The incidence of significant pathology in patients presenting with benign-appearing unilateral nasal polyps.

OBJECTIVE: The presentation of unilateral nasal polyps traditionally necessitates histological evaluation for a neoplasm. This study sought to determine the rates of significant pathology in patients presenting with benign-appearing unilateral nasal polyps, to inform practice. METHOD: All patients who underwent nasal polypectomy for benign-appearing unilateral nasal polyps over a 13-year period were included. RESULTS: A total of 77 patients were included. On histology, 60 cases (77.9 per cent) were found to be inflammatory polyps. Thirteen cases were neoplastic, of which 11 (14.3 per cent) were benign and 2 (2.6 per cent) were malignant neoplasms. The following significant pathologies were found: Schneiderian papillomas, in 10 cases (13.0 per cent); neurofibroma, in 1 case (1.3 per cent); adenoid cystic carcinoma, in 1 case (1.3 per cent); and malignant melanoma, in 1 case (1.3 per cent). CONCLUSION: Our data support routine histological assessment for all unilateral nasal polyps. Malignancy is rare (2.6 per cent) in patients presenting with benign-appearing unilateral nasal polyps. In elderly, unfit patients with minimal symptoms, initial conservative management may be reasonable.

Suppurative pylephlebitis caused by toothpick perforation.

We have reported a case of suppurative pylephlebitis in an elderly, debilitated patient. The infection was caused by toothpick perforation of and migration from the gastrointestinal tract. The patient had risk factors for foreign body ingestion, including poor dentition, aphasia caused by a previous cerebrovascular accident, and alcohol abuse. Investigation for the otherwise obscure cause of suppurative hepatic disease should take into account the possible, yet difficult to define, source related to an ingested foreign body.