Clinical, Radiological and Histopathological Characteristics of Unilateral Sinonasal Lesions: An 8-Year Retrospective Study of 202 Patients

Yıl 2025, Cilt: 12 Sayı: 3, 229 - 236, 29.12.2025

Furkan Yavuz , Kerimcan Çakıcı , Sabri Köseoğlu

https://doi.org/10.47572/muskutd.1725596

https://izlik.org/JA78RY47FN

Öz

Unilateral sinonasal pathologies encompass a wide spectrum of conditions ranging from benign inflammatory lesions to rare malignancies, often posing diagnostic challenges due to their ability to mimic innocuous entities while potentially harboring aggressive disease. In this retrospective study conducted at a tertiary otorhinolaryngology center in southwestern Turkey, the epidemiological and histopathological characteristics of 202 adult patients who underwent surgical excision of unilateral sinonasal masses between January 2017 and January 2025 were analyzed. Patients with bilateral disease, previous biopsies at external centers, or incomplete medical records were excluded. The mean patient age was 48.1 ± 17.4 years, with a male predominance of 65.8%. The most prevalent diagnosis was inflammatory polyp or chronic inflammation (57.4%), followed by inverted papilloma (16.8%) and antrochoanal polyp (11.4%), while fungal pathologies, including allergic fungal rhinosinusitis and fungus ball, accounted for 6% of cases. Malignancies were identified in three patients (1.5%). Although computed tomography demonstrated bone erosion or destruction in 17.3% of cases, the majority of these lesions were benign. Nasal obstruction emerged as the most common presenting symptom, noted in 79.7% of patients. The findings emphasize that while most unilateral sinonasal pathologies are benign, the relatively high frequency of inverted papillomas and fungal lesions necessitates meticulous clinical and radiological assessment, with histopathological confirmation remaining indispensable for definitive diagnosis. These region-specific data offer valuable insight into the epidemiology of unilateral sinonasal pathologies and may inform future multicenter investigations aimed at enhancing diagnostic accuracy and treatment strategies.

Anahtar Kelimeler

Inverted Papilloma , Nasal Polyps , Turkey , Unilateral Nasal Obstruction

Proje Numarası

250094

Tek Taraflı Sinonazal Lezyonların Klinik, Radyolojik ve Histopatolojik Özellikleri: 202 Hastayı İçeren 8 Yıllık Retrospektif Çalışma

https://izlik.org/JA78RY47FN

Öz

Tek taraflı sinonazal patolojiler, benign inflamatuar lezyonlardan nadir malignitelere kadar uzanan geniş bir hastalık spektrumunu kapsar ve masum görünümdeki kitlelerin altında agresif hastalıkların gizlenebilmesi nedeniyle tanısal açıdan güçlük oluşturabilir. Bu retrospektif çalışmada, Türkiye’nin güneybatısındaki üçüncü basamak bir otorinolarengoloji merkezinde Ocak 2017 ile Ocak 2025 tarihleri arasında tek taraflı sinonazal kitle nedeniyle cerrahi uygulanmış 202 erişkin hastanın epidemiyolojik ve histopatolojik özellikleri analiz edilmiştir. Bilateral hastalık, dış merkezde önceden yapılan biyopsi öyküsü veya eksik tıbbi kaydı olan hastalar çalışma dışı bırakılmıştır. Hastaların yaş ortalaması 48.1 ± 17.4 yıl olup, erkek hastaların oranı 65.8%’dir. En sık tanı inflamatuar polip ya da kronik inflamasyon (57.4%) olup, bunu inverted papillom (16.8%) ve antrokoanal polip (11.4%) izlemiştir. Alerjik fungal rinosinüzit ve fungus topu dahil olmak üzere fungal patolojiler 6% oranında saptanmıştır. Malignite üç hastada (1.5%) tespit edilmiştir. Bilgisayarlı tomografi, hastaların 17.3%’ünde kemik erozyonu veya destrüksiyonu göstermiş olsa da bu olguların büyük çoğunluğu benign karakterde bulunmuştur. En sık başvuru semptomu, hastaların 79.7%’sinde görülen nazal obstrüksiyondur. Bulgular, tek taraflı sinüs patolojilerinin büyük oranda benign olduğu izlenimini desteklemekle birlikte, özellikle inverted papillomlar ve fungal lezyonların kayda değer sıklığı, bu hastalık grubunun dikkatli klinik ve radyolojik değerlendirmesini gerekli kılmaktadır. Ancak, kesin tanı için histopatolojik doğrulama vazgeçilmezdir. Bölgeye özgü bu veriler, tek taraflı sinüs patolojilerinin epidemiyolojisine yönelik literatüre katkı sağlayabilir ve gelecekte yapılacak çok merkezli çalışmalara zemin oluşturabilir.

Anahtar Kelimeler

İçeri Dönük Papillom , Nazal Polipler , Türkiye , Tek Taraflı Nazal Obstrüksiyon

Proje Numarası

250094

Kaynakça

• Tritt S, McMains KC, Kountakis SE. Unilateral nasal polyposis: clinical presentation and pathology. Am J Otolaryngol Head Neck Med Surg. 2008;29(4):230-232.
• Unsal AA, Kılıç S, Dubal PM, et al. A population-based comparison of European and North American sinonasal cancer survival. Auris Nasus Larynx. 2018;45(4):815-824.
• Kilic S, Shukla PA, Marchiano EJ, et al. Malignant Primary Neoplasms of the Nasal Cavity and Paranasal Sinus. Curr Otorhinolaryngol Rep. 2016;4(4):249-258.
• Kuan EC, Wang EW, Adappa ND, et al. International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors. Int Forum Allergy Rhinol. 2024;14(2):149-608.
• Shin HS. Clinical significance of unilateral sinusitis. J Korean Med Sci. 1986;1(1):69-74.
• Paz silva M, Pinto JM, Corey JP, et al. Diagnostic algorithm for unilateral sinus disease: A 15-year retrospective review. Int Forum Allergy Rhinol. 2015;5(7):590-596.
• Shanbag R, Arunkumar JS, Pai S, et al. Clinical and histopathological correlation of unilateral nasal mass – A retrospective observational study. Indian J Heal Sci Biomed Res. 2023;16(1).
• Dogan ME. Retrospective analysis of pathological changes in the maxillary sinus with CBCT. Sci Rep. Published online 2024:1-7.
• Sakthivel S, Ajila V, Babu GS, et al. Incidental Maxillary Sinus Pathologies in Asymptomatic Subjects — A CBCT Study. Eur J Ther. 2021.
• Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464.
• Lasrado S, Naaz S, Moras K, et al. Analysis of Disease Patterns in Patients with Unilateral Sinonasal Diseases: A Tertiary Care Hospital Experience. Indian J Otolaryngol Head Neck Surg. 2022;74(1):63-69.
• Dutta A, Bhat SN, Kg S, et al. A Clinicopathological Radiological Correlation of Unilateral Sinonasal Masses. Clin Rhinol An Int J. 2024;15(1):5-8.
• Zhang Y, Yang J, Wu Y. Malignant transformation of sinonasal inverted papilloma invading the external nose: A case report and literature review. Sci Prog. 2025;108(2):368504251336024.
• Fulla M, Szafarowski T, Frias-Gomez J, et al. Human Papillomavirus and Factors Associated with Recurrence in Sinonasal Inverted Papillomas from Poland and Spain. Head Neck Pathol. 2020;14(3):758-767.
• Gupta R, Rady PL, Sikora AG, et al. The role of human papillomavirus in the pathogenesis of sinonasal inverted papilloma: a narrative review. Rev Med Virol. 2021;31(3).
• Long C, Jabarin B, Harvey A, et al. Clinical evidence based review and systematic scientific review in the identification of malignant transformation of inverted papilloma. J Otolaryngol-Head Neck Surg. 2020;49(1):1-11.
• Lisan Q, Laccourreye O, Bonfils P. Sinonasal inverted papilloma: From diagnosis to treatment. Eur Ann Otorhinolaryngol Head Neck Dis. 2016;133(5):337-341.
• Upadhya IB, Rao K. Sinonasal Inverted Papilloma: A Narrative Review. Indian J Otolaryngol Head Neck Surg. 2022;74(s2):1017-1022.
• Goudakos JK, Blioskas S, Nikolaou A, et al. Endoscopic Resection of Sinonasal Inverted Papilloma: Systematic Review and Meta-Analysis. Am J Rhinol Allergy. 2018;32(3):167-174.
• Kim DY, Hong SL, Lee CH, et al. Inverted papilloma of the nasal cavity and paranasal sinuses: A Korean multicenter study. Laryngoscope. 2012;122(3):487-494.
• Belli Ş. Single-sided synonasal mass, retrospective study. North Clin Istanb. 2017;5(2):139-143.
• Freitas MR De, Giesta RP, Pinheiro SD, et al. Antrochoanal polyp: a review of sixteen cases. Braz J Otorhinolaryngol. 2006;72(6):831-835.
• Islamoglu Y, Kesici GG, Canan Y, et al. Investigation of Oxidative Stress in Antrochoanal Polyp Etiology. Ear Nose Throat J. 2020;99(10):633-636.
• Yaşar M, Şahin M, Bayram A, et al. Antrokoanal Polipli Hastalara Yaklaşımımız. JAMER. 2021;6(3):81-4.
• Chen YC, Wang X, Pan YW, Teng YS, Pan HG. Distinct and Shared Molecular Mechanisms in Pediatric Antrochoanal Polyps and Chronic Rhinosinusitis with Nasal Polyps: A Proteomic and Metabolomic Integrative Analysis. J Inflamm Res. 2025;18:4435-4447.
• Knör M, Tziridis K, Agaimy A, et al. Human Papillomavirus (HPV) Prevalence in Nasal and Antrochoanal Polyps and Association with Clinical Data. PLoS One. 2015;10(10):e0141722.
• Berg O, Carenfelt C, Silfverswärd C, et al. Origin of the choanal polyp. Arch Otolaryngol Head Neck Surg. 1988;114(11):1270-1271.
• Islas FAE, González JLT, Camarillo JMM. Antrochoanal Polyp: A Literature Update. J Otolaryngol Rhinol. 4:049.
• Ozcan C, Zeren H, Talas DU, et al. Antrochoanal polyp: a transmission electron and light microscopic study. Eur Arch Otorhinolaryngol. 2005;262(1):55-60.
• Yaman H, Yilmaz S, Karali E, et al. Evaluation and management of antrochoanal polyps. Clin Exp Otorhinolaryngol. 2010;3(2):110-114.
• ATA N. Tek taraflı sinonazal cerrahi: semptomlar ve patolojik tanıların analizi. Harran Univ Tip Fak Derg. 2019;16(2):346-51.
• Shuaibu I, Usman M, Ajiya A. Unilateral sinonasal masses: Review of clinical presentation and outcome in Ahmadu Bello university teaching hospital, Zaria, Nigeria. Niger Med J. 2020;61(1):16.
• Chakrabarti A, Denning DW, Ferguson BJ, et al. Fungal Rhinosinusitis: A Categorization and Definitional Schema. Laryngoscope. 2009;119(9):1809-1818.
• Jun YJ, Shin JM, Lee JY, et al. Bony Changes in a Unilateral Maxillary Sinus Fungal Ball. J Craniofac Surg. 2018;29(1):e44-e47.
• Marple BF. Allergic fungal rhinosinusitis: current theories and management strategies. Laryngoscope. 2001;111(6):1006-1019.
• Ghegan MD, Lee FS, Schlosser RJ. Incidence of skull base and orbital erosion in allergic fungal rhinosinusitis (AFRS) and non-AFRS. Otolaryngol Head Neck Surg. 2006;134(4):592-595.
• Kuhn FA, Swain RJ. Allergic fungal sinusitis: diagnosis and treatment. Curr Opin Otolaryngol Head Neck Surg. 2003;11(1):1-5.
• Borish L, Rosenwasser L, Steinke JW. Fungi in chronic hyperplastic eosinophilic sinusitis: reasonable doubt. Clin Rev Allergy Immunol. 2006;30(3):195-204.
• Khammas AH, Hameed HS, Alobaidy FJ. Types and Clinical Profile of Unilateral Sinonasal Masses. Al-Anbar Med J. 2022;18(1):1-4.
• Nair S, James E, Awasthi S, Nambiar S, Goyal S. A review of the clinicopathological and radiological features of unilateral nasal mass. Indian J Otolaryngol Head Neck Surg. 2013;65(Suppl 2):199-204.
• Lehnerdt G, Weber J, Dost P. Unilateral opacification of the paranasal sinuses in CT or MRI: an indication of an uncommon histological finding. Laryngorhinootologie. 2001;80(3):141-145.