Question

Inverted papilloma.

Hint:

Inverted papillomas should be suspected in patients with unilateral nasal symptoms, especially if there is a history of recurrent epistaxis or nasal obstruction.

Answer 1

Step 1: Overview of Inverted Papilloma.
Inverted papilloma (IP) is a benign but locally aggressive epithelial tumor that arises from the mucosa of the nasal cavity or paranasal sinuses. It is characterized by its tendency to invade the surrounding tissues, including the bone and the orbit.
Step 2: Clinical Presentation.
The most common clinical features of inverted papilloma include:
(1) Nasal Obstruction: Patients often present with chronic nasal congestion and obstruction due to the tumor’s growth in the nasal cavity.
(2) Nasal Discharge: Mucoid or bloody nasal discharge is frequently reported.
(3) Recurrent Epistaxis: Nosebleeds are common due to the vascularity of the tumor.
(4) Facial Pain or Swelling: If the tumor extends into the sinuses or orbit, it may cause facial pain, pressure, or swelling.
(5) Reduced Sense of Smell (Anosmi: The tumor can interfere with the olfactory system, leading to anosmia or hyposmia.
Step 3: Diagnosis.
The diagnosis of inverted papilloma is made based on clinical examination and imaging studies. Key diagnostic steps include:
(1) Endoscopy: Nasal endoscopy often reveals the characteristic cauliflower-like growth, which is typically gray or pinkish in appearance.
(2) CT Scan or MRI: Imaging studies help assess the extent of the tumor, including any invasion into adjacent structures like the sinuses, orbit, or skull base.
(3) Biopsy: A biopsy is essential for confirming the diagnosis. Histologically, inverted papillomas exhibit a characteristic pattern of epithelial proliferation with downward growth into the underlying stroma.
Step 4: Treatment.
The treatment of inverted papilloma is primarily surgical excision, often requiring wide local resection to ensure complete removal and reduce the risk of recurrence. Surgical approaches may include endoscopic or open surgery, depending on the tumor’s size and location.
Step 5: Prognosis.
While inverted papillomas are benign, they have a tendency to recur, and there is a risk of malignant transformation (particularly to squamous cell carcinom. Regular follow-up is essential to monitor for recurrence.