The following is an interactive article focusing on a fictional medical case study. Use the following information to deduce what medical condition the patient is experiencing. There will be options at the end, each with a brief explanation of what each condition is to help you make your diagnosis. Please post your conclusion and why you chose it in the comments. After some time has passed, the correct answer will be revealed for you to check your work!
A 32-year-old male presented to his ENT (ear, nose, and throat doctor) for a routine ear cleaning appointment. The patient informed the doctor of difficulty breathing out of his right nostril. Using an endoscope, the doctor examined the right nostril and determined a mass in the patient’s sinus cavity. The doctor retrieved a sample of the mass and ordered a CT scan.
The patient reported no unusual incidents leading to a sudden onset of breathing difficulty, but rather a slow decline in the ability to breathe out of the right nostril over several months. The patient and his family have no history of ear, nose, throat, or sinus conditions. The patient smokes cigarettes regularly. The patient does not have a history of working with cancer-causing airborne chemicals.
The results of the CT scan indicated that there was a golf-ball sized tumor in the posterior aspect of the patient’s nasal cavity, extending into the sinuses. The biopsy revealed that the tumor was benign but still growing quickly, extending in finger-like projections toward both the orbital bones around the eye and the temporal fossa in such a manner that it would threaten the patient’s life. The doctor also indicated that there was a risk that the tumor could become cancerous if left untreated.
A surgical treatment called the Functional Endoscopic Endonasal Approach was performed, removing the mass through the nose and sinus of the patient without having to make incisions on the face.
The patient was able to recover at home after a brief observation period. He reported regular discharge of mucus for several weeks, which was expected, and all follow-up appointments have been unremarkable and show no sign of the tumor returning.
Here are four potential conditions the patient could be experiencing. Use the information from the article and the information about the conditions provided below to narrow down a diagnosis.
Nasal Polyps:
These are painless and benign growths in the thin, soft tissue lining nasal and sinus passages. Nasal polyps usually appear on both sides of the nose and can become irritated and swollen, making it hard to breathe through the nose. When they grow larger, they resemble peeled grapes that are pink, yellow, or gray. Symptoms can include nasal congestion, headaches, runny nose, sinus pressure, and snoring.
Adenocarcinoma:
Sinonasal adenocarcinoma is a type of cancer that forms in the air-filled spaces (sinuses) located in the nasal cavity behind the nose. Symptoms can include nasal obstruction or congestion, a feeling of pain or pressure in the ears, headaches, or sinus pain. Treatment options include removal by either endoscopic sinus surgery or an open approach with an external incision.
Inverted papilloma:
Inverted papillomas are noncancerous tumors that form in the back of the nasal cavities, often extending into the sinuses, and their growth can threaten the orbital bones and, more rarely, the brain. Despite being benign, they must be treated with surgery, as the tumor will not go away on its own, and can cause damage to the surrounding bone and tissue. They also have the potential to become cancerous. In most cases, the inverted papilloma can be removed by endoscopic sinus surgery. Symptoms may include nasal obstruction usually on just one side, sinus infections, nosebleeds, or runny nose.
Osteoma:
Osteomas are benign, slow-growing bony tumors that usually arise on the bony walls of the sinus cavities. They are the most common paranasal sinus tumors. Small osteomas frequently do not cause symptoms and are incidentally discovered. However, larger osteomas may cause symptoms including sinus infections, facial pains, or headaches. Larger osteomas can encroach upon the brain or structures around the eye. Although many osteomas can simply be observed and remain untreated since they grow slowly, surgical removal can be considered based on the symptoms and location of the tumor. Osteomas can be removed using endoscopic sinus surgery.
What is your diagnosis for the patient? Comment down below!
Update (9/8/24): Time for the reveal! The correct diagnosis was inverted papilloma.
Thanks for reading,
Ashby
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