Malignant Transformation of Exophytic Sinonasal Papilloma: Case Report
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 12, Issue 1
Abstract
Malignant transformation of exophytic sinonasal papilloma (SP) is exceptionally rare. The authors present a case of a 48 years old woman who presented to hospital with unilateral nasal obstruction, a tissue mass in the right nasal entrance. After CT scans of the paranasal sinuses endoscopic surgery was carried out, and the lesion was removed. The histological examination discovered an exophytic SP with a part of squamosus cell carcinoma. The patient underwent radiotherapy. After that the thickened mucosa from the right sinus maxillaries was removed. Histological examination revealed SP fragments in the polypoid mucosa without any sign of malignancy. To date we have found no sign of recurrent papilloma or carcinoma. The pathogenesis of papillomas is not clear. In one third of sinonasal papillomas HPV-6 and 11 are present. In our patient no HPV DNA was identified in the removed tissues. The carcinoma and the dysplastic area was p16 positive, while the exophytic SP epithelium was negative.Schneiderian papillomas (SPs) of the nose (also known as sinonasal papillomas) were described by Ward in 1854. In 1991, the World Health Organization classified sinonasal papillomas into three distinct histopathological subtypes: exophytic, inverted, and oncocytic. The incidence of sinonasal papillomas is approximately 2.3 cases per 100,000 population per year. The inverted and the exophytic types are more common than the oncocytic. Malignant transformation of SP is estimated in the literature from 2 to 27 %and appears mostly in inverted papillomas [1]. Malignant transformation of exophytic SP is exceptionally rare.A 48-year-old woman presented to the hospital with nasal obstruction. She had noticed this problem first time 27 years before. During the last months a tissue mass appeared in the nasal entrance, which deformed the right alar part of the nose. Nasal endoscopy and CT scan of paranasal sinuses showed a polyplike soft tissue mass, that filled the right sinus maxillaris, destructed its medial wall and the right ethmoid cells (Figure 1). This tissue enlargement posteriorly reached the epipharynx and anteriorly bulged into the left common nasal cavity through a septal defect. Endoscopic surgery was performed in general anesthesia. The lesion was removed in multiple parts. The tissue samples from the right nasal cavity and from the right sinus maxillaris have shown the structure of a typical exophytic Schneiderian papilloma with a part of invasive high grade planocellular carcinoma (Figure 2). Histologically exophytic proliferations with a fibrovascular core covered by transitional type epithelium could be seen, in some locations squamosus metaplasia and koilocytosis were present. The malignant transformation represented a proportion of 10- 15% of the sample. At the margins of the malignant transformed area extensive features of dysplasia in the whole thickness of the epithelium was found, which represented the in situ component of the tumor.
Authors and Affiliations
István Magyarosi, Cifra J, Takács I, Somogyvári K, P Móricz
Keywords
Related Articles
- EP ID EP592720
- DOI 10.26717/BJSTR.2018.12.002192
- Views 194
- Downloads 0
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