Inflammatory Nasal Polyps Can Be Identified via Routine Histopathology

Routine histopathological examination of surgically removed polyps may improve the diagnosis and treatment of chronic rhinosinusitis with bilateral nasal polyps (CRSwNP), according to the results of a recent study.

To better understand the need for histopathological examinations, the researchers conducted a retrospective study. Included were 235 patients who had undergone functional endoscopic nasal surgery in a tertiary medical center from 2006 to 2015. All participants had had a nasal polypectomy, a histological examination, and included data on whether a neoplasm was suspected prior to surgery.

The results indicated that 4.3% (n = 10) of participants had inverted papilloma. Of the participants with neoplasms, 94% (n = 220) had clinically nonsuspicious lesions during the preoperative and operative course. The final pathology revealed that 97.7% (n = 215) of these samples were inflammatory polyps, while 2.3% (n = 5) of patients had inverted papilloma.

Among the 6% (n = 15) of participants with suspicious lesions, the final pathology revealed that 67% were inflammatory polyps, and 33% were inverted papilloma. Among the suspicious lesions:

• 7 were asymmetric (4 of which were inflammatory polyps)
• 2 were bleeding lesions (1 of which was an inflammatory polyps)
• 2 were firm (both of which were inflammatory lesions)
• 4 had caused local bone thinning (all of which were inflammatory lesions)

When compared with patients who were negative for neoplasm, participants whose final pathology was positive for neoplasm were significantly older in age. The risk of a final pathology positive for neoplasm increased by 6% for every year in age in patients with bilateral polyposis.

“To conclude, inverted papilloma and other neoplasms are considered rare incidental findings in patients presenting with bilateral nasal polyps. This study demonstrated a higher rate of the latter than that reported in the literature,” the authors concluded. “Our study further examines that despite the low incidence of these pathologies, a histopathologic examination of every nasal polypectomy is warranted so as not to miss potential serious pathologies. We stress that a routine histopathological examination should be practiced at least in the elderly population.”

—Leigh Precopio

Reference:

Safadi A, Carmel-Neiderman NN, Toledano R, et al. The efficiency of routine histopathological examination for bilateral nasal polyposis. Ear Nose Throat J. 2021;100(5 Suppl):670S-674S. https://doi.org/10.1177/0145561319872728