Nasal polyposis with stromal atypia. Review of follow-up study of 14 cases
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Abstract:
The clinical, microscopical, and gross pathological features of 14 cases of intranasal and paranasal sinus polyposis with unusual stromal cell atypia are described. In gross appearance, the lesions were polypoid, translucent masses, similar to the usual nasal polyp. Although clinically the lesions were indicative of allergic and inflammatory nasal polyposis, microscopical examination showed numerous large, often pleomorphic histiocytes or facultative fibroblasts that were suggestive or sarcomatous, malignant degeneration. Diagnoses by the original contributing pathologists included embryonal rhabdomyosarcoma, stromal neoplasia, and juvenile masopharyngeal angiofibroma. Follow-up data showed no evidence of neoplasia, despite the remarkable cytological changes found in the stroma. The stromal atypia most likely represents a reactive phenomenon secondary to inflammation.
Insights
Nasal polyps with unusual cell changes can mimic cancer but are typically benign. This study found that stromal atypia in these polyps is likely a reactive inflammatory process, not malignancy.
Area of Science:
- Pathology
- Otorhinolaryngology
- Oncology
Background:
- Intranasal and paranasal sinus polyposis can present with atypical stromal cells.
- These cytological changes can be mistaken for malignant neoplasms.
Purpose of the Study:
- To describe the clinical, microscopical, and gross pathological features of nasal polyposis with unusual stromal cell atypia.
- To determine if these atypical changes represent true malignancy or a reactive process.
Main Methods:
- Review of 14 cases of intranasal/paranasal sinus polyposis.
- Analysis of clinical, gross pathological, and microscopical features.
- Evaluation of follow-up data for evidence of neoplasia.
Main Results:
- Lesions appeared as typical polypoid, translucent nasal masses.
- Microscopically, numerous large, pleomorphic histiocytes/fibroblasts mimicked sarcomatous changes.
- Initial diagnoses included rhabdomyosarcoma, stromal neoplasia, and angiofibroma.
- Follow-up data revealed no evidence of neoplasia in any case.
Conclusions:
- Stromal cell atypia in nasal polyposis is likely a reactive phenomenon secondary to inflammation.
- Despite concerning cytological features, these lesions do not appear to be neoplastic.