Case 5
History:
35 year old male with nose stuffiness
Findings:
There is a mass occupying the right maxillary sinus extending into the nasal cavity with enlargement of the maxillary ostium. There is no bony destruction.
Diagnosis:
Discussion:
Antrochoanal polyp derives its name from histological appearance, characterized by inversion of the neoplastic epithelium into the underlying stroma. It presents clinically with unilateral nasal obstruction. The tumors are histologically benign but associated foci of squamous cell carcinoma not uncommon. They usually arise from lateral nasal wall and extend into maxillary and ethmoid sinuses. Bone destruction is rare, usually the result of pressure necrosis and is typically different from aggressive destruction encountered with SCC. Differential considerations classically include: antrochoanal polyp and squamous cell carcinoma.
It can sometimes be difficult to differentiate between an inverted papilloma and antrochoanal polyp. However, the patient’s age (antrochoanal tend to occur in children and young adults) and gadolinium enhancement (inverted papilloma enhance, antrochoanal polyp don’t) can help differentiate the two. The presence of bony erosion and destruction strongly favors squamous cell carcinoma.
