Inflammatory pseudotumour of the nasal cavity and sinuses

Abstract

The term inflammatory pseudotumour encompasses a very diverse group of conditions, with different sites, whose only common feature is the absence of a specific histological diagnosis. The histopathological and aetiopathogenic data have been derived from experience in the thoracic, orbital and abdominal forms, which are much more frequent than disease affecting the nasal cavities and sinuses. However, there is no evidence that these data are applicable to sino-nasal pseudotumour. We present a case of inflammatory pseudotumour of the nasal cavity and a review of the literature (19 cases in 30 years) with respect to the clinical and radiological findings, the natural history and the specific management of disease at these sites. Surgery seems to be the best option for this localization. Corticosteroids and radiotherapy may be of value in cases of residual tumour after the histological confirmation of the diagnosis and the exclusion of neoplasia.

Pseudotumor inflamatório de seios paranasais

“…1 Often, these areas are secondarily involved by the extension of a primary tumor of the orbit. 6 There appears to be no sex or age preference. In a review of the literature that included 28 cases of mouth and maxillary sinus inflammatory pseudotumors, Vigneswaran found a 1.5:1 male to female ratio and a mean presentation age of 33 years (ranging from 2 to 67 years).…”

“…1,8 There are many synonyms, such as histiocytoma, xanthogranuloma, plasmocytic cell granuloma, and inflammatory myofibroblastic proliferation, due to its wide histological presentation spectrum. 2,6,8 Histology is non-specific, 8 showing two typical cell types: myofibroblasts and inflammatory cells. Myofibroblasts express vimentin in 99% of cases and actin in 89 to 92% of cases on immunohistochemistry.…”

“…It should be realized that this description of microscopy might vary significantly among different tumors and within the same lesion. 6 Inflammatory pseudotumors occur in various anatomical sites; the lung is the most commonly affected organ. 2 Inflammatory pseudotumors of the head and neck occur mainly in the orbit, and less frequently in the mouth and paranasal sinuses.…”

“…The most frequent clinical picture is a non-specific nasosinusal tumor that grows to a stable state over months or years; it may be painful and may be associated with nasal obstruction, nose bleeding, proptosis, increased lymph nodes, dysphagia or cranial nerve dysfunction. 5,6 Variation in symptoms, edema, erythema and fever may suggest an inflammatory etiology. 7 Systemic symptoms are usually not encountered.…”

“…5 There have been few reports of inflammatory pseudotumors in the nasal cavity and the paranasal sinuses; of these, most were in the maxillary sinus. 6 We present three cases of nasal and paranasal sinus inflammatory pseudotumors, including the methods for diagnosis and therapy; these patients were seen at the Division of Clinical Otorhinolaryngology in the Clinical Hospital of the São Paulo University Medical School (HC/FMUSP).…”