Maxillary Sinus Lobular Capillary Hemangioma in a 15-Year-Old Boy.

Lobular capillary hemangioma (LCH) is a benign capillary proliferation with a microscopically distinctive lobular architecture, composed of small to medium-sized vessels of capillary type. Rarely, it originates from the mucosa of the nasal cavity, most frequently from the anterior nasal septum, turbinates, and nasal vestibule. Etiology is unclear, but previous investigations suggest that this lesion is associated with injury, hormonal factors, some viral infections, and therapy with some drugs. We present a case of LCH arising from the medial wall of the maxillary sinus in a 15-year-old boy, which was completely excised by preoperative embolization and endoscopic sinus surgery. To our knowledge, this is the second reported case of an LCH originating from the maxillary antrum. Etiology, pathogenesis, diagnosis, and treatment modalities of LCH were also discussed.

Simultaneous Nasal Septal Schneiderian Papilloma and Respiratory Epithelial Adenomatoid Hamartoma.

Schneiderian papilloma is typically found on the lateral nasal wall, but, in rare cases, can be located at the mucosa of the nasal septum. Respiratory epithelial adenomatoid hamartoma (REAH) is rare, non-neoplastic lesion characterized by an abnormal proliferation of glandular part of the respiratory nasal mucosa. We present a case of a 42-year-old man with five-year history of bilateral nasal obstruction, rhinorrhea, epistaxis, and hyposmia. On endoscopic examination, we found lobulated, yellowish-pink soft tissue masses on both sides of the nasal septum. The results of histopathological analyses showed the characteristics of Schneiderian papilloma in the lesion excised from the right and REAH in the lesion excised from the left side of the nasal cavity. To our knowledge, cases of simultaneous presentation of Schneiderian papilloma and REAH on opposite sides of the nasal septum have not been published so far. An appropriate cooperation of rhinologist and pathologist allows for a correct diagnosis of these rare and unusual lesions.

Different levels of mucus inflammatory mediators in nasal polyposis with and without aeroallergen sensitivity.

Objectives: Biomarker levels in nasal secretions can reflect the inflammatory status of nasal mucosa and evolution of sinus disease. The aim of this study was to evaluate the relationship between local inflammatory mediator production and clinical characteristics of patients with nasal polyposis (NP). Methods: Thirty-one nonaeroallergen sensitized patients with NP (NANP), 29 aeroallergen sensitized patients with NP (ANP), and 30 subjects without inflammation of nasal mucosa as controls (C) entered this prospective, cross-sectional study. Clinical parameters (symptoms, endoscopic, and radiological findings) were assessed. The concentrations of heat shock protein 70 (HSP70), eosinophil cationic protein (ECP), tryptase, substance P and Clara cell protein 16 (CC16) were measured in the nasal secretion samples of all participants by ELISA method. Results: Our results showed higher concentrations of HSP70, ECP, and tryptase in ANP than in NANP and C (p < .001 for all markers). On the other hand, levels of CC16 were significantly higher in C than in NANP and ANP groups (p < .001; p < .001, respectively). We found positive correlations between HSP70, ECP, tryptase, and substance P levels and nasal symptom score in patients with NP. Also, HSP70, ECP, tryptase, and substance P showed different levels of positive correlation among themselves, with HSP70 showing highest positive correlation with ECP. Finally, relatively strong negative correlations were found between the levels of CC16 and nasal symptoms, as well as between the CC16 levels and levels of other four mediators in nasal fluid. Conclusion: HSP70, ECP, tryptase, and substance P might play a role in the pathogenesis of NP. The results suggest that chronic inflammation in NP involves a self-sustaining local release of HSP70, ECP, and tryptase, independent of aeroallergen stimulation of the mucosal layer, although the production of these mediators is higher in aeroallergen sensitized NP patients.

Choanal polyps in children and adults: 10-year experience from a tertiary care hospital.

PURPOSE: Choanal polyps (CPs) are benign, solitary, soft-tissue lesions extending towards the junction between the nasal cavity and the nasopharynx through the choana. The aim of this retrospective study was to evaluate clinical and histological characteristics of CPs in children comparing to adult patients. METHODS: Characteristics of CPs treated in our hospital (demography, main complaints, side, localization, surgical approach, histological characteristics, accompanying paranasal sinus diseases, association with allergic rhinitis, postoperative follow-up period, and recurrence rates) were retrospectively reviewed. RESULTS: Seventy-eight patients with CPs were included, 22 (28%) patients in children and 56 (72%) patients in adults. We found no differences in the prevalence of main nasal complaints (nasal obstruction, rhinorrhea, snoring, and epistaxis) between the child and adult. In 27% children and in 7% adults, we found the oropharyngeal extension of CPs (p < 0.01). In 18% children and in 5.3% adults, we found the histological characteristics of an angiomatous CP (p < 0.05). The association with allergic rhinitis was more frequent in children (32%) than in adults (18%) (p < 0.05). In 32% pediatric patients and in 14% adult patients, we found the association with ipsilateral chronic maxillary rhinosinusitis without nasal polyps (CRSsNP) (p < 0.05). After the surgical treatment, we found the recurrence in 3 (14%) pediatric and in 5 (8%) adult patients, without the significant difference. CONCLUSION: Our results suggest some specificities of CPs in children comparing to adults. Oropharyngeal extension, association with allergic rhinitis and ipsilateral CRS, and the presence of angiomatous histological type of CPs are more frequent in the pediatric population.