Tumours of the Nose

Benign lesions

Squamous cell papillomas

  • Most common

Sinonasal papillomas

Aetiology
  • HPV (low risk), organic solvents
  • Patients tend to be 50+ and more common in males
Histology
  • Inverted, exophytic or oncocytic
    • Inverted and oncocytic on lateral walls and paranasal sinuses, exophytic on nasal septum
    • Epithelium can be respiratory, squamous, or oncocytic with mucocytes and neutrophilic infiltrate
  • Rarely undergo malignant change
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Recurrent respiratory papillomatosis

  • Rare condition in which papilloma form along the aerodigestive tract
  • Associated with HPV
  • Can often present in children with hoarse voice and progressive SOB

Others

  • Angiofibromas

Malignant lesions

Squamous cell carcinoma

  • Most common

Nasopharyngeal carcinoma

Aetiology
  • Low incidence in UK, very high in far east
  • Higher incidence in males
  • Strong association with EBV, as well as volatile nitrosamines in food
  • Other risk factors - occupation, family history, smoking, alcohol, HPV
Histology
  • Keratinising SCC, non-keratinising SCC, baseloid SCC
  • Highly malignant - extensive local spread, early nodal metastasis

Others

  • Primary adenocarcinoma
  • Neuroblastoma
  • Lymphoma

Epstein-Barr virus in carcinogenesis

  • Seen in association with Burkitt's lymphoma, other B-cell lymphomas and Hodgkin's lymphoma
  • Infects epithelial cells of oropharynx and B-cells
  • Ubiquitous infection, mostly subclinical
  • EBV genes 'hi-jack' normal signalling pathways
    • LMP-1 acts as an oncogene
    • EBNA-2 promotes transition from G0 to G1