Background: Lesions of the nasal cavity and paranasal sinuses encompass a broad spectrum of pathological entities ranging from non-neoplastic inflammatory conditions to benign and malignant neoplasms. These lesions vary widely depending on age, occupation and addiction habits and other environmental factors. A careful clinical workup including symptomatology, radiological investigations &endoscopy helps to determine a differential diagnosis but histopathology provides the final diagnosis. Objective: To evaluate the histopathological features of sinonasal lesions in a tertiary care setting and document their frequency and distribution. Methods: A prospective cross-sectional study of 80 cases conducted over 2years (January 2024–January 2026) in department of Pathology, Government General hospital, Mahabubnagar. Histopathological examination was performed using hematoxylin and eosin staining, with relevant Immunohistochemistry and classified based on WHO guidelines. Results: Non-neoplastic lesions predominated (75%), with Rhinosinusitis being most common (40%). Benign neoplasms (18.75%) outnumbered malignant ones (6.25%). Hamartoma (REAH) and Hemangioma were the most frequent benign tumors, while Sinonasal squamous cell carcinoma, Sinonasal undifferentiated carcinoma and Olfactory neuroblastoma represented malignant cases. Conclusion: Histopathology remains the cornerstone for definitive diagnosis of sinonasal lesions. Awareness of rare entities such as REAH and inverted papilloma is essential to avoid misdiagnosis.