Pediatric Sinonasal Inverted Papilloma: An Uncommon Occurrence and Its Proposed Management

Abstract

Inverted papilloma (IP) represents 0.4 to 4.7% of polypoid lesions of the nose and paranasal sinuses. It characteristically presents in the 5th to 6th decade of life, with a 3:1 male predilection. IP most commonly arises along the lateral nasal wall or occasionally from the maxillary antrum or sinus.1,2 Although characterized as a benign tumor, it demonstrates a high recurrence rate and has the capacity to expand by local extension into vital structures.3 Concurrent squamous cell carcinoma (SCC) has been found in 3-10% of cases.3,4 The etiology of IP is unclear, but human papillomavirus (HPV) and Epstein-Barr Virus (EBV), have been implicated in its development.1,2,4 Endoscopic exam reveals a papillomatous, polypoid mass which can fill the entire nasal cavity, often involving more than one sinus, making the point of attachment difficult to identify in the awake patient. CT imaging may delineate the origin at a point of bony sclerosis or deformation of the nasal wall, whereas MRI helps distinguish the mass from inspissated secretions or inflammatory changes, and allows evaluation of the extent of tumor growth.2 Pathologic examination is necessary to distinguish IP from other polypoid lesions of the sinonasal tract. It is histologically characterized by hyperplastic ribbons of squamous or ciliated columnar multilayered epithelium mixed with mucocytes that grows endophytically into the underlying stroma.1,4 IP has rarely been described in the pediatric patient population, with less than 20 confirmed cases in the English language literature. Hyam’s landmark study of 149 patients with sinonasal IP included no pediatric cases.5 Schramm’s series of 376 pediatric nasal masses did not include a single case of IP.6 Pediatric Sinonasal Inverted Papilloma: An Uncommon Occurrence and Its Proposed Management Benjamin Y. Rafii, MD1,3; Maggie A. Kuhn, MD1,3; Elana Opher, MD4; Aaron Hartman, MD4; and Jessica W. Lim, MD2,3 Department of Otolaryngology, 1NYU School of Medicine and 2SUNY Downstate, Departments of 3Otolaryngology and 4Pathology, Lenox Hill Hospital