The International Tinnitus Journal

Location-Specific Histopathological Phenotypes of Maxillary Sinus Cysts: A Secondary Analysis of 140 Surgical Cases

Ulugbek Khasanov, Lola Khasanova, Jamolbek Djuraev, Nozim Axundjanov, Ulugbek Abdullayev, Sunatillo Mirzayev, Ilyos Soatov, Xurshed Mardonov, Gulruh Shodmonkulova1*

Background: Maxillary sinus cysts are frequently identified on cross-sectional imaging, yet radiologic appearance alone does not reliably characterize the underlying tissue response. Whether imaging-defined anatomical localization is associated with reproducible histopathological phenotypes remains insufficiently investigated. Objective: To determine whether maxillary sinus cyst localization is associated with distinct epithelial, inflammatory, and stromal histopathological patterns in surgically treated patients. Methods: This secondary cross-sectional analysis included 140 adults who underwent surgery for maxillary sinus cysts at a single tertiary center between 2023 and 2025. Preoperative multislice computed tomography, supplemented by cone-beam computed tomography when odontogenic or alveolar relationships required clarification, was used to classify lesions into four anatomically defined groups: ostium-adjacent/medial-superior (n=51), inferior wall/alveolar recess (n=31), anterior wall/anterior-inferior (n=16), and anteromedial/crista conchalis (n=42). Resected cyst walls were processed with hematoxylin-eosin staining. Seven binary histopathological features were compared across groups using Pearson’s chi-square tests; sparse distributions were checked by Monte Carlo exact testing. False-discovery-rate correction and Cramer’s V were used to assess multiplicity and effect size. Results: Five of seven histopathological features differed significantly by anatomical group after false-discovery-rate correction. Eosinophilic infiltration was most frequent in the ostium-adjacent/medial-superior group (92.2%; q<0.001; V=0.682), whereas lymphocytic-leukocytic-plasmacytic infiltration (71.0%; q<0.001; V=0.523) and basement membrane thickening (77.4%; q<0.001; V=0.433) predominated in inferior wall/alveolar recess lesions. Epithelial metaplasia was concentrated in anterior wall/anterior-inferior lesions (43.8%; q=0.002; V=0.332). Fibrous tissue proliferation was most common in ostium-adjacent/medial-superior lesions (84.3%; q<0.001; V=0.369). The strongest pooled associations were observed for eosinophilic infiltration in group I (odds ratio [OR] 20.93, 95% confidence interval [CI] 6.91-63.44), inflammatory infiltration in group II (OR 8.66, 95% CI 3.53-21.26), and epithelial metaplasia in group III (OR 7.99, 95% CI 2.49-25.63). Conclusion: Imaging-defined anatomical localization was associated with distinct histopathological phenotypes in maxillary sinus cysts. The findings support a location-aware diagnostic framework and targeted tissue sampling but do not justify replacing histopathological confirmation with imaging. External validation with blinded pathology review, standardized imaging protocols, and adjustment for odontogenic and allergic factors is required.