Sphenochoanal polyp presenting with concomitant nasal polyps

A sphenochoanal polyp is a rare lesion that originates in the sphenoid sinus. It occurs most often in adolescents and young adults. We present what to the best of our knowledge is the first reported case of a sphenochoanal polyp associated with concomitant nasal polyps. The patient was a 54-year-old man who presented with bilateral nasal obstruction, possible obstructive sleep apnea, and an altered voice, all of which had likely been caused by the presence of a massive left sphenochoanal polyp and bilateral grade III anterior and posterior ethmoid polyps. Because the patient had dilated cardiomyopathy, he was not a good candidate for general anesthesia. Therefore, the polyps were removed endoscopically under local anesthesia. The sphenochoanal polyp measured 7.5 cm in its greatest dimension and weighed 41 g. The patient remained symptom-free at the 1-year follow-up. The presentation of a sphenochoanal polyp is similar to that of the more common antrochoanal polyp, but the two can usually be differentiated on computed tomography. Endoscopic sinus surgery allows for complete removal of the polyp, including its site of origin, which minimizes the risk of recurrence.     

Angiomatous ethmoidochoanal polyp in an infant: case report

Nasal polyps are rare in children younger than 10 years. We describe the case of an infant girl who had undergone a traumatic intubation at birth that had resulted in nasal bleeding. At the age of 5 months, she was brought to us with an obstructive left nasal mass. Imaging revealed the presence of an ethmoidochoanal polyp, as well as a fracture of the posterior cribriform plate and a small associated meningocele. Four months later, the polyp was excised, and the meningocele was corrected with endoscopic nasal surgery. Pathologic evaluation identified the lesion as an angiomatous polyp, which was probably related to the previous traumatic episode. We discuss the clinical aspects of a pathologic entity that has not been previously reported in an infant.     

Isolated sphenochoanal polyp: A rare clinical entity

Choanal polyps almost always appear as solitary growth and most commonly arise from the maxillary sinus. Isolated polyp originating from the anterior wall of the sphenoid sinus or from its interior and extending as choanal polyp in to the nasopharynx are extremely rare clinical entities. Here we report a 34-year-old male presenting with a history of headache, intermittent nasal discharge and nasal obstruction. A diagnosis of sphenochoanal polyp (SCP) was made on nasal endoscopy and magnetic resonance imaging. The SCP was removed endoscopically via a transnasal sphenoidotomy and histopathologically it was confirmed as inflammatory polyp. In this paper we discuss the clinical presentation and surgical management of this rare clinical entity.     

Plasma cell polyp of the vocal fold

Plasma cell polyps of the vocal fold (plasma cell granulomas) are rare inflammatory polyps of the larynx. They should be included in the clinical and histological differential diagnosis of laryngeal polyps. Histologically they are polyclonal aggregates of plasma cells. It is essential to distinguish them from monoclonal, neoplastic plasma cell proliferations. The treatment of choice is surgical resection, although radiotherapy, laser ablation, antibiotics and steroids have been used successfully. We present a case of plasma cell granuloma presenting as a vocal fold polyp, treated surgically.     

Multiple synchronous fibrovascular polyps of the hypopharynx

PURPOSE OF THE STUDY: To evaluate the clinical, radiological presentation and surgical management of fibrovascular polyps of the hypopharynx. METHODS: Retrospective medical analysis of a case report. We report the case of a 66-year-old man, who presented with an incarcerated left inguinal hernia, vomiting and regurgitation of a large mass into the oral cavity resulting in syncope. MRI and cine-esophagram demonstrated a large mass in the cervical esophagus. At the time of herniorrhaphy, endoscopy revealed an 11.8-cm hypopharyngeal mass that completely obstructed the oropharynx. RESULTS: The airway was secured by tracheostomy and the lesion was subsequently removed via open pharyngotomy. Postoperatively, a second polyp was found ball-valving into the airway, and an endoscopic resection was performed prior to decannulation. Histopathology of both lesions confirmed the diagnosis of a fibrovascular polyp. CONCLUSION: Fibrovascular polyps are rare benign intraluminal esophageal lesions resulting in mild symptoms of dysphagia that may also cause significant morbidity such as syncope and asphyxia. This is the first report of synchronous fibrovascular polyps of the hypopharynx.     

Choanal polyp originating from the nasal septum: a case report

Almost all nasal polyps originate from the mucosa of the lateral walls of the nasal cavity or from the paranasal sinuses. A choanal polyp is the intranasal portion of a cyst that has arisen from the wall of the maxillary sinus near the ostium. Medially based polyps, such as those that arise from the nasal septum, are rare. The literature cites a wide range of incidence rates for polyps originating from this structure, but choanal extension of this type of polyp is extremely unusual. This report describes a polyp that arose from the superior aspect of the posterior nasal septum and extended through the choana into the nasopharynx. The histology of this choanal lesion was typical of nasal polyps, but the site of origin is rare. The ethiopathogenesis of nasal polyps with its common location remains controversial so it is difficult to speculate what mechanism triggered the development of this lesion on the nasal septum. Some form of local inflammation may have induced choanal polyp formation at this atypical site.     

Choanal polyp originated from the inferior nasal concha

Almost all choanal polyps originate from the maxillary sinus and a choanal polyp (CP) originating from the inferior nasal concha (INC) is a rare entity. It presents in a similar manner to the more common antrochoanal polyp and may be confused on anterior rhinoscopy. In this report, an unusual case of a CP taking origin from the INC that was removed by endoscopic endonasal surgery in a young man is presented. No intraoperative or postoperative complication occured, and the symptoms immediately resolved after the operation. Although very rare, CPs arising from the INC should be kept in mind in the differential diagnosis of a solitary nasal polyp.     

Tissue-specific immunoglobulin E in human nasal polyps

Allergy is generally believed to be an underlying cause of nasal polyps. The objective of this study was to define allergic nasal polyps. We investigated specific immunoglobulin E (sIgE) in polyp tissue. Thirty pieces of polyp tissue were taken from patients with positive allergic symptoms, and 30 from patients without allergic symptoms. Nasal polyp tissue homogenate and serum from these patients were prepared for detecting sIgE by a CAP method. For patients with allergic symptoms and/or positive serum CAP test results, the rates of positive tissue CAP tests were low: 36.7% and 35.7%, respectively. However, nearly all of the tissue CAP-positive subjects had allergic symptoms and positive serum CAP tests. We conclude that the local tissue sIgE profile reflects more specifically the allergic status of patients with nasal polyps than does the systemic serum test or the presentation of allergic symptoms. Thus, polyp tissue CAP tests might be performed in patients with positive allergic symptoms and positive serum CAP tests to define an allergy-induced polyp precisely. Then, specific antiallergic treatment could be administered to prevent polyp recurrence.     

Angiolipoma of hypopharynx: A diagnostic dilemma

Fibro vascular polyps of esophagus are rare tumours. They usually arise close to cricopharyngeus muscle. The commonest symptom is dysphagia but regurgitation of fleshy mass into mouth, regurgitation of recently digested food and sensation of lump in throat are also reported. Several reports of polyp regurgitation and subsequent airway obstruction are mentioned. We present a 48-year-old male with fibrovascular polyp of hypopharynx. Diagnosis was established by barium swallow and oesophagoscopy.Transoral route was used to remove the polyp and histopathology reported as angiolipoma.     

Choanal and angiomatous polyps of the sinonasal tract.

Choanal and angiomatous polyps can be distinguished from ordinary sinonasal polyps by either a distinctive clinical presentation (choanal) or the histopathologic appearance (angiomatous). Nearly all choanal polyps arise within paranasal sinuses, with the antrochoanal polyp the most common. The angiomatous polyp is most often a secondary change in a choanal polyp and can be mistaken for vascular neoplasms, eg, angiofibroma.     

Detection of activated eosinophils in nasal polyps of an aspirin-induced asthma patient

Aspirin-induced asthma (AIA) is frequently accompanied by nasal polyps. Eosinophil infiltration is a characteristic feature of nasal polyps associated with AIA. Even though steroids are well known to be effective on managing AIA and its nasal polyps, histochemical examinations after steroid therapy and at recurrence, involving eosinophil infiltration of nasal polyps, have been less studied. To know the histochemical effects of steroid treatment on eosinophil accumulation in nasal polyps of AIA and the histochemical feature of a recurring polyp and to detect distributional differences between storage and secreted forms of eosinophil cationic proteins, we carried out immunocytochemical labelling with antibodies against EGI (recognizing resting and activated eosinophils) and EG2 (recognizing only activated eosinophils), and determined eosinophil infiltration in nasal polyps that were obtained before and after steroid treatment, and at recurrence of polyps. A large number of eosinophils in AIA polyps were found before steroid treatment and at recurrence, and they were predominantly composed of activated eosinophils (EG2-positive). In contrast, eosinophil infiltration was rare in polyps obtained immediately after steroid treatment. This finding suggests that eosinophil infiltration may be associated with nasal polyp formation in AIA, and that activation of eosinophils plays an important role in accumulation of eosinophils and polyp formation beginning with the initial stage.     

Clinical presentation of a sphenochoanal polyp

Although choanal polyps frequently arise from the maxillary sinus, a choanal polyp originating from the sphenoid sinus is a rare entity. In this report, an unusual case of a large choanal polyp taking origin from the sphenoid sinus is presented. The reasons for its development and methods of management are discussed. Received: 1 August 1996 / Accepted: 20 January 1997     

Sphenochoanal polyp: endoscopic surgery

Sphenochoanal polyp is a rare entity originating from sphenoid sinus. It may be confused with antrochoanal polyp on anterior rhinoscopy because of its similar appearance. Computerized tomography and nasal endoscopy have contributed to an increase of accuracy in the diagnosis of these masses. Simple polypectomy that leaves some part of the polyp inside the sphenoid sinus carries a high risk of recurrence. Destructive external approaches to gain access to the sphenoid sinus are also not advisable in children for a benign disease. We present two cases of sphenochoanal polyps in two children that were operated by endonasal endoscopic approach. They were free of symptoms after surgery. No complications and recurrences were observed at 28 and 18 months of follow-up periods respectively.     

Bilateral antrochoanal polyps

An extremely rare case of bilateral antrochoanal polyp in an otherwise fit 12-year-old girl is reported. The antrochoanal polyps were removed by bilateral Caldwell-Luc operation. Histopathological examination showed them to be of benign inflammatory nature.     

喉纤维上皮性息肉1例并文献复习

目的 探讨喉纤维上皮性息肉（FEP）病因、临床特征、诊断、鉴别诊断,提高对头颈部FEP的认识。方法 回顾性分析1例原发于喉的FEP患者的临床资料,结合文献复习总结FEP的临床诊断治疗经验。该患者先行气管切开解除气道梗阻并行喉肿物活检,病理示FEP后再次支撑喉镜下等离子行喉FEP完整切除。结果 患者术后恢复好,成功拔除气套管,随访1年未见复发及恶变。结论 喉FEP为来源于中胚层的良性肿瘤,临床罕见,治疗以手术完整切除为主,预后良好,不易恶变。     

Polypoidal rhinosinusitis in cystic fibrosis: a clinical and histopathological study

The eosinophil may play a key role in the pathogenesis of nasal polyposis. Polyps in cystic fibrosis, however, have been described as neutrophilic. We compared the cell counts in polyps from 44 patients with cystic fibrosis to polyps from 50 patients without cystic fibrosis. The clinical profile, CT-scan and time to polyp recurrence were also compared with the cell counts in the patients with cystic fibrosis. No significant difference was detected in the number of patients with eosinophils (P > 0.25). Significantly more patients in the group with cystic fibrosis had polyp neutrophils (P < 0.01). Polyps from patients without cystic fibrosis contained more eosinophils (P < 0.001) whilst polyps from patients with cystic fibrosis contained more neutrophils (P = 0.001) and plasma cells (P = 0.038). Significant correlation was found between the neutrophil count and the CT score (P = 0.025) and between the recurrence time of polyps and the macrophage count (P = 0.01). Eosinophils are present in varying degrees in polyps from patients with and without cystic fibrosis and to classify polyps as eosinophilic or neutrophilic may be a false distinction.     

Regression of a sphenochoanal polyp in a child

OBJECTIVES: To present an unusual case of a sphenochoanal polyp that regressed and review the etiology of such polyps in comparison to the commoner antrochoanal polyp. STUDY DESIGN: Case study. METHODS: One was incidentally discovered in a girl aged 3 years, 8 months at postnasal mirror examination after adenotonsillectomy. RESULTS: Computed tomography scans 1 month later confirmed the polyp, but three months later, MRI scans only revealed sphenoid sinus opacification. Sphenoidotomy revealed normal sinuses implying inflammation had resolved. CONCLUSION: This patient is believed to be the youngest reported to have sphenochoanal polyp, and the only one where the polyp had completely regressed. This regression suggests that sphenochoanal polyps may be more common than is thought but are mostly asymptomatic.     

Nasal allergy and nasal polyp with special reference to the mucosal IgE antibodies

Immunologic conditions were studied in 8 patients with nasal allergies and nasal polyps and in 20 patients with nasal polyps. The present study showed the following: Nasal polyp mucosa contains a low level of mucosal IgE antibodies; nasal polyp mucosa is devoid of or deficient in the capacity of producing IgE antibodies; the presence of mucosal IgE antibodies in nasal polyp mucosa does not always imply the clinical manifestation of nasal allergies, and the antigen and antibody interaction does not always result in nasal symptoms.     

Immunological features of patients with polypous ethmoiditis

34 patients with nasal polyps (NP) and 12 normal individuals were studied immunologically to investigate association of nasal polyp formation with disorders of general and local immunity. In NP patients there were decreased preoperative and early postoperative levels of peripheral blood T- and B-lymphocytes, functional activity of lymphocytes and neutrophils. In contrast to normal individuals, nasal secretion of NP patients contained degenerative epithelial cells and neutrophils, activated lymphocytes, monocytes and eosinophils. Nasal polyp tissues obtained after polypectomy contained more B-lymphocytes than T-lymphocytes. Lymphocytes and neutrophils in nasal polyps had elevated functional activity in tissue culture. We conclude that local hyperactivation of T- and B-lymphocytes as well as neutrophils contribute much to nasal polyp formation.     

Malignant transformation of nasal polyp. Case report

Malignant transformation of nasal polyps is believed to be very rare. A 49-year-old man had suffered from nasal polyposis and visited the hospital complaining of nasal obstruction and a huge nasal polyp in the right nostril. Histologic findings showed squamous cell carcinoma with microinvasion on the surface of the polyp and no invasion of carcinoma in the stalk. Simultaneously, malignant transformation of a small polyp was found in the left nasal cavity. Clinical and histologic findings are discussed.