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. 2011 Nov;1(2):111-4.
doi: 10.1055/s-0031-1280738. Epub 2011 Jun 9.

Aggressive inverted papilloma with intracranial invasion and short malignization time

Peter Valentin Tomazic  1 , Heinz Stammberger, Walter Habermann, Christoph Schmid, Wolfgang Koele, Michael Mokry, Verena Gellner, Alfred Beham
Affiliations

Aggressive inverted papilloma with intracranial invasion and short malignization time

Peter Valentin Tomazic et al. Skull Base Rep. 2011 Nov.

Abstract

Inverted papillomas (IP) are considered benign lesions with a prevalence up to 4% among all sinunasal tumors; however, invasive growth and varying tendency for malignization are reported in literature. We report the case of a 69-year-old woman suffering from a large, aggressively growing IP invading the orbit, skull base, and frontal lobe of the brain. Within only 3 months' time the papilloma showed transformation into an invasive carcinoma, leaving surgical therapy in vain due to explosive recurrence. Intracranial and intraorbital expansion by IP is possible despite histology not showing signs of malignancy initially. In "regular" IP close endoscopic follow-up is mandatory to not overlook recurrence harboring malignancy.

Keywords: Inverted papilloma; endoscopic surgery; intracranial involvement; rapid malignization.

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Figures

Figure 1
Figure 1
Preoperative MRI and CT at the time of first diagnosis. (A) Coronal preoperative MRI showing intracranial involvement of IP. (B) Coronal CT showing tumor extent into frontal sinus and intracranial invasion. (C) Axial CT showing intraorbital involvement on the right.
Figure 2
Figure 2
Histological examination after first operation. (A) Hematoxylin/eosin-stained slice under microscope showing regular inverted papilloma (IP) tissue after first operation (magnification original ×45). (B) Hematoxylin/eosin-stained slice under microscope showing carcinoma in situ after first operation (magnification original ×200).
Figure 3
Figure 3
Histological examination 3 months after first operation. (A) Hematoxylin/eosin-stained slice under microscope showing invasive carcinoma after transcranial operation for recurrence (magnification original ×200). (B) Hematoxylin/eosin-stained slice under microscope showing invasive carcinoma with stromal invasion (marked with arrow) after transcranial operation for recurrence (magnification original ×45).
See this image and copyright information in PMC

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