Otorhinolaryngology (ENT)
Tumours of the Nose and Paranasal Sinuses
Nose and sinus tumours for MBBS ENT: juvenile angiofibroma, inverted papilloma, maxillary sinus carcinoma and Epstein-Barr virus linked nasopharyngeal carcinoma, mapped to NMC codes EN4.
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Tumours of the Nose and Paranasal Sinuses
Nose and sinus tumours for MBBS ENT: juvenile angiofibroma, inverted papilloma, maxillary sinus carcinoma and Epstein-Barr virus linked nasopharyngeal carcinoma, mapped to NMC codes EN4.
This chapter covers benign and malignant tumours of the nose, paranasal sinuses and nasopharynx. It highlights juvenile angiofibroma, inverted papilloma, maxillary sinus carcinoma and Epstein-Barr virus related nasopharyngeal carcinoma, and stresses the warning signs that should prompt urgent investigation.
High-yield: Tumours of the Nose and Paranasal Sinuses
- Juvenile nasopharyngeal angiofibroma is a benign but highly vascular tumour of adolescent boys causing recurrent epistaxis and nasal obstruction.
- Biopsy of an angiofibroma is avoided because of the risk of torrential bleeding; diagnosis is by contrast imaging.
- An inverted papilloma is a benign nasal tumour that can recur, erode bone and has a small risk of malignant change.
- Maxillary sinus carcinoma often presents late with cheek swelling, epistaxis, loosening of teeth or facial numbness.
- Nasopharyngeal carcinoma is linked to Epstein-Barr virus and to certain populations and diets, and often presents with a neck node.
- A persistent unilateral neck lump with a bloody or blocked nose should raise suspicion of nasopharyngeal carcinoma.
- Nasopharyngeal carcinoma is radiosensitive, and radiotherapy is the mainstay of treatment.
- Involvement of the orbit by a sinus tumour can cause proptosis, diplopia and visual loss.
- Any unilateral nasal mass, especially with bleeding, in an adult should be regarded as a tumour until proven otherwise.
- A CT scan shows bony destruction and MRI shows soft-tissue extent when staging nose and sinus tumours.
- Sinonasal malignancy can spread through the skull base to the anterior cranial fossa.
- Squamous cell carcinoma is the commonest malignant tumour of the nose and paranasal sinuses.
- Adenoid cystic carcinoma has a tendency for perineural spread, which explains facial pain and numbness.
- Epistaxis in an adolescent boy with a nasal mass strongly suggests angiofibroma rather than simple nosebleed.
Key nose and sinus tumours
- **Juvenile angiofibroma:** Adolescent boys. Recurrent epistaxis, obstruction. Highly vascular. Do not biopsy.
- **Inverted papilloma:** Benign, recurs, erodes bone, small risk of malignant change.
- **Maxillary sinus carcinoma:** Late presentation: cheek swelling, epistaxis, loose teeth, facial numbness.
- **Nasopharyngeal carcinoma:** Epstein-Barr virus linked. Neck node common. Radiosensitive.
NMC competencies in this chapter
- **EN4.29:** Nasal masses and their evaluation
- **EN4.31:** Benign tumours of the nose and paranasal sinuses
- **EN4.32:** Malignant tumours of the nose and paranasal sinuses
- **EN4.34:** Juvenile nasopharyngeal angiofibroma
- **EN4.35:** Nasopharyngeal carcinoma: features and management
Frequently Asked Questions
Why is an angiofibroma not biopsied?
It is extremely vascular, so a biopsy risks torrential bleeding. The diagnosis is made instead on contrast imaging in an adolescent boy with recurrent epistaxis and nasal obstruction.
What is the link between nasopharyngeal carcinoma and Epstein-Barr virus?
Nasopharyngeal carcinoma is strongly associated with Epstein-Barr virus infection, along with genetic and dietary factors, and often first presents as a painless neck node.
What are the warning signs of a maxillary sinus cancer?
Cheek swelling, unilateral epistaxis, loosening of upper teeth, facial numbness and a mass in the nose or palate. It often presents late because early disease is silent.
When should a nasal mass be treated as a tumour?
Any persistent unilateral nasal mass in an adult, especially with bleeding, should be regarded as a tumour until proven otherwise and investigated with imaging and biopsy.
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