Most Common Nasal Mass
Nasal polyps are the most common benign nasal mass, accounting for approximately 85-90% of all polypoidal lesions in the nasal cavity. 1
Epidemiology and Clinical Context
Inflammatory nasal polyps represent the most frequent mass lesion encountered in clinical practice, with a prevalence of 2-4% in the general population 2
Among all polypoidal lesions presenting to clinical settings, true nasal polyps (inflammatory and allergic types combined) comprise 44% of cases, while the remaining are neoplastic (34%) or other nonneoplastic lesions 3
In pediatric populations specifically, inflammatory nasal polyps remain the most common benign or malignant nasal mass, though polyps are notably rare in children overall 4
Histopathologic Classification
The edematous, eosinophilic type (often called "allergic" polyps) dominates the histologic spectrum:
Edematous eosinophilic polyps constitute 85-90% of all nasal polyps, characterized by edema, goblet cell hyperplasia, basement membrane thickening, and numerous eosinophils 1
Fibroinflammatory polyps represent the second most common histological type, with chronic inflammation and metaplastic epithelial changes 1
Rare variants include polyps with pronounced seromucinous gland hyperplasia and atypical stromal polyps 1
Clinical Presentation Patterns
Nasal obstruction is the most frequent presenting symptom, occurring in 76.9% of cases, followed by rhinorrhea, anosmia, and post-nasal drip 5, 6
Polyps typically occur after age 40 years in adults, with no clear sex predominance in recent large population studies 2
Bilateral presentation is the norm for inflammatory polyps; unilateral masses should immediately raise suspicion for alternative diagnoses including inverted papilloma (which accounts for 0.5-4.5% of presumed polyps) or malignancy 7
Critical Diagnostic Caveat
While nasal polyps are the most common mass, any unilateral polypoid lesion, masses in children/adolescents, or lesions with atypical endoscopic features (brick red, black necrotic areas, firm lobulated appearance) mandate tissue biopsy to exclude neoplasia, with a diagnostic discrepancy rate of 4.5% in unilateral disease 7