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Large right nasal cavity mass
Contrast CT of a soft tissue mass
MRI with gadolinium showing an enhancing mass
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Painless, soft mass on the glabellar region
Gray-white polypoidal mass in right nostril
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Fragile grayish white mass
Contributed by Diana Bell, M.D.
Intestinal adenocarcinoma (ITAC)
Various architectures
Tubular and cribriform growth pattern
Papillary growth pattern
Nonintestinal adenocarcinoma (non-ITAC)
Low grade with uniformly located nuclei
Tubular growth pattern
Sinonasal renal cell-like adenocarcinoma
Nested architecture
Clear cytoplasm
CAIX positivity
Sinonasal carcinoma: updated phenotype and molecular characterization
Malignant tumors of the paranasal sinuses by Dr. Nadir Ahmad
Contributed by Margie Brandwein-Gensler, M.D.
Allergic fungal rhinosinusitis
Contributed by Kelly R. Magliocca, D.D.S., M.P.H.
Eosinophilic mucin associated with allergic fungal sinusitis
Charcot-Leyden crystals
Grocott-Gomori methenamine silver
Contributed by Margie Brandwein-Gensler, M.D.
Eosinophilic mucin
Fungal detection
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Lateral wall
Bones and cartilages
Case #390
Various images
Contributed by Josephine K. Dermawan, M.D., Ph.D. and Laura O. Rabinowitz, M.D.
Superior nasal cavity mass (coronal)
Superior nasal cavity mass (transverse)
Contributed by Josephine K. Dermawan, M.D., Ph.D. and Laura O. Rabinowitz, M.D.
Cellular spindle proliferation
Prominent stromal vasculature
Surface epithelial invaginations
Hemangiopericytoma-like vasculature
Herringbone pattern
Medium to long fascicles
Positive S100
Positive SMA
Negative CD34
Contributed by Margie Brandwein-Gensler, M.D.
Sinonasal polyps
Chronic rhinosinusitis
Various images
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CT of face
MR of face
Likely calcific in nature
Normal pneumatization
Opacification
Contributed by @Andrew_Fltv on Twitter
Fungal ball
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Maxillary sinusotomy
Contributed by Margie Brandwein-Gensler, M.D. and @Andrew_Fltv on Twitter
Large fungus ball
Fungal hyphae, fungal sexual reproduction (fruiting heads)
Fungal ball
Fungal ball
Aspergillus lesions of the sinuses
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Aspergilloma
Hyphae of mycetes
Foot
Contributed by Nasir Ud Din, M.B.B.S.
Nasal swelling
Nasal cavity lesion
Nasal cavity mass
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External nasal lesion with skin tightening
Globular swelling at the root of nose
Nasal endoscopy
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Homogeneous, tan, firm cut surface
Contributed by Nasir Ud Din, M.B.B.S.
Polypoid lesion
Syncytial architecture
Nested architecture
Astrocytes in fibrillary matrix
Astrocyte morphology
Astrocytes in mild inflammatory stroma
Vascularized background
Fibrotic appearance
Positive GFAP expression
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Epidemiology and clinical features over 2 decades
Contributed by Muthu Kumar Sakthivel, M.D.
Mass with fat attenuation
Pedunculated tubular fatty mass
3 dimensional reconstructed oral lesion
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Nasal oropharyngeal mass
Nasal vestibule mass
Contributed by Ezer Benaim, M.D.
Mobile oropharyngeal mass
Nasal endoscopy
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Polypoid lesion from mouth
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Skin covered pedunculated lesion
Polypoidal lesion
Contributed by Surekha Bantumilli, M.D. and Steven Johnson, M.D.
Squamous epithelium
Polypoidal appearance
Stratified squamous epithelium
Mesoderm derivative
Mesenchymal core
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Mass of maxillary sinus
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Expansile swelling of maxilla
Contributed by Bin Xu, M.D., Ph.D.
Small cell carcinoma
Finely granular chromatin
Frequent mitoses and nuclear molding
CAM5.2 (dot-like pattern)
Synaptophysin
Chromogranin
INSM1
Elevated Ki67 proliferation index
TTF1
Large cell neuroendocrine carcinoma
Large tumor cells
Synaptophysin
Chromogranin
Combined small cell carcinoma and squamous cell carcinoma
Squamous and neuroendocrine component
p40
Contributed by Bin Xu, M.D., Ph.D.
Small cell carcinoma
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Aggressive mass in the inferior nasal cavity
Contributed by Bin Xu, M.D., Ph.D.
Surface involvement
Spindle cell area
Cribriform architecture
Tubular pattern
Basaloid area
Basaloid area with peripheral palisading
Resembling adenoid cystic carcinoma
Squamous differentiation
Calponin
SMA
p16
S100
p40
Contributed by Bin Xu, M.D., Ph.D.
RNA-ISH positive for HPV
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Coronal CT
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Translucent polyps with a smooth surface
Contributed by Bin Xu, M.D., Ph.D.
Edematous stroma
Mixed inflammatory infiltrate
Respiratory epithelium lining
Surface ulceration, squamous metaplasia
Stroma with hemorrhage
Infarction
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Frontoethmoidal sinus mass
Frontal sinus mass
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Mass on glabellar region
Wide excision of mass
76 days after surgery
Endoscopic resection
Contributed by Kelly Magliocca, D.D.S., M.P.H.
Macroscopic appearance
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Open biopsy masses
Contributed by Vladyslav Ilchenko, M.D., Diana Bell, M.D. and Kelly Magliocca, D.D.S., M.P.H.
Complex glands
Papillary pattern with goblet cells
Tubuloglandular architecture
Complex colonic type glands and stroma
Mucinous type
Mucinous type
CK20
CDX2
Update on sinonasal carcinoma
Malignant tumors of the paranasal sinuses
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Mucosal thickening
Advanced manifestations
Extrasinonasal extension
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Periorbital swelling
Palatal ulceration
Contributed by Bin Xu, M.D., Ph.D. and Kelly Magliocca, D.D.S., M.P.H. (Case #493)
Fungal hyphae invade tissue
Angioinvasion
Angioinvasion and necrotic wall
Tissue necrosis
Necrotic and adjacent viable sinonasal mucosa
Ossified cartilage
and adjacent
viable sinonasal
mucosa
Angioinvasion
GMS: 90 degree branching
GMS stain
PAS stain
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Pedunculated tumor without bone destruction
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Well defined large polypoid tumor
Contributed by Diana Bell, M.D. and Lester Thompson, M.D.
Tumor underneath nasopharyngeal mucosa
Tumor infiltrating underlying stroma
Interwoven papillae and glands
Papillae lined by columnar cells
Nuclear overlapping
Nuclear features mimicking PTC
Pseudoinclusions and nuclear clearing
Psammoma bodies
TTF1 IHC
Thyroglobulin IHC
Contributed by I Weng Lao, M.D., Ph.D. and Jian Wang, M.D., Ph.D.
CT scan
Contributed by I Weng Lao, M.D., Ph.D. and Jian Wang, M.D., Ph.D.
7 month old infant boy
Case #291
Various images
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Angiography
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Facial swelling
Contributed by Kelly Magliocca, D.D.S., M.P.H.
Gross appearance, cut surface
Gross appearance with ink
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Polypoid, beige to brown, firm, fibrotic mass
Contributed by Bin Xu, M.D., Ph.D.
Polypoid mass
Large caliber vessels
Slit-like vasculature
Cellular stroma
Bland fibroblasts
Edematous or collagenized stroma
Beta catenin
AR
Contributed by Kelly Magliocca, D.D.S., M.P.H.
Correlate to "Gross appearance with ink"
Vascular channel, low magnification
Vascular channel, higher magnification
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Age standardized incidence
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CT scan: wedge shaped mass
MRI: Enhanced mass in the fossa of Rosenmüller
Contributed by Bin Xu, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D. and Songyang Yuan, M.D., Ph.D.
Nonkeratinizing, undifferentiated subtype
Nonkeratinizing undifferentiated subtype
AE1 / AE3+
EBV LMP1 IHC
Nonkeratinizing undifferentiated subtype
CK5 / 6+
EBER+
p63+
Nonkeratinizing, differentiated subtype
Nonkeratinizing differentiated subtype
Keratinizing subtype
Keratinizing subtype
Contributed by Marino E. Leon, M.D. and Case #100
FNA of a neck mass (Diff-Quik)
Pap stain
Cell block
Contributed by Andrey Bychkov, M.D., Ph.D. and Bin Xu, M.D., Ph.D.
EBER ISH
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Heterogeneously hyperintense lesion on T2 weighted image
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Eustachian tube tumor
Contributed by Diana Bell, M.D. and Wai Szeto, M.D., M.S.
Low grade sinonasal adenocarcinoma
Low grade sinonasal adenocarcinoma
Tubular growth pattern
High grade sinonasal adenocarcinoma
High grade sinonasal adenocarcinoma
CK7
SOX10
Sinonasal renal cell-like adenocarcinoma
Sinonasal renal cell-like adenocarcinoma
Mimics renal cell carcinoma
Clear cytoplasm
CAIX
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Eustachian tube tumor
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Bland serous glands
Complex papillary growth pattern
Tubulopapillary pattern
Eustachian tube tumor
TTF1+ case
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Large nasal mass
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Lacrimal mass
Nasopharyngeal endoscopy
Contributed by Lisa Rooper, M.D.
Primitive small to medium cells
Highly infiltrative growth
Monotonous nuclei
Prominent necrosis
Abrupt keratinization
Prominent spindled foci
Infiltrating neutrophils
NUT1
Contributed by Brendan Dickson, M.D.
Abrupt keratinization
Necrosis
Undifferentiated areas
p63
NUT1
AE1 / 3
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Aspirate of metastasis
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Tumor extending into cribriform plate and lateral lamella
Large, avidly enhancing skull base mass in left nasal cavity
Olfactory neuroblastoma, a. coronal view, b sagittal view
| Grade I | Grade II | Grade III | Grade IV | |
| Architecture | Lobular | Lobular | Variable | Variable |
| Fibrillary matrix | Prominent | Present | Minimal | Absent |
| Mitosis | Absent | Present | Prominent | Marked |
| Necrosis | Absent | Absent | May present | Common |
| Nuclear pleomorphism | Absent | Moderate | Prominent | Marked |
| Rosettes | Homer Wright | Homer Wright | Flexner- Wintersteiner |
Flexner- Wintersteiner |
Table 2: Staging systems of olfactory neuroblastoma
Kadish staging:
Morita modification:
|
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Nasal endoscopy
Bifrontal craniotomy
Contributed by Bin Xu, M.D., Ph.D.
Lobulated growth,
microcalcification,
abundant fibrillar
neural matrix
Lobulated growth with
infiltration between
submucosal glands
Hyams grade I
olfactory
neuroblastoma
Flexner-Wintersteiner
rosettes
Homer Wright
pseudorosettes
Synaptophysin
diffusely positive
in tumor cells
S100 highlights
sustentacular cells
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Widened olfactory cleft
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Polypoid glistening mass
Contributed by Bin Xu, M.D., Ph.D.
Respiratory epithelial adenomatoid hamartoma (REAH)
Proliferation of medium sized glands
Thickened basement membrane
Glands with cilia
Scattered seromucinous glands
Chondro-osseous respiratory epithelial (CORE) hamartoma
Glands and chondromyxoid stroma
Myxoid mesenchyme and gland
Epithelium with cilia
Contributed by Hanni Gulwani, M.B.B.S. (Case #97), Veena Maheshwari, M.D., Kiran Alam, M.D., Anshu Jain, M.D., Alia Albawardi, M.B.B.S. and @DrTravisBrown on Twitter
Various images
28 year old from Nepal with uvular mass; left to right: H&E (4 images), GMS, PAS
Rhinosporidiosis
Contributed by Scott Poswilko, M.D.
Naso-oropharyngeal mass (T1 axial)
Naso-oropharyngeal mass (T1 coronal)
Naso-oropharyngeal mass (T2 axial)
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Lobulated mass
Contributed by Josephine K. Dermawan, M.D., Ph.D. and Laura O. Rabinowitz, M.D.
Submucosal lobular proliferation
Nonkeratinizing squamous mucosa
Epithelial and mesenchymal components
Duct-like structures and calcifications
Focal chondromyxoid stroma
Ovoid to spindled stromal cells
Positive CK7
Positive p63
Variable SMMS1
Focal S100
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Maxillary sinus squamous cell carcinoma (CT)
Large exophytic squamous cell carcinoma (CT)
Maxillary sinus adenocarcinoma (MRI)
Sinonasal undifferentiated carcinoma (CT)
SCC bone destruction (CT)
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Endoscopic view of squamous cell carcinoma
Exophytic squamous cell carcinoma
Contributed by Kelly Magliocca, D.D.S., M.P.H.
Maxillary sinus squamous carcinoma
Squamous carcinoma ex papilloma
HPV related multiphenotypic carcinoma
Maxillary sinus adenoid cystic
HPV associated adenosquamous carcinoma
Sinonasal intestinal type adenocarcinoma
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Craniectomy with squamous cell carcinoma
Contributed by Wai Szeto, M.D., M.S.
Squamous cell carcinoma and inverted papilloma
Intestinal type adenocarcinoma
Intestinal type adenocarcinoma
Maxillary nonintestinal type adenocarcinoma
Sinonasal undifferentiated carcinoma
Sinonasal undifferentiated carcinoma mitotic activity
Nonintestinal type adenocarcinoma (CK7)
Nonintestinal type adenocarcinoma (SOX10)
Sinonasal undifferentiated carcinoma (pancytokeratin+)
Retained INI1
Contributed by Jinping Lai, M.D., Ph.D.
Right nasal mass (MRI axial)
Right nasal mass (MRI coronal)
Right nasal mass (MRI sagittal)
Contributed by Jinping Lai, M.D., Ph.D.
Nasal endoscopy
Contributed by Jinping Lai, M.D., Ph.D.
Cut surface
Contributed by Jinping Lai, M.D., Ph.D.
Subepithelial grenz zone and whorled features
Perivascular hyalinization and staghorn vessels
No mitosis, eosinophils
Beta catenin nuclear staining
Positive cyclin D1
Positive CD99
Positive SMA
Low Ki67 index
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CT findings of an inverted papilloma
MRI findings of an inverted papilloma
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Squamous papilloma
Endoscopic image
of an inverted
papilloma
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Inverted papilloma
Contributed by Bin Xu, M.D., Ph.D.
Inverted papilloma
Exophytic papilloma
Oncocytic papilloma
Malignant transformation (carcinoma ex sinonasal papilloma)
Contributed by Bin Xu, M.D., Ph.D. and Abeer Salama, M.D.
MRI
Contributed by Bin Xu, M.D., Ph.D. and Abeer Salama, M.D.
Lobules and sheets of malignant cells
Cytologic features of malignant epithelial cells
High grade features: mitosis and apoptosis
Cytokeratin AE1 / AE3
IDH2 R172T immunohistochemistry
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Keratinizing squamous cell carcinoma
Nonkeratinizing squamous cell carcinoma
Basaloid SCC: H&E and p63
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Infiltration into orbit
Contributed by Lisa Rooper, M.D.
Highly infiltrative growth
Cytologic uniformity despite high grade
Nests of basaloid cells
Interspersed
basaloid and
rhabdoid
plasmacytoid cells
Sheets of rhabdoid plasmacytoid cells
No surface dysplasia
Cytoplasmic vacuoles
Loss of SMARCB1 (INI1)
WHO's new in sinonasal tract pathology
Dr. Thompson
Cardesa: 2016
Franchi: 2020
Gnepp: 2021
IARC: 2024
Neville: 2023
Robinson: 2012
Stelow: 2020
Thompson: 2022
Volavsek: 2016
Wenig: 2017
Wenig: 2024
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