Sinonasal inflammatory polyp

This is an inflammatory nasal polyp that has been surgically removed.  It has a soft and fleshy texture with yellowish/pinkish color.  The color and size can vary widely.

The respiratory epithelium is intact (left).  The stroma is characterized by edema and inflammatory cell infiltrates (right).  Seromucous glands are usually absent.

Axial (left) and coronal (right) view of CT imaging of the face demonstrating multiple nasal polyps (arrows)  that appear to have originated from both the lateral wall and the ethmoid process.  The patient who has had prior nasal polypectomy presented with chronic sinusitis, nasal obstruction and mild headache. 

Most sinonasal polyps originate from the lateral nasal wall or from the ethmoid process, and it can be single or multiple. Etiology includes allergy, infections, cystic fibrosis, diabetes, and aspirin intolerance. It is most commonly seen in adults over 20 years old. It is rarely seen in children. Patients classically present with nasal obstruction, rhinorrhea, obstructive sleep apnea, and headache. Some patients with nasal polyps also present with aspirin insensitivity and asthma – this is known as the Samter’s triad. Treatment is surgical resection (e.g., Functional Endoscopic Sinus Surgery or FESS) of the polyps, but it is important to identify and treat any underlying factors. Recurrence is common. Differential diagnosis includes: infectious (TB, sarcoid); amyloidosis, angiofibroma; Wegener’s granulomatosis, rhabdomyosarcoma, and squamous epithelial lesions.