Septal Masses

Any neoplasm with a predilection for the upper respiratory tract
can involve all or part of the septum. These include squamous
cell carcinoma, minor salivary gland neoplasms, or olfactory
neuroblastomas. Metastatic disease from a large number of
sources may also involve the nose, affecting the nasal septum. In
a 25-year review of cases from the Armed Forces Institute of Pathology,
Thompson et al. found that 17% of 115 melanomas of
the sinonasal tract involved the nasal septum alone. However,
these are exceedingly rare and constitute approximately
0.5% of all sinonasal neoplasms. Other rare tumors include
paragangliomas, chordomas, chondromas, glomus tumors,
and chondrosarcomas.
Sinonasal papillomas are divided into three distinct histologies:
exophytic (fungiform), inverted, and cylindrical (oncocytic).
It should be noted that the sinonasal membrane and papillomas
that occur therein are often named for J.V. Schneider, an
early pioneer of the histology of this region. Thus, the alternative
terms of Schneiderian membrane and Schneiderian papilloma
are occasionally utilized.
Inverted papillomas have a predilection for the lateral nasal
wall and are characterized by squamous cell architecture with
classic papilloma-like features extending into the underlying
stroma. Mucinous cysts or cells can be identified either grossly
or by special stains. Hyams found a 46% recurrence rate and
a 13% malignancy rate in this papilloma subtype. Malignant
transformation has also been reported in cylindrical papilloma,
but because of its rarity, it is difficult to quantify its malignant
potential. Exophytic or fungiform papilloma
is the entity with the highest predisposition for the nasal septum,
and the septum is only rarely the site of origin of the other
papilloma subtypes. Presenting signs include nasal mass, nasal
obstruction, or bleeding. Exophytic papilloma is histologically
similar to papilloma found elsewhere on the body, such as the
common cutaneous wart. In contrast to the inverting and cylindrical
forms, exophytic papilloma does not have any malignant
potential. Complete excision is usually curative.


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