Transitional neoplasms of the naso-lacrimal system: A review of the histopathology and histogenesis

Abstract

Transitional papilloma (inverted papilloma, Schneiderian papilloma) is a relatively common, benign epithelial neoplasm of the sinonasal tract that also occurs in the lacrimal drainage system. The name transitional papilloma is recommended because it reflects the key histological features required for pathological diagnosis, as well as the histogenesis of the tumour. The histogenesis of the tumour is reviewed, together with its natural history, which is characterized by bone remodelling and destruction, a tendency to recur and to undergo malignant transformation. Biomarkers associated with these features have been identified in the sinonasal tumours and may also be of relevance to the lacrimal sac tumours, although the necessary studies have not yet been undertaken.

Keywords: Inverted papilloma; Lacrimal sac; Schneiderian papilloma; Transitional cell carcinoma; Transitional papilloma.

Figure 1

Surface epithelial changes in a recurrent transitional papilloma of the maxillary sinus. (a) Normal ciliated upper respiratory tract epithelium; (b) metaplastic transitional epithelium with surface layer of ciliated cells; (c) thickened transitional epithelium; (d) endophytic growth of surface transitional epithelium; (e) bland epithelium with microcysts and intra-epithelial neutrophils characteristic of transitional epithelium.

Figure 2

A man with a 12 month history of a lump in the left medial canthus and epiphora. (a) CT scan showing apparent invasion of orbit by mass in left lacrimal fossa, interpreted as malignant by radiologist; (b) dacryocystectomy specimen: sac lumen obliterated by papilloma with ‘ribbon’ of thickened epithelium; (c) transitional papilloma with mixed exophytic and endophytic growth pattern [haematoxylin & eosin]; (d) residual fragments of bone of lacrimal fossa on outer surface of sac stained black with von Kossa reagent.

Figure 3

Transitional cell carcinoma of lacrimal sac. (a) CT scan showing mass in right medial canthus; (b) circumscribed nests of atypical transitional epithelium in biopsy of mass; (c) surface origin of invasive transitional cell carcinoma in dacryocystectomy specimen [haematoxylin & eosin].