[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Head and neck](https://durgical.com/en/general-pathology/areas/head-neck/) › Sinonasal tumours

# Sinonasal tumours

- Lesion

Rare nasal and sinus tumours: a bleeding vascular tumour of teenage boys, inverted papillomas, an olfactory neuroendocrine tumour and an aggressive carcinoma.

Updated Nov 12, 2026

## Key points

- Angiofibroma: adolescent males, recurrent epistaxis; posterolateral nasal wall; many vessels in collagenous stroma; CTNNB1 (β-catenin) mutations, link to FAP; preoperative embolisation.
- Sinonasal (Schneiderian) papilloma: inverted (commonest), oncocytic and exophytic; inverted grows downward into stroma, recurs and can transform to SCC.
- Olfactory neuroblastoma (esthesioneuroblastoma): roof of nasal cavity near the cribriform plate; nests of small round cells with neurofibrillary stroma, Homer Wright rosettes; synaptophysin, chromogranin, S-100 sustentacular cells.
- NUT carcinoma: NUTM1 fusions (often BRD4::NUTM1); poorly differentiated with abrupt keratinisation; most patients survive less than a year.
- Small round blue cell differential: lymphoma, small cell carcinoma, Ewing sarcoma, rhabdomyosarcoma, melanoma.

## What it is

The nasal cavity and paranasal sinuses host uncommon but characteristic tumours. Sinonasal (nasopharyngeal) angiofibroma is a benign but locally aggressive vascular tumour almost only of adolescent boys. Sinonasal papillomas, especially the inverted type, recur and can turn malignant. Olfactory neuroblastoma is a small round blue cell tumour of the olfactory mucosa, and NUT carcinoma is a rare, very aggressive carcinoma defined by a gene fusion.

## Structure

- Angiofibroma: unencapsulated mass of thin-walled and staghorn vessels in dense fibrous stroma with stellate fibroblasts.
- Inverted papilloma: thick ribbons of transitional-type epithelium with intraepithelial microcysts and neutrophils, growing inward.
- Olfactory neuroblastoma: lobules of uniform small cells in fibrovascular stroma, fibrillary matrix, rosettes.
- NUT carcinoma: sheets of monotonous undifferentiated cells with abrupt foci of keratin; nuclear NUT staining.

## Step by step

- In angiofibroma, β-catenin mutations and androgen sensitivity drive stromal and vascular growth in teenage boys.
- Papillomas arise from the ciliated Schneiderian mucosa; low-risk HPV or EGFR mutations are found in some.
- Olfactory neuroblastoma arises from neuroectodermal cells of the olfactory epithelium.
- In NUT carcinoma the fusion protein blocks differentiation and keeps MYC active.

## Sinonasal tumours

| Tumour | Who | Key feature | Behaviour |
| --- | --- | --- | --- |
| [Sinonasal angiofibroma](https://durgical.com/en/conditions/juvenile-nasopharyngeal-angiofibroma/) | Adolescent males | Vessels in fibrous stroma, CTNNB1 | Benign, locally aggressive, bleeds |
| Inverted sinonasal papilloma | Men 30–60 | Endophytic epithelial ribbons | Recurs, may become SCC |
| Olfactory neuroblastoma | Peak 40s–60s | Small round cells, neuroendocrine markers | Malignant |
| NUT carcinoma | Any age | NUTM1 fusion | Very aggressive |

## Markers

- β-catenin
- Synaptophysin
- S-100 sustentacular cells
- NUT

## Clinical notes

- Unilateral nasal obstruction and epistaxis in an adolescent boy suggest angiofibroma: avoid biopsy in clinic because of bleeding.
- Unilateral polyp-like mass in an adult needs biopsy to exclude inverted papilloma or cancer.
- Olfactory neuroblastoma can cause anosmia and spread into the anterior cranial fossa.

## Memory aid

Teen boy plus nosebleed equals angiofibroma until proven otherwise.

## Test yourself

Think of the answer, then tap the question to see it.

## Who typically develops a sinonasal angiofibroma and how does it present?

Adolescent males, with nasal obstruction and recurrent epistaxis.

## Which sinonasal papilloma is commonest and why is it important?

The inverted papilloma; it grows into the stroma, recurs often and can transform into squamous cell carcinoma.

## What genetic event defines NUT carcinoma?

A rearrangement of the NUTM1 gene, most often a BRD4::NUTM1 fusion.

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## Connections

## Related 4

- [Benign vs malignant tumours: the comparison table](https://durgical.com/en/general-pathology/benign-vs-malignant-tumours-the-comparison-table/)
- [Nasopharyngeal carcinoma: EBV, keratinizing and nonkeratinizing types](https://durgical.com/en/general-pathology/nasopharyngeal-carcinoma-ebv-keratinizing-and-nonkeratinizing-types/)
- [Necrotizing lesions of the nose and upper airway](https://durgical.com/en/general-pathology/necrotizing-lesions-of-the-nose-and-upper-airway/)
- [Benign lesions of the larynx](https://durgical.com/en/general-pathology/benign-lesions-of-the-larynx/)

## Related conditions 1

- [Juvenile nasopharyngeal angiofibroma](https://durgical.com/en/conditions/juvenile-nasopharyngeal-angiofibroma/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Head and Neck Cancer](https://medlineplus.gov/headandneckcancer.html) (MedlinePlus, US National Library of Medicine, 2025).

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Source: https://durgical.com/en/general-pathology/sinonasal-tumours/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/sinonasal-tumours/