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Giant Rhinosinusal Inverted Papilloma
A N Căpitănescu1, M R Mitroi1, C Foarfă2
1Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, Romania.
Abstract:
Sinonasal papilloma is a benign tumor, derived from Schneiderian sinonasal epithelium. There have been described three histological subtypes: inverted, oncocytic and exophytic. The case presented here is A 66-year-old male patient, which was hospitalized in our Otolaryngology Department for a giant tumor, that was exteriorized from the left nostril, repeated epistaxis, nasal obstruction and anosmia. The computed tomography scan revealed an iodophilic and non-homogeneous tumor, with areas of necrosis, which included the entire left nasal cavity, with extension to the rhinopharynx and the left maxillary sinus. We completely removed the tumor by an endoscopic medial maxillectomy, with the subsequent histopathological examination revealing an inverted papilloma, with areas of low grade dysplasia and also areas with oncocytic Schneiderian papilloma. At the six-months postoperative control, there was no tumor recurrence. Major issues of this type of tumor is fast invasion capacity and numerous local recurrence. More recent studies have shown that these relapses are often overdue tumors.
Insights
A giant sinonasal inverted papilloma was successfully removed via endoscopic surgery. This case highlights the importance of complete resection to prevent recurrence of this aggressive benign tumor.
Area of Science:
- Otolaryngology
- Pathology
Background:
- Sinonasal papillomas are benign tumors originating from the Schneiderian epithelium, with inverted, oncocytic, and exophytic subtypes.
- Inverted papillomas are known for their rapid invasion and high recurrence rates.
Observation:
- A 66-year-old male presented with a large, externally visible tumor protruding from the left nostril, accompanied by epistaxis, nasal obstruction, and anosmia.
- CT imaging revealed a non-homogeneous, iodophilic tumor occupying the left nasal cavity, extending into the rhinopharynx and left maxillary sinus.
Findings:
- The tumor was completely resected using endoscopic medial maxillectomy.
- Histopathology confirmed an inverted papilloma with areas of low-grade dysplasia and oncocytic Schneiderian papilloma.
Implications:
- Complete endoscopic resection is crucial for managing large sinonasal inverted papillomas.
- Early and accurate diagnosis is vital due to the tumor's invasive potential and tendency for recurrence.
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