J Rhinol.  2023 Jul;30(2):120-124. 10.18787/jr.2023.00020.

A Case of Sinochoanal Polyp Originating From the Ethmoid Sinus

• Kim BH
• Hong S
• Jang Y
• Myung JK
• Cho SH

• KMID: 2544622
• DOI: http://doi.org/10.18787/jr.2023.00020

Abstract

A nasal polyp is a distinct mucosal pathology that obstructs the nasal cavity and paranasal sinuses, with various phenotypes and endotypes. Nasal polyps should be distinguished from inverted papillomas, squamous cell carcinomas, juvenile angiofibromas, lymphomas, and olfactory neuroblastomas. A choanal polyp is a solitary benign lesion that originates in the paranasal sinus and extends to the choana through the natural ostium of the sinus. Choanal polyps usually originate from the maxillary sinus; however, we recently experienced the case of 41-year old women with sinochoanal polyp originated from the ethmoid sinus. As choanal polyps can recur even after appropriate surgery, complete resection, including the surrounding mucosa at the site of origin, is required. Therefore, it is essential to consider anatomical differences in polypectomy. We recently diagnosed and successfully performed surgery on an ethmochoanal polyp; herein, we report our experience and present a literature review.

Keyword

Nasal polyps; Ethmoid; Choana: Pathology; Endoscopy

Figure

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  Fig. 1. Endoscopic findings of the ethmochoanal polyp. The pedunculated polyp (P) emerged from the left anterior ethmoid and extended to the middle meatus and the choana. MT, middle turbinate; IT, inferior turbinate; S, septum.

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  Fig. 2. Radiologic findings of the ethmochoanal polyp. Paranasal sinus computed tomography images (axial and coronal) of the ethmochoanal polyp (P). CT scans showed its origin (A), stalk (passage through the ethmoid sinus, B and D) and final extension to the middle meatus and choana (C and E).

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  Fig. 3. Gross findings of the ethmochoanal polyp. The ethmochoanal polyp, with a length of approximately 6.5 cm, showed a pedunculated structure. The stalk of its origin (O) was about 3.5 cm long, and the two branches of the polyp were each about 3 cm long.

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  Fig. 4. Pathologic findings of the ethmochoanal polyp. Representative images of an ethmochoanal polyp (A), a nasal polyp (B), and an antrochonal polyp (C) (H&E, magnification ×40 and ×400). The surfaces of the three polyps are lined by benign respiratory epithelium. The ethmochoanal polyp showed numerous dilated cystic structures lined by columnar epithelium and filled with mucus within the stroma. The stroma of the ethmochoanal polyp showed an edematous or loosely myxoid appearance without infiltration of mixed inflammatory cells. Compared to the ethmochoanal polyp, the nasal polyp and antrochonal polyp revealed prominent inflammatory cells composed of a mixture of lymphocytes, plasma cells, eosinophils, and neutrophils, without a dilated cystic structure in the stroma.

Reference

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