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Objectives: To explore the value of the synthetic MRI (SyMRI), combined with amide proton transfer–weighted (APTw) MRI for quantitative and morphologic assessment of sinonasal lesions, which could provide relative scale for the quantitative assessment of tissue properties. Methods: A total of 80 patients (31 malignant and 49 benign) with sinonasal lesions, who underwent the SyMRI and APTw examination, were retrospectively analyzed. Quantitative parameters (T1, T2, proton density (PD)) and APT % were obtained through outlining the region of interest (ROI) and comparing the two groups utilizing independent Student t test or a Wilcoxon test. Receiver operating characteristic curve (ROC), Delong test, and logistic regression analysis were performed to assess the diagnostic efficiency of one-parameter and multiparametric models. Results: SyMRI-derived mean T1, T2, and PD were significantly higher and APT % was relatively lower in benign compared to malignant sinonasal lesions (p < 0.05). The ROC analysis showed that the AUCs of the SyMRI-derived quantitative (T1, T2, PD) values and APT % ranged from 0.677 to 0.781 for differential diagnosis between benign and malignant sinonasal lesions. The T2 values showed the best diagnostic performance among all single parameters for differentiating these two masses. The AUCs of combined SyMRI-derived multiple parameters with APT % (AUC = 0.866) were the highest than that of any single parameter, which was significantly improved (p < 0.05). Conclusion: The combination of SyMRI and APTw imaging has the potential to reflect intrinsic tissue characteristics useful for differentiating benign from malignant sinonasal lesions. Clinical relevance statement: Combining synthetic MRI with amide proton transfer–weighted imaging could function as a quantitative and contrast-free approach, significantly enhancing the differentiation of benign and malignant sinonasal lesions and overcoming the limitations associated with the superficial nature of endoscopic nasal sampling. Key Points: • Synthetic MRI and amide proton transfer–weighted MRI could differentiate benign from malignant sinonasal lesions based on quantitative parameters. • The diagnostic efficiency could be significantly improved through synthetic MRI + amide proton transfer–weighted imaging. • The combination of synthetic MRI and amide proton transfer–weighted MRI is a noninvasive method to evaluate sinonasal lesions. [ABSTRACT FROM AUTHOR]

Introduction: Immunoglobulin G4-related disease (IgG4-RD) is a systemic inflammatory disease characterized by elevated serum IgG4, tissue infiltration of IgG4-positive cells, and fibrosis. Although a number of IgG4-RD patients show sinonasal involvement, there is little known about sinonasal inflammation associated with IgG4-RD. This study aimed to describe the clinicopathological features of sinonasal inflammation associated with IgG4-RD and to compare with other inflammatory diseases, such as eosinophilic chronic rhinosinusitis (ECRS) and granulomatosis with polyangiitis (GPA). Methods: A retrospective analysis of clinicopathological features of patients with sinonasal lesions and high serum IgG4 was performed. Patient data were reviewed to determine whether they fulfilled the diagnostic criteria for other inflammatory diseases. Results: Six of 7 patients were diagnosed with IgG4-RD, while 1 patient was diagnosed with GPA. In the 6 patients with IgG4-RD, intranasal findings showed nasal polyps in 3 patients (50%) and nasal crusting in the 3 patients (50%). Computed tomography showed ethmoid sinus involvement in 5 patients (83%). Five of the 6 patients (83%) were diagnosed with IgG4-RD based on nasal biopsy, whereas 1 patient (17%) was diagnosed based on lacrimal gland biopsy. Four patients fulfilled the Japanese epidemiological survey of refractory ECRS (JESREC) criteria. However, none of the patients showed eosinophil infiltration. Although the patient with GPA showed high levels of serum IgG4 and tissue infiltration of IgG4-positive cells in the nasal biopsy, the patient showed common clinical features of GPA. Conclusion: Patients with sinonasal inflammation associated with IgG4-RD had similar clinical characteristics with ECRS and GPA. Histopathological findings of the nasal biopsy from clinically diagnosed GPA was consistent with that of IgG4-RD. Sinonasal inflammation associated with IgG4-RD should be diagnosed based not only on tissue infiltration of IgG4-positive cells but in conjunction with clinical findings such as local nasal characteristics, involvement of other organs, and serum antineutrophil cytoplasmic antibody levels. IgG4-RD should be ruled out in patients with eosinophilia without histopathological eosinophil infiltration. Plain Language Summary: Immunoglobulin G4-related disease (IgG4-RD) is a systemic inflammatory disease characterized by elevated serum IgG4 levels and tissue IgG4-positive cells. A part of IgG4-RD patients has sinonasal lesions. Because other inflammatory diseases also have features common to IgG4-RD, accurate knowledge of IgG4-RD is required. However, very little is known about IgG4-related rhinosinusitis. This study retrospectively analyzed clinicopathological features of IgG4-related rhinosinusitis and compared IgG4-related rhinosinusitis with other inflammatory diseases. Seven patients with sinonasal lesions and high serum IgG4 levels were retrospectively reviewed. Six of 7 patients were diagnosed with IgG4-RD, while one was diagnosed with granulomatosis with polyangiitis (GPA). In the 6 patients with IgG4-RD, intranasal findings showed nasal polyps in 3 patients (50%) and computed tomography showed ethmoid sinus involvement in 5 patients (83%), which shared common features with eosinophilic sinusitis (ECRS). However, no patients showed histopathological eosinophil infiltration. Although the patient with GPA revealed tissue infiltration of IgG4-positive cells in the nasal biopsy, the patient also had saddle nose and positivity of myeloperoxidase-antineutrophil cytoplasmic antibody (ANCA), which indicated GPA. We diagnosed the patient with GPA, which is a known mimicker of IgG4-RD. In this study, the patients with IgG4-related rhinosinusitis had clinical and pathological characteristics similar to those of ECRS and GPA. IgG4-related rhinosinusitis should be diagnosed based on not only tissue infiltration of IgG4-positive cells but also systemic findings including nasal findings and serum ANCA levels. IgG4-RD should be ruled out in patients with eosinophilia without histopathological eosinophil infiltration. [ABSTRACT FROM AUTHOR]

Background: A variety of neoplastic and non-neoplastic conditions involve the nasal cavity and paranasal sinuses, amongst which the prevalence of non-neoplastic sinonasal lesions in the general population is 1-4%. It can give rise to a very diverse assay of neoplasms i.e., about 1% of all malignancies. Methods: The study was conducted in the Department of Pathology Mahadevappa Rampure Medical College over a period of two years (2019-2021). A total of 30 cases of sinonasal tract lesions were identified and their histopathological examination was carried out and special staining was done wherever necessary. Results: Out of 30 sinonasal cases, 16 lesions were inflammatory, seven lesions were benign neoplastic lesions and the other seven were malignant. Nasal polyps were the most common inflammatory lesions, mostly in females. Out of seven malignant lesions, squamous cell carcinoma was found in three lesions, and in benign lesions, sinonasal papillomas were found in five lesions. Conclusion: Various lesions of the sinonasal tract including non-neoplastic, benign, and malignant can occur in any age group and both sexes.

Angiomatous antrochoanal polyps (AACP) are rare sinonasal lesions characterized by vascular proliferation within polypoid tissue. We presented a case of a 16-year-old male with bilateral nasal obstruction and recurrent epistaxis, diagnosed with AACP based on clinical presentation and radiological findings. Contrast-enhanced computed tomography (CECT) revealed a soft tissue density mass causing extensive occlusion of paranasal sinuses, with atypical enhancement and arterial pedicle supply from the right lateral nasal wall. Histopathological examination confirmed dilated vascular spaces within the polypoid tissue. Management involved surgical excision, achieving complete resection with preservation of sinonasal anatomy. The patient experienced symptomatic relief postoperatively with no evidence of recurrence at follow-up. The case underscores the diagnostic challenges posed by AACP due to its variable clinical presentation and radiological features, necessitating a multidisciplinary approach for accurate diagnosis and optimal management. This report contributes to the existing literature on AACP, emphasizing the importance of heightened awareness and comprehensive evaluation in the assessment of sinonasal masses. Further research is warranted to elucidate the pathophysiology and optimal treatment strategies for AACP. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to describe the clinico-histological pattern of sinonasal space occupying lesions in patients admitted in Ear Nose and Throat (ENT) Department of tertiary care Hospital. STUDY DESIGN: A retrospective descriptive study. PLACE AND DURATION: Pathology Department Bannu Medical College and ENT Department Khalifa Gul Nawaz Teaching Hospital Bannu KPK, from 1st January 2011 to 31st December 2016. METHODOLOGY: In this study a total of 68 patients with sinonasal lesions were analyzed. All patients of any age and sex were studied. Patients clinical record was collected from ENT ward register of the Hospital and biopsy histopathological reports were collected from register of Pathology Deptt of Bannu Medical College. The parameters age, sex, clinical findings and histological pattern of different sinonasal lesions were assessed for frequencies with percentages and mean with standard deviation in Statistical Package for Social Sciences (SPSS) version 20. RESULTS: The mean age was 31.55±13.5 years with age range of 15 to 65 years. Male patients were 67.64% and female 32.35% and male to female ratio was 2.09:1. Nasal obstruction was present in 57 (83.82%) patients followed by nasal discharge in 42 (61.76%) and epistaxis in 13 (19.11%). The common non neoplastic lesion was inflammatory nasal polyp 34 (50.0%). In benign neoplastic lesions inverted papilloma was the common lesion 9 (13.23%) and squamous cell carcinoma was the common malignant lesion in 5 (7.35%) cases. CONCLUSION: This study show almost the same clinico-histological pattern of sinonasal mass lesions as in other studies. Inflammatory nasal polyp was the commonest non neoplastic inflammatory lesion, whereas inverted papilloma was the commonest benign neoplastic lesion and squamous cell carcinoma was the commonest malignant lesion in this study. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to evaluate diffusion kurtosis imaging (DKI) in the differentiation between benign and malignant sinonasal lesions, and to compare the diagnostic performance of DKI with diffusion weighted imaging (DWI).Materials and Methods: Eight-one patients with solid sinonasal lesions confirmed by surgery and pathology (46 malignant and 35 benign) underwent conventional MRI, DWI, and DKI. DKI was performed employing a 13 extended b-value ranging from 0 to 2500 s/mm2 . Apparent diffusion coefficient (ADC) from DWI, kurtosis (K), and diffusion coefficient (D) from DKI were measured and compared between two groups.Results: ADC and D values were significantly lower in the malignant sinonasal lesions than in the benign sinonasal lesions (1.11 ± 0.41 versus 1.58 ± 0.50 × 10-3 mm2 /s and 1.45 ± 0.36 versus 2.03 ± 0.49 × 10-3 mm2 /s, respectively, both P < 0001). K value was significantly higher in the malignant lesions than in the benign lesions (0.91 ± 0.23 versus 0.57 ± 0.24, P < 0001). The receiver operating characteristic curve analyses yielded a cutoff ADC value of 1.27 × 10-3 mm2 /s for differentiating between benign and malignant lesions, with a sensitivity of 69.6%, a specificity of 77.1% and an accuracy of 74.0%; a cutoff D value of 1.75 × 10-3 mm2 /s, with a sensitivity of 82.6%, a specificity of 77.1% and an accuracy of 80.2%; a cutoff K value of 0.63 with a sensitivity of 95.7%, a specificity of 77.1% and an accuracy of 87.7%. The area under the curve of K value was significantly larger than that of ADC value (0.875 versus 0.762; P < 0.05).Conclusion: K value of DKI demonstrates significantly higher accuracy compared with ADC value for the differentiation between benign and malignant sinonasal lesions. DKI may be a noninvasive method to evaluate the sinonasal lesions.Level Of Evidence: 1 J. MAGN. RESON. IMAGING 2017;45:1446-1454. [ABSTRACT FROM AUTHOR]

Fourier transform infrared imaging (FTIRI) is a powerful tool for analyzing biochemical changes in tumoral tissues. The head and neck region is characterized by a great variety of lesions, with different degrees of malignancy, which are often difficult to diagnose. Schneiderian papillomas are sinonasal benign neoplasms arising from the Schneiderian mucosa; they can evolve into malignant tumoral lesions (squamous cell carcinoma). In addition, they can sometimes be confused with the more common inflammatory polyps. Therefore, an early and definitive diagnosis of this pathology is mandatory. Progressing in our research on the study of oral cavity lesions, 15 sections consisting of inflammatory sinonasal polyps, benign Schneiderian papillomas, and sinonasal undifferentiated carcinomas were analyzed using FTIRI. To allow a rigorous description of these pathologies and to gain objective diagnosis, the epithelial layer and the adjacent connective tissue of each section were separately investigated by following a multivariate analysis approach. According to the nature of the lesion, interesting modifications were detected in the average spectra of the different tissue components, above all in the lipid and protein patterns. Specific band-area ratios acting as spectral markers of the different pathologies were also highlighted. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Cross–sectional imaging has had a significant impact on the management of the sinonasal malignancy. Staging of these lesions has been closely monitored by dependence on computerized tomography (CT) scan and now in small proportion with MRI. The objective of the study was to evaluate the reliability of CT scan in assessing the extensions of the sinonasal mass lesions and their impact on tumor staging. MATERIALS AND METHODS: All cases of sinonasal lesions were reviewed retrospectively from June 2001 to May 2006 (five years) at KMIO, Bangalore. Only those cases that had CT scan reports and Histopatholgy Examination (HPE) reports were included in the study. All the cases, which were subjected to radiotherapy prior to surgery, were excluded from the study. There were a total of 38 cases with slight male preponderance. Tumor staging was done according to the sixth edition of TNM classification of malignant tumors. Two observers evaluated all the cases (Blinded Study) and sensitivity, specificity, positive predictive value, negative predictive value and predictive accuracy were estimated. RESULTS: The relation between the CT scan findings and HPE reportswas high. Though false positivity was noted more in the ethmoid sinuses, significant impact on tumor staging was noted with false positivity of the nasopharynx. Also, false positivity was noted with orbital wall/content extensions, resulting in unnecessary exenterations of the orbit. However, CT scan reliably predicted infratemporal fossa extension in the absence of trismus. False negativity was noted more often in soft palate, indicating the need of using MRI for delineation of tumor extension. Thus, we conclude that judicious use of CT scan in all cases and MRI in selected cases will translate into better tumor–free resections and improves survival. [ABSTRACT FROM AUTHOR]