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Plain X-ray appearances of inverted papilloma. Approximately half the patients presented with an opaque antrum on the affected side and a mass in the nasal cavity.
Source publication
Inverted papilloma is an uncommon benign tumour of the nose and paranasal sinuses which has a characteristic histological pattern, high recurrence rate after surgery and may undergo malignant change. The X-ray features are reviewed in 60 patients with histologically confirmed tumours. Plain X-ray appearances were negative or non-specific in nearly...
Contexts in source publication
Context 1
... of the 60 patients examined had negative plain sinus views or showed non-specific X- ray features, such as mucosal thickening in several sinuses, unrelated to the presence of the inverted papilloma. (2) In 32 patients (53%) an opaque antrum was present on the affected side and in 29 (48%) a mass could be seen in the nasal cavity on the same side (Fig. 1). In 16 (27%) the ethmoids were opaque and in 6 (10%) the frontal sinuses were also involved. (3) In 11 (18%) a soft tissue mass was demonstrated at the posterior nares or in the ...
Context 2
... other features were demonstrated by CT scan. In six patients there were areas of calcification within the tumour mass (Figs 6, 7, 8) and in eight patients there was bone sclerosis of the sinus walls and septa adjacent to the tumour (Figs. 9, 10A, B), sometimes associated with deformation of their normal contour (Figs. 11, ...
Context 3
... other features were demonstrated by CT scan. In six patients there were areas of calcification within the tumour mass (Figs 6, 7, 8) and in eight patients there was bone sclerosis of the sinus walls and septa adjacent to the tumour (Figs. 9, 10A, B), sometimes associated with deformation of their normal contour (Figs. 11, ...
Context 4
... of the sinus walls is a non-specific change most frequently seen in chronic sinus infection. However, in these patients the new bone formation is distributed evenly along the sinus walls without deformation. The combination of bone deformity and sclerosis suggests a slow-growing tumour such as an inverted papilloma (Fig. ...
Similar publications
Inverted Schneiderian papilloma (ISP) is a neoplasm of epithelial lining origin which arises in the respiratory mucosa that lines the nasal cavity and paranasal sinuses. The inverted Schneiderian papilloma frequently appears as a unilateral lesion in the nasal septum and extends secondarily to the nasal and paranasal sinuses. This paper reports an...
OBJECTIVES
To evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela).
MATERIAL AND METHODS
We reviewed 94 patients with SP that were treated at our otolaryngology center, from July 1st 1993 to June 31st 2015....
More than 70 benign and malignant sinonasal tumours and tumour-like conditions have been described. However, sinonasal tumours are rare, and sinonasal cancers comprise only 3% of all head and neck cancers and 1% of all malignancies, with a peak incidence in the 5th to 7th decades and with a male preponderance. The early symptoms and imaging finding...
Patient: Male, 51-year-old
Final Diagnosis: Sinonasal inverted papilloma
Symptoms: Nasal congestion • nasal mass
Medication: —
Clinical Procedure: —
Specialty: Pathology
Objective
Rare disease
Background
Inverted papilloma is a benign epithelial lesion of the nasal cavities. Although commonly encountered in clinical practice, it rarely presents w...
Citations
... It shapes like a pyramid and each contains three cavities. They are basically mucus lined cavities that reduce the skull weight, produce mucus, affect the tone quality of a person's voice and they also aids in trapping dust and dirt particles (Lund and Lloyd, 1984). Maxillary sinus drains into nose by an opening called ostia. ...
Background: Recent advances in the understanding the pathophysiology of paranasal sinuses has revolutionized the surgical management of chronic and recurrent sinusitis. Coronal plane computerized tomographic (CT) scanning has dramatically improved the imaging of paranasal sinus anatomy as compared to sinus radiographs. Increasingly, subtle bony anatomic variations and mucosal abnormalities of this region are being detected. Data regarding the background prevalence of these findings are needed to determine their clinical relevance. Objective(s): To determine the frequency of computed tomography paranasal sinuses in the evaluation of sinusitis. Methodology: A cross-sectional study was conducted at Al-Razi Health Care, Lahore. From May 2018 to September 2019, data of 177 patients were collected through convenient sampling. Adults and children with acute maxillary sinusitis/ rhino sinusitis were included in the study. Data of patients with recent cold associated with irritating runny nose and headache along with congestion was collected from the patients. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Results: Out of 177 patients collected, 82 were females and 95 were males. History of running nose was collected. 51 out of 185 had running nose. 120 patients were presented with headache. 115 had the history of cough. 102 had shortness of breath and 107 had congestion. 59 patients were suffering from cold. The final result came out to be 106 sinusitis patients. Conclusion(s): Pathologies in the maxillary sinus are frequently found in CBCT imaging and have to be treated or followed-up accordingly. CBCT is applicable for diagnosis and treatment planning of clinically present sinusitis.
... Currently, the radiologic characteristics of SNIP have been categorized. [2][3][4][5][6][7][8] In most of the previous findings, emphasis has been placed on the diagnostic significance of SNIP. Some studies have also focused on the identification of the extent of disease or tumor recurrence. ...
... Because of these limitations in the imaging of SNIP, endoscopic evaluation during surgery has been regarded as the only credible method for determining the areas in which tumors are attached. 9,10 Changes in the bone that have been detected using CT scanning in patients with SNIP include intratumoral calcification, bowing, thinning, erosion, and sclerosis 4,5,7 CT findings of bowing, bone thinning, and erosion might be due to an increase in the pressure exerted by the tumor as the tumor grows. So, it is unlikely that such changes in bone are associated with the origin site of the tumor. ...
... In our findings, there wereassociation betweenthe CT-based detection of areas within which there were sclerotic changes or endoscopic determination and hyperostosis of the tumor origin. However sclerotic changes of bone in the SNIP have been described previously, 4,5,13 the relationship between these findings and the origin of tumors has not been examined in detail. Generally, the origins of SNIP are localized to areas within the walls of the sinonasal cavity, despite the fact that these tumors usually have a large volume. ...
... Лунд и соавт. выявили различия в вариантах гиперостоза в случаях инвертированной папилломы и хронических риносинуситов [11]. В подтверждение их теории, мы выявили, что гиперостоз в месте зоны инвертированной папилломы обычно локализован и эксцентричен, что отличается от четкой, диффузной и концентрической картины склеротического изменения при хроническом воспалительном процессе. ...
Precise localization and excision of the originating site of a sinonasal inverted papilloma is essential for decreasing tumor recurrence. In this study we evaluated the use of preoperative computed tomography (CT) to pinpoint the attachment/origi-nating sites of the tumor.
... The cause of focal hyperostosis is not fully understood but it is hypothesized that tumour induced inflammation at the site of origin leads to bone remodeling and increased bone deposition with vascularity at the site of attachment. 6,12,13,14 This is different from the diffuse, concentric sclerosis of the bony walls of paranasal sinuses seen in chronic rhinosinusitis and is concurred by Lund and Lloyd et al. 15 In the present study, we identified focal hyperostosis in 13 out of 15 cases of IP (86.7%) and all corresponded with tumour origin identified endoscopically and is in agreement with Lee et al. 12 The controversy exists in literature regarding the approach to management of sinonasal inverted papilloma. Open approach is considered to be the standard of care but endoscopic approach in recent time has taken precedence over the traditional open approach. ...
Introduction
Inverted papillomas are notorious for recurrence. The surgical cause attributed to recurrence is failure to achieve good surgical exposure and inadequate clearance of disease. Pre-operative prediction about the site of origin by CT Scan may contribute to a better surgical outcome. This study was undertaken to assess if focal hyperostosis on pre-operative CT scan can be considered to be a predictor of the site of tumour origin and correlate with endoscopic finding of the site of origin.
Materials and Method
A prospective descriptive study was carried out between Jan 2014 and May 2016. Fifteen patients of histopathologically proven inverted papilloma that reported during this time period were evaluated using contrast enhanced CT Scan and subsequently underwent endoscopic excision of tumour identifying the tumour origin. Assessment of age, gender, symptoms, pre-operative staging, location of the tumour origin on CT Scan and surgical correlation of origin was done. Post-operative follow-up was done at 1 month, 3 months and 6 monthly thereafter.
Results
Six (40%) were classified as Krouse II and nine (60%) were classified as Krouse III. 12 (80%) arising from maxillary sinus, 02 (13.3%) arising from maxillary sinus and anterior ethmoids and 01 (6.7%) from sphenoid. Thirteen (86.7%) cases CT scan could predict the tumour origin which was confirmed during surgery. All cases managed by endoscopic technique with no recurrence or co-existence of malignancy.
Discussion
Focal hyperostosis in the walls of paranasal sinus is seen to be associated with IP tumour origin, the cause of which is not fully understood. It is hypothesized that tumour induced inflammation at the site of origin leads to bone remodeling and increased bone deposition with vascularity at the site of attachment.
Conclusion
CT scan is a good predictor of tumour origin and a conservative endoscopic approach can be planned accordingly for complete clearance of disease.
... 29,30 In contrast, Lund et al. reported differences in the patterns of osteogenesis between SIP and chronic paranasal sinusitis. 31 According to our study, hyperostosis in SIP usually was localized and eccentric, unlike the pattern of sclerotic change in chronic paranasal sinusitis that is characteristically diffuse and concentric. Moreover, no tumor cells or apparent bone destruction but only bone thickening on one side of the lamella was detected in chronic paranasal sinusitis. ...
Objective
The aim of this study is to provide histopathological evidence for a better understanding of the excision of bone underlying tumor.
Study Design
Retrospective study.
Methods
Thirty patients with histopathological diagnosis of sinonasal inverted papilloma (SIP) were enrolled. All patients underwent preoperative radiography to define the tumor location. The primary tumor and underlying bone, removed during endoscopic surgery, were examined under microscope.
Results
Twenty-five of 30 specimens exhibited bony hyperostosis on computed tomography (CT) images, and 12 of 30 specimens showed evidence of bony lamellar erosion. Both coexisted in 11 cases. Half of the relapse cases (8 of 16) presented bone discontinuity on CT, which indicates a higher propensity for bone involvement when compared with primary SIP. On histopathology, 26 cases presented hyperostosis and 11 cases showed bone invasion. In total, 90% of cases covered both. Sixteen cases showed a growing tendency of inflammatory cells infiltration.
Conclusion
Histopathological evidence of bone involvement indicates the importance of removal of the underlying bone at the time of endoscopic tumor resection. We hypothesized that bone involvement including bone invasion and osteogenesis may be induced by the tumor, and any microscopic lesion in the bony crevices probably indicates recurrence of SIP. Furthermore, infiltration of inflammatory cells may facilitate bone involvement and cause recurrence.
Level of Evidence
3b. Laryngoscope, 2017
... Focal or expansile erosion, osteolysis and oesorption (∼70% of cases) Focal or expansile remodeling (∼70% of cases) Focal or eccentric hyperostosis (∼89% of cases) Plaque-like (lateral nasal wall) or cone-shaped (paranasal sinuses; nasal septum) NBF Focal or eccentric osteitis (∼95% of cases) Cortical thinning Focal or eccentric sclerosis Intratumoral calcification (∼10% of ISPs); Bone entrapment (∼40% of ISPs) Hyperemic demineralization; erosive pressure atrophy Remodeling of the nasal vault and facial bones Bowing of the cranio-facial bones; septal deviation Potentially aggressive bone destruction Intracranial extension and associated sequalae Chronic (Rhino) sinusitis and associated sequelae Carcinogenesis and associated sequelae (1-53% of cases) of clinical cases this affects the underlying periosteal or perichondrial tissue, resulting in various degrees of hyperostosis, sclerosis, osteoneogenesis, remodeling, resorption and NBF (Dammann et al., 1999;Eggers et al., 2007;Lee et al., 2007;Lund and Lloyd, 1984;Okamoto et al., 2011;Saha et al., 2011;Thapa, 2010;Tsuzuki et al., 2010;Unlu et al., 2007;Woodruff and Vrabec, 1994) (Table 1). As the tumor increases in mass and volume, excessive pressure on the contiguous structures, impingement of the arterio-venous complexes, or remodelling of the cranio-facial foramina may result in localized erosive pressure atrophy, hyperemic demineralization, and osteitis (Bull and Almeyda, 2011;Eggers et al., 2007;Lee et al., 2003;Maroldi and Nicolai, 2006;Rothfeld et al., 1977). ...
During the routine assessment of skeletal material unearthed from Middenbeemster, a post-Medieval (AD 17-19th century) cemetery in Northern Holland, an adult male with an unidentified choanal lesion was discovered. The affected individual was analysed macroscopically and via computer tomography. Based on the phenotypic and radiographic characteristics of the lesion, and after a comprehensive review of clinical literature, it was determined that the lesion was likely caused by an inverted Schneiderian papilloma (ISP), a benign but locally aggressive endophytic neoplasm histopathologically characterized by the inversion of the epithelium into the lamina propria (Schneiderian membrane) of the respiratory nasal mucosa. This study presents a detailed description of the pathophysiology and aetiology of ISPs, using both bioarchaeological and biomedical frameworks. Several differential diagnoses are discussed, with emphasis on the reasons for their rejection as the primary pathogenic mechanism(s). To the best of the authors' knowledge, this research is the first reported case of ISP within palaeopathology, which highlights the need to consider ISPs whenever slow-growing sinonasal neoplasms are suspected, as well as in cases that exhibit focal rhinitis.
... Of the three distinct forms of Schneiderian papillomas, the inverted papilloma has the most highly characteristic imaging manifestation as a lobulated soft tissue mass along the lateral nasal wall and middle meatus region with a ''cerebriform'' appearance on T2-weighted and/or contrastenhanced T1-weighted MR images ( Fig. 1) [8,9]. Occasional calcifications within this tumor are related to residual bone fragments [10]. Other papillomas vary in appearance, from small nasal cavity polypoid masses to those that expand the nasal cavity through pressure erosion effects and extend into the adjacent paranasal sinuses [11]. ...
Imaging evaluation of sinonasal tumors is most often conducted with computed tomography, which excels at identifying the effects of these masses on adjacent osseous structures, and magnetic resonance imaging that is ideal for distinguishing pathologic masses from mucosal thickening and fluid that are common in the sinonasal spaces and depicting extension into the surrounding soft tissues, orbits, and intracranial compartment. Accordingly, the two studies are complementary exams and both are commonly utilized in the assessment of these masses. Less commonly, positron emission tomography can provide additional metabolic evaluation of potential metastatic disease in patients with malignant disease. While these imaging modalities are excellent for the portrayal of an abnormality, there is considerable overlap in the imaging appearance of these tumors and specific imaging manifestations linked to a particular tumor are frequently lacking. Therefore, while the mass may be readily identified, narrowing the differential diagnosis to a single specific entity is rare. Nevertheless, cross-sectional imaging plays an essential role in patient management and valuable guidance for successful biopsy or surgical resection in virtually all cases. This review emphasizes essential imaging manifestations that correlate with sinonasal tumors in general and highlight certain features that may implicate a specific disease process.
... Contrast-enhanced CT was used in most cases in our study. Unilateral lesions, with local hyperostosis, sometimes with intra-tumoral calcifications, bowing of the sinuses and sometimes erosion, are suggestive for graph 3. Distribution of patients according to Krouse's classification IP 9,10,17 . MRI is sometimes helpful in preoperative diagnosis, showing a columnar pattern, with a cerebriform pattern. ...
Inverted papilloma is a benign tumor of the nose and sinuses, with a high risk of recurrence and malignant degeneration. The inverted papilloma is a slow growing tumor that can be approached through an endoscopic or external approach, depending on its stage.
OBJECTIVE. The aims of the study are to identify the particularities of diagnosis of the inverted papilloma, to establish the correct steps in surgical treatment of this tumor and to open the access for other steps of treatment.
MATERIAL AND METHODS. The authors present their experience in managing the sinonasal inverted papilloma in a 15-year retrospective clinical study, which included 162 patients. The preoperative protocol consisted in clinical examination, nasal endoscopy, radiologic imaging (CT scan) and biopsy with histopathology results and immunohistochemistry findings. Surgical removal of the inverted papilloma was performed by endoscopic techniques, according to the stage of the tumor. We were interested in the recurrence rate of the tumor and its malignancy after a long-term follow-up.
RESULTS. In our series, we included 162 patients and we had 26 (16.04%) recurrences and 12 (7.40%) malignant degenerations. All our patients were diagnosed in Krouse stages I, II and III and underwent endoscopic resection of the tumor.
CONCLUSION. In order not to have any leftover tumor (the most important factor of recurrence and malignant transformation), it is mandatory to have a complete diagnosis of the inverted papilloma, a precise surgical technique and a rigorous followup. In some cases, the surgical treatment is associated with other type of treatment (antiviral, antiangiogenetic).
... 3 Lund and Lloyd reported the different patterns of hyperostosis between inverted papilloma and chronic sinusitis. 4 The hyperostosis in inverted papilloma is usually localized and eccentric, which is different from the even, diffuse, and concentric pattern of sclerotic change in chronic sinusitis. 3 Most recurrences take place at the same site where the tumor originated and are frequently attributable to incomplete local resection. ...
... Erosion, remodeling, and widening of the natural orifice of the sinuses on a CT scan are useful signs indicating IP. Calcification is usually, but not invariably, demonstrated in more benign processes and may calcify in punctate, nodular, linear, or circular patterns [6,297]. Evidence of necrosis and hemorrhage may be seen, although this offers no definite diagnostic or prognostic information. ...
Skull base inverted papilloma (IP) is an unusual entity for many neurosurgeons. IP is renowned for its high rate of recurrence, its ability to cause local destruction, and its association with malignancy. This paper is a comprehensive review of the reports, studies, and reviews published in the current biomedical literature from 1947 to September 2010 and synthesize this information to focus on its potential invasion to the base of the skull and possible intradural extension. The objective is to familiarize the clinician with the different aspects of this unusual disease. The role of modern diagnostic tools in medical imaging in order to assess clearly the limits of the tumors and to enhance the efficiency and the safety in the choice of a surgical approach is pointed out. The treatment guidelines for IP have undergone a complex evolution that continues today. Radical excision of the tumour is technically difficult and often incomplete. Successful management of IP requires resection of the affected mucosa which could be achieved with open surgery, endoscopic, or combined approach. Radio and chemotherapy were used for certain indications. More optimally research would be a multicenter randomized trials with large size cohorts.
