp is composed usually of three part: a cystic or antral part filling the maxillary sinus and a solid part arising from the natural or accessory maxillary ostium into the middle meatus (nasal part), and choanal part [1]. Cases of bilateral ACP are extremely rare. In 1995, Myatt and al. descibed the first bilateral ACP in a fit 12-year-old child [2]. In order to obtain more relevant information on this seemingly rare entity, we performed a literature review without language restriction. Our search was conducted in PubMed (up to January, 2018) using the following terms: (Antrochoanal polyp OR bilateral antrochoanal polyp). only eleven articles have been documented in the literature until 2018, that reported 11 cases. Available clinical data were extracted from these articles and summarized in Table 1. Our case was added for analysis purpose (...truncated)