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Does antrochoanal polyp present with epistaxis?

Published online by Cambridge University Press:  11 December 2009

R H Sayed  and
E E Abu-Dief
R H Sayed*
Affiliation:
Department of ENT, Faculty of Medicine, Sohag University, Egypt
E E Abu-Dief
Affiliation:
Department of Histology, Faculty of Medicine, Sohag University, Egypt
*
Address for correspondence: Dr Ramadan Hashem Sayed, ENT Department, Faculty of Medicine, Sohag University, Sohag, Egypt. Fax: 0020934602963 E-mail: ramadan3_eg@yahoo.co.uk
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Abstract

Objective:

To compare the gross and microscopic appearance of antrochoanal polyps associated with recurrent epistaxis, with those with a more typical presentation.

Design:

Prospective, controlled study.

Methods:

All patients underwent clinical and endoscopic examination, computed tomography scanning, and examination under anaesthesia, in order to detect the gross diagnostic criteria for antrochoanal polyp. Histological findings on light microscopy were compared for polyps presenting with epistaxis versus those without. The number of predominant inflammatory cells in the corium was determined in both groups and statistically compared using the Student t-test.

Results:

Recurrent epistaxis was a presenting symptom in 10/84 (11.9 per cent) patients with gross diagnostic criteria for antrochoanal polyp. Grossly, these patients' polyps had a reddish, vascular surface in parts. Histologically, these polyps showed a highly vascular stroma with multiple dilated blood vessels, the typical appearance of an angiomatous antrochoanal polyp. Thrombi at different stages of development were detected, with no infarcts. The remaining cases (88.1 per cent) had no history of epistaxis; histologically, these patients' polyps showed an oedematous connective tissue core with few inflammatory cells. Plasma cells were predominant in the angiomatous polyps, being significantly more prevalent than in the ordinary antrochoanal polyps (p < 0.00).

Conclusions:

It would appear that only angiomatous antrochoanal polyps present with epistaxis. Detection of the characteristic gross appearance of these polyps may help avoid unwanted surgery. Histopathological analysis confirms the diagnosis. A significantly increased number of plasma cells may be the underlying cause of the histological changes seen in angiomatous antrochoanal polyps.

Keywords

Nasal PolypsMaxillary SinusEpistaxis
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 5 , May 2010 , pp. 505 - 509
Copyright
Copyright © JLO (1984) Limited 2009

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References

1Robson, AK, Barker, CS, Whittet, HB. Epistaxis as an unusual presentation of an antrochoanal polyp. J Laryngol Otol 1990;104:643–4CrossRefGoogle ScholarPubMed
2Batsakis, JG, Sneige, N. Choanal and angiomatous polyps of the sinonasal tract. Ann Otol Rhinol Laryngol 1992;101:623–5CrossRefGoogle ScholarPubMed
3Gendeh, BS, Long, YT, Misiran, K. Antrochoanal polyps: clinical presentation and the role of powered endoscopic polypectomy. Asian J Surg 2004;27:22–5CrossRefGoogle ScholarPubMed
4Franche, GL, Granzotto, EH, de Borba, AT, Hermes, F, Saleh Cde, Sde Souza, PA. Endoscopic polipectomy with middle meatal antrostomy for antrochoanal polyp treatment. Bras J Otorrinolaringol 2007;73:689–92CrossRefGoogle ScholarPubMed
5Virós Porcuna, D, Montserrat Gili, JR, Gras Cabrerizo, JR, López Vilas, M, Pujol Olmo, A. Unilateral benign choanal polyp: review of 51 patients [in Spanish]. Acta Otorrinolaringol Esp 2008;59:52–6Google ScholarPubMed
6Hardy, G. The choanal polyp. Ann Otol Rhinol Laryngol 1957;66:306–26CrossRefGoogle ScholarPubMed
7Som, PM, Cohen, BA, Sacher, M, Choi, IS, Bryan, NR. The angiomatous polyp and the angiofibroma: two different lesions. Radiology 1982;144:329–34CrossRefGoogle ScholarPubMed
8Irnberger, T. Computed tomographic diagnosis and differential diagnosis of juvenile angiofibroma and angiomatous polyps [in German]. Rofo 1985;142:391–4Google ScholarPubMed
9De Vuysere, S, Hermans, R, Marchal, G. Sinochoanal polyp and its variant, the angiomatous polyp: MRI findings. Eur Radiol 2001;11:55–8CrossRefGoogle ScholarPubMed
10Ole-Lengine, L, Manni, JJ. A strangulated antrochoanal polyp. A case report. J Laryngol Otol 1993;107:342–3CrossRefGoogle ScholarPubMed
11Wittekindt, C, Hess, A, Bloch, W, Sultanie, S, Michel, O. Immunohistochemical expression of VEGF and VEGF receptors in nasal polyps as compared to normal turbinate mucosa. Eur Arch Otorhinolaryngol 2002;259:294–8Google ScholarPubMed
12Ito, A, Hirota, S, Mizuno, H, Kawasaki, Y, Takemura, T, Nishiura, T et al. Expression of vascular permeability factor (VPF/VEGF) messenger RNA by plasma cells: possible involvement in the development of edema in chronic inflammation. Pathol Int 1995;45:715–20Google ScholarPubMed