Introduction: Benign nasosinus tumors (BNST) of epithelial origin are relatively rare and arise from the various lining tissues of the nasal and sinus cavities, and from glands developed from these epithelial invaginations. These include nasosinusal polyps, pleiomorphic adenoma and inverted papilloma. The aim of our study was to investigate the epidemiological, clinical, morphological, therapeutic, and evolutionary particularities of these three clinical entities, including two tumors with the potential for progressive malignancy (pleiomorphic adenoma and inverted papilloma) and one strictly benign tumor with a favorable evolution (nasosinus polyp or Schneider polyp). Materials and Methods: This was a retrospective, analytical, cross-sectional study conducted from January 1, 2006 to December 31, 2019 (13 years), in the Department of Otolaryngology and Cervicofacial Surgery at Adolphe SICE Hospital, Pointe-Noire, Congo-Brazzaville. Results: During the study period, 74 patients were registered for a nasosinus tumor, of which 23 were benign tumors of epithelial origin (31%) distributed as follows: 15 cases of nasosinus polyp, 5 cases of pleomorphic adenoma and 3 cases of inverted papilloma. The mean age was 42.5 for polyps, with an estimated median of 38, and 42.9 for the other two entities (pleomorphic adenoma and inverted papilloma), with an estimated median of 41. Nasosinus allergy accounted for 17% of cases, followed by chronic sinusitis (12%); however, in 49% of cases, the patient’s history was not specified. There was no sexual predominance, the sex ratio being 1.08. Occupation, socio-economic level, and education had no impact on the development of these tumors. Most of our patients (52%, 12 cases) had a consultation delay of more than one (1) year, whatever the histological nature of the tumor. The complete nasosinus syndrome (NSS) included nasal obstruction, rhinorrhea, epistaxis, and anosmia, and was found in 19 cases (83%), most often reflecting a nasosinus polyp. CT scans were performed in all patients, with hyperdense images predominating in 22 cases. Management of benign nasosinus tumors was mainly surgical. Postoperative management was straightforward in 15 cases (65%). Conclusion: Benign nasosinus tumors are dominated by nasosinus polyps. Management of these tumors is essentially surgical, with the best clinical outcome.
Benign nasosinus tumors (BNSTs) of epithelial origin are relatively rare and arise from the lining epithelium of the nasal and sinus cavities, and from glands developed from epithelial invaginations. The three most common pose problems of diagnosis of certainty prior to surgical management. These include nasosinusal polyps, pleiomorphic adenomas and inverted papillomas [
In professional environments with limited resources, particularly in developing countries, these tumors pose a problem of diagnostic delay, often with aesthetic prejudice [
This is a retrospective, analytical, cross-sectional study conducted from January 1, 2006 to December 31, 2019, a period of 13 years, in the Otolaryngology and Cervicofacial Surgery Department of the Adolphe SICE Hospital in Pointe-Noire, Congo-Brazzaville.
The general population consisted of patients referred to the department following a presumptive diagnosis of a nasosinus tumor. The study sample consisted of patients with histologically confirmed benign nasosinus tumors of epithelial origin. All non-processable files were excluded from the study.
A triple epidemiological, clinical and paraclinical survey was carried out to create a database of nasosinus tumors, as well as to collect therapeutic and evolutionary data from archived operating room records and from patients seen in medical consultations.
The study variables were epidemiological (age, sex, profession, socio-economic level, education), clinical (history, consultation delay, characteristics of symptoms and associated clinical signs, mode of onset, location), endoscopic, radiological, therapeutic, and evolutionary.
The anatomopathological study was carried out on surgical excisions of the polypoid formation, using 5 - 6 µm sections stained with hematoxylin and eosin. External macroscopic aspects and microscopic details were described: tumor architecture, cell arrangement, nature of the polyp lining, presence, or absence of histological criteria of malignancy (cytonuclear atypia, nucleocytoplasmic ratio, abnormal mitoses, neovascularization), presence or absence of koïlocytes associated or not with disorganization of the tumor epithelium. On histological examination, two (2) groups were formed: group n˚1 (G1), comprising patients with a nasosinus polyp (NSP), and group n˚2, comprising patients with either a pleiomorphic adenoma (PA) or an inverted papilloma (IP).
Univariate and bivariate statistical analysis was performed using Excel 2017 software to create the database and calculate proportions. An associativity relationship was sought between epidemiological, clinical, paraclinical and evolutionary variables, using the Chi-square test with a p-value of 0.05.
The present work was carried out in the context of scientific and hospital research. The epidemiological and clinical investigation guaranteed the confidentiality of patient data. There were no conflicts of interest.
Univariate analysis yielded the following results of socio-demographic characteristics (
During the study period, we recorded a total of 74 patients treated for nasosinus tumors, 23 of whom had benign tumors (31%).
The mean age was 42.5 for nasosinusal polyp, with an estimated median of 38,
| N case | Percentage (%) | |
|---|---|---|
| Gender | ||
| Male | 11 | 48% |
| Female | 12 | 52% |
| Total | 23 | 100% |
| Professions | ||
| Driver | 1 | 4.35% |
| Secretary | 1 | 4.35% |
| Student | 1 | 4.35% |
| Retired | 1 | 4.35% |
| Teacher | 2 | 8.70% |
| Housewife | 2 | 8.70% |
| Engineer | 2 | 8.70% |
| Student | 2 | 8.70% |
| Shopkeeper | 5 | 21.74% |
| Hairdresser | 6 | 26.09% |
| Total | 23 | 100.00% |
| Socio-economic status | ||
| Low | 2 | 8.70% |
| Medium | 8 | 34.78% |
| Good | 13 | 56.52% |
| Total | 23 | 100.00% |
| Education level | ||
| Primary | 5 | 20% |
| Secondary | 9 | 40% |
| Tertiary (university) | 9 | 40% |
| Total | 23 | 100% |
| AGE | NSP (n case) | PA + IP (n case) | TOTAL |
|---|---|---|---|
| [20 - 29 years] | 4 | 2 | 6 |
| [30 - 39 years] | 5 | 1 | 6 |
| [40 - 49 years] | 0 | 4 | 4 |
| [50 - 59 years] | 5 | 0 | 5 |
| ≥60 years | 1 | 1 | 2 |
| TOTAL | 15 | 8 | 23 |
p > 0.005. NSP = naso-sinusal polyp; PA= pleomorphic adenoma; IP = inverted papilloma.
and 42.9 for the other two entities (pleomorphic adenoma and inverted papilloma), with an estimated median of 41. There was no significant difference (p > 0.05).
Most of our patients (52%, 12 cases) had a consultation delay of more than one year, whatever the histological nature of the tumor (
The complete nasosinus syndrome (NSS) included nasal obstruction, rhinorrhea, epistaxis, and anosmia, and was found in 19 cases (83%), most often reflecting a nasosinus polyp.
Nasosinus allergy accounted for 17% of cases, followed by chronic sinusitis (12%); however, in 49% of cases, the patient’s history was not specified.
In these 22 cases, the complete sinus syndrome was associated with headache, and in 2 cases and 1 case respectively with facial pain and lacrimation (
The onset of these symptoms was predominantly progressive in 23 cases (92%). Facial swelling was noted on inspection in 18 cases. This swelling affected the face (44%), cheek (2%), nasolabial fold (17%) and nasofrontal-orbital region (2%) respectively.
The location of benign nasosinus tumors was unilateral in 22 cases (88%), and bilateral in 3 cases (12%) (
Anterior rhinoscopy revealed an endonasal mass in 22 cases (
The physical examination included an endobuccal, otological and ophthalmological examination. On endobuccal examination with a tongue depressor, palatal cupping was found in 8 cases. Otoscopy revealed seromucosal otitis in 2 cases. Ophthalmological examination revealed unilateral exophthalmos in 4 cases,
| Consultation deadline | NSP (n case) | PA + IP (n case) | TOTAL |
|---|---|---|---|
| <6 months | 7 | 3 | 10 |
| [6 - 12 months] | 0 | 1 | 1 |
| >12 months | 8 | 4 | 12 |
| TOTAL | 15 | 8 | 23 |
p > 0.005.
| Clinic Features | PNS (n case) | AP + PI (n case) | TOTAL |
|---|---|---|---|
| Complete NSS = NO + RH + EP + AN | 14 | 5 | 19 |
| Incomplete NSSs | 1 | 3 | 4 |
| TOTAL | 15 | 8 | 23 |
Nasosinusal syndrome (NSS) = nasal obstruction (NO), rhinorrhea (RH), epistaxis (EP), and anosmia (AN).
| Localization | PNS (n case) | AP + PI (n case) | TOTAL |
|---|---|---|---|
| Bilateral | 3 | 0 | 3 |
| Unilateral | 12 | 8 | 20 |
| TOTAL | 15 | 8 | 23 |
p > 0.005.
with visual acuity maintained.
CT scans were performed in all patients, with hyperdense images predominating in 22 cases.
The most common histological type was nasosinus polyp in 15 cases (
Management of benign nasosinusal tumors was mainly surgical, with three types of procedure performed: endoscopic (2 cases), vestibular (6 cases), CADWELL-LUC (4 cases) and DEGLOWIG (2 cases), and transfacial routes in 17 cases represented by the paralateronasal route of MOURE and SIBELIAU with a few variations (
The postoperative course was mostly straightforward in 16 cases (64%), with complications observed in 9 cases (36%); these depended on the therapeutic approach, with the transfacial approach accounting for 6 complications (
| HISTOLOIC FEATURES | N CASE | PERCENTAGE (%) |
|---|---|---|
| Inverted Papilloma (IP) | 3 | 12% |
| Pleiomorphic adenoma (PA) | 5 | 20% |
| Naso-sinusal polyp (NSP) | 15 | 60% |
| TOTAL | 23 | 100% |
p > 0.005.
| TYPE OF PROCEDURE SURGICAL | FOLLOW-UP | TOTAL | |
|---|---|---|---|
| Simple | Complicated | ||
| Endoscopic pathways | 2 | - | 2 |
| Vestibular pathways | 4 | 2 | 6 |
| Transfacial pathways | 10 | 7 | 17 |
| TOTAL | 16 | 9 | 25 |
p > 0.005.
The relative frequency in our study over a 13-year period was 33.7%. This frequency is close to Amana et al. in TOGO 4.78% [
Nasosinus allergy accounted for 17% of cases, followed by chronic sinusitis (12%); however, in 49% of cases, the patient’s history was not specified. There was no sexual predominance, the sex ratio being 1.08. Occupation, socio-economic level, and education had no impact on the development of these tumors.
Repeated personal history of allergy (17%) and chronic sinusitis (12%) were probably risk factors associated with the development of pseudo-inflammatory tumors. The delay in consultation was most often late, at 1 year (14 cases, 56%) or 6 months (10 cases), as reported by Kharoubi et al. [
Clinically, a complete nasosinus syndrome was found by most authors [
The various phases of the physical examination (endobuccal tongue depressor, anterior rhinoscopy, otoscopy) are highly sensitive in evoking the clinical diagnosis, and must be carried out meticulously, especially in cases of palatal curvature (8 cases), unilateral endonasal mass (22 cases, 88%) and associated otitis (2 cases of seromucous otitis).
Complementary ophthalmological examination is an essential part of the physical examination, as it enables us to search for associated ophthalmic lesions (unilateral exophthalmos, with visual acuity, in 4 cases, 16%). This observation was made by Amana et al., who reported orbital involvement (12%), with reduced visual acuity in 5.6% of cases.
On imaging, CT was the gold standard, with hyperdense images found in 22 cases (88%). Histologically, benign nasosinusal tumors were represented by naso-sinusal polyps in 15 cases (60%), followed by pleiomorphic adenomas in 5 cases (20%) and 33 cases (12%). Our results are close to those of Amana et al., Ette et al., who found 66.2% and 60% respectively for benign tumors [
Open surgery was our therapeutic strategy due to the weakness of the technical platform, and this is in line with the attitude of various sub-Saharan authors [
Benign nasosinus tumors are dominated by nasosinus polyps. In our practice, their relative frequency is estimated at around 30% of all tumors diagnosed over a period of more than ten years, with characteristics identical to those reported in the literature from sub-Saharan Africa. The complete nasosinus syndrome, together with rhinoscopy and CT scan data, constitutes a clinical criterion with a strong presumptive diagnosis; and the anatomopathological study of surgical specimens confirms the diagnosis with certainty. Management of these tumors is mainly surgical, with paralateronasal techniques predominating.
The authors declare no conflicts of interest regarding the publication of this paper.
Diembi, S., Ngatali, S.F.C., Otouana, H.B., Gouoni, G.C., Itiere Odzili, F., Moukassa, D. and Ondzotto, G. (2024) Benign Nasosinus Tumors: Epidemiological, Clinical, Morphological, Therapeutic, and Evolutionary Aspects at the Adolphe SICE General Hospital in Pointe-Noire (Congo-Brazzaville). Open Journal of Pathology, 14, 1-10. https://doi.org/10.4236/ojpathology.2024.141001