Nasal papilloma

• squamous papilloma are very common
  • they are wart-like growths arising from the nasal vestibule
  • they tend to cause irritation or be cosmetically undesirable
  • they will bleed if traumatised
  • treatment is by excision under local anaesthesia.
    
    
• inverted papilloma, also known as transitional papilloma, Ringertz tumour or Schneiderian papilloma
  • an inverted papilloma (IP) is a rare benign tumour representing only 0.5% to 4% of all nasal neoplasms (1)
  • an IP derives from the Schneiderian mucosa of the nasal cavity - the Schneiderian mucosa is of ectodermal origin and is embryologically different from the endodermally derived mucosa of the upper respiratory tract
  • an IP most commonly arises from the lateral nasal wall, particularly from the middle turbinate and middle meatus
    • rarely and IP arises from the mucosa of the paranasal sinuses so that the involvement of the paranasal sinuses, such as the maxillary sinus and ethmoid sinus, usually represents a secondary extension of the tumour from the lateral nasal wall
  • an IP is rarely multicentric and bilateral and is associated with malignant lesions in 9% of cases
    • in a review of 89 cases of inverted papilloma malignancy was simultaneously associated with an IP in 8 cases (9%). In 5 patients, a squamous cell carcinoma (SCC) was found associated with an IP (in 2 cases, the SCC was in situ, whereas in 3, it was invasive); in the other patients, the IP was associated with an adenocarcinoma (ADC) in 2 cases and with an esthesioneuroblastoma (ENB) in the other case (2)
  • aetiology of an IP is still unknown, but smoking, chemical pollutants, allergens, chronic sinusitis, and human papilloma virus have been indicated as possible predisposing causes
  • IP tends to present in the fifth to seventh decades of life,with a markedly male predominance
  • clinical features depend mainly on the anatomic site of its occurrence, and unilateral nasal obstruction represents the most frequent symptom
  • surgical treatment represents the principal approach for an IP - treatments such as radiotherapy, because of the risk of radiotherapically induced transformation of the papillomatous epithelium, are used mostly in inoperable cases and in those cases of an IP associated with a malignancy
  • recurrent IPs
    • no case of associated malignancy was encountered in those cases of recurrent IP (2). In the same study the recurrent tumours were residual tumours rather than real recurrences (2)
  • another study revealed malignant transformation in 7% of IPs (3)

Reference:

1. E.M. Skolnick, A. Loewy and J.E. Friedman, Inverted papilloma of the nasal cavity. Arch Otolaryngol 84 (1966), pp. 83–89.
2. Ernesto Pasquini et al. Inverted papilloma: report of 89 cases. American Journal of Otolaryngology, Volume 25, Issue 3, May-June 2004, Pages 178-185
3. Lawson W et al. Treatment outcomes in the management of inverted papilloma: an analysis of 160 cases. Laryngoscope. 2003 Sep;113(9):1548-56