Clinico-pathological profile of sinonasal masses: an experience in national ear care center Kaduna, Nigeria

Bakari et al. BMC Research Notes 2010, 3:186 http://www.biomedcentral.com/1756-0500/3/186 DATA NOTE Open Access Clinico-pathological profile of sinonasal masses: an experience in national ear care center Kaduna, Nigeria Aminu Bakari, Olushola A Afolabi*, Adeyi A Adoga, Aliyu M Kodiya, Babagana M Ahmad Abstract Background: The presence of a mass in the nose and paranasal sinuses may seem to be a simple problem; however it raises many questions about the differential diagnosis. The aim of this study is to evaluate the clinicopathological profile of sinonasal masses in our environment This is a retrospective analytical review of all the patients with sinonasal masses that presented to the national ear care center, Kaduna over a six year (2003-2008) period. Their biodata, clinical profile and histological diagnoses were analyzed. Findings: A total of 76 patients were analyzed, age range 5 to 64 yrs with a mean age of 33.3 yr median and modal age of 35.00 (SD = 13.1 ± 1.5). Majority of the patients were in the age groups 21-50 yrs. There were 34 male and 42 female with M: F ratio of 1:1.2. The main presenting symptoms are nasal blockage 97.4% and rhinorrhea 94.7%. It was bilateral in 34 (44.7%), left side in 24(31.6%) and right side in 18(23.7%) patients. The commonest clinical diagnoses were simple nasal polyp 47(61.8%) and antrochoanal polyp 10(13.2%). About 59 (77.6%) were benign, 2 (2.6%) were malignant and 15 (19.7%) were lost to follow up. The commonest histological diagnosis is simple inflammatory nasal polyp in 28 (36.8%) patients and the least was nasal capillary hemangioma 2 (2.6%). About 55(72.4%) patients had surgical treatment. Conclusions: Nasal obstruction and rhinorrhea are the commonest symptoms of presentation, simple inflammatory nasal polyp is still the commonest histological pattern seen in our environment, and surgery is still the best modality of treatment for benign tumor thus the need for advocacy for early recognition and referral to the ENT surgeon. Introduction The presence of a mass in the nose and paranasal sinuses may seem to be a simple problem; however it raises many questions about the differential diagnosis. Nasal polyps (NPs) as part of sinonasal masses (SNM) have been a medically recognized condition since the time of the ancient Egyptians and their removal with a snare was described by Hippocrates, a method which persisted well into the second half of the 20th century [1]. Simple nasal polyps are round, smooth, soft, translucent, yellow or pale glistening structures attached to the nasal or sinus mucosa by a relatively narrow stalk or pedicle. They are non-tender and displaced backwards * Correspondence: National Ear Care Center, PMB 2438, No 3 Golf/Independence Way, Kaduna, Nigeria on probing. These features clinically distinguish them from the turbinates, which are sometimes assumed to be nasal polyps by the less experienced [2]. Classically they are caused by a combination of allergy and infection [3]. Turbinates will shrink on application of vasoconstrictors but polyps will not shrink [2]. Polyps are a common cause of nasal obstruction in the adult, while the diagnosis in children is so rare (0.1%) as to be questionable [1]. In the general population, the prevalence of NP is considered to be around 4% [3]. In cadaveric studies, this prevalence has been shown to be as high as 40% [4]. It predominantly affects adults usually those older than 20. Benign neoplasia of the nose and paranasal sinuses is relatively not uncommon [4]. Cancers of the nose and paranasal sinuses account for less than 1% of all © 2010 Afolabi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Bakari et al. BMC Research Notes 2010, 3:186 http://www.biomedcentral.com/1756-0500/3/186 malignancies and about 3% of all head and neck cancers [5]. It has a geographic tendency to affect the African, the Japanese, and the Arab [5]. It is rarer in Western Europe and America [5]. The aim of this study is to evaluate the clinicopathological profile of sinonasal masses (SNM) seen during the study period and to draw attention to the fact that not all cases of nasal obstruction/discharge are due to chronic infective/allergic sinusitis. Method This is a retrospective analytical review of all the patients with sinonasal masses that presented to the national ear care center, Kaduna over a six year period (2003-2008). The data retrieved included biodata such as age, sex, occupation, aetio-pathological profile which includes presenting complaint, duration of complaints, associated history of allergy, number of episode(s), associated condition(s), nasal obstruction, epistaxis, nasal discharge, loss of smell, site, bilateral or unilateral, clinical diagnosis, histological diagnosis and outcome. Patients with clinical diagnosis of benign lesion like inflammatory polyps had intranasal polypectomy with intranasal antrostomy while others had examination under anaesthesia (EUA) with incisional and excisional biopsy. Patients with clinical diagnosis of malignant nasal masses had examination under anaesthesia and tumour biopsy and some had nasal clearance in advanced disease to reduce tumour bulk and provide biopsy specimen. All masses excised were subjected to histological examination. All the data were entered into the SPSS version 11.0 computer soft ware for analysis and results presented in tables and figures. Results A total of 84 patients had SNM in the study period however only 76 patients had complete data for analysis which form the basis for this report. The age range from 5-64 yrs with a mean age of 33.3 yr median and modal age of 35.00 (SD = 13.1 ± 1.5). Majority of the patients were in the age groups 21-50 yrs (Figure 1). There were 34 males and 42 females with M: F ratio of 1:1.2. About 31% of the patients that presented were either pupils or students, 30.1% were self employed, 21.5% were civil servants and 17.4% were housewives. The main presenting symptoms are nasal blockage 97.4%, rhinorrhea 94.7%, allergic symptoms 52.6%, anosmia 34.6% others are as in Table 1. Duration before presentation was within 1 to 360 months with a mean duration of 40 months. Page 2 of 5 Sinonasal masses were found to be bilateral in 34 (44.7%), left sided in 24(31.6%) and right sided in 18 (23.7%) patients. The clinical diagnosis in most of the cases correlates with the post operative histological diagnosis. The clinical diagnosis were simple nasal polyp in 47(61.8%) Out of the 47 with ethmoidal polyp 31 were male and 16 were females with M: F ratio of 2:1. Antrochoanal polyp occurred in 10(13.2%) of the total sinonasal masses and common among those less than 20 yrs (60%), inverted papilloma 5(6.6% of the total sinonasal masses) wi (...truncated)