Inverted papilloma presenting as unilateral proptosis: A case report with review of literature

Abstract

Inverted papilloma is an interesting benign tumour arising from lining epithelium of paranasal sinuses which most commonly involves nasal cavity and paranasal sinuses. However, involvement of orbit and intracranial extension without malignant transformation is very rare. We report a case of extensive inverted papilloma of frontal sinus which primarily presented with proptosis, an uncommon presentation. Ophthalmologic symptoms are rare manifestations of paranasal sinus inverted papilloma without malignant transformation and signify extensive disease with possible intracranial extension.

Keywords: Frontal sinus; Inverted papilloma; Proptosis.

Fig. 1

Clinical image showing globe displacement and eye swelling.

Fig. 2a

CEMRI brain, orbit and PNS (coronal section) showing altered signal intensity enhancing lesion right anterior cranial fossa, orbit, frontal and ethmoid sinuses with deviation of eyeball infero-laterally.

Fig. 2b

CECT brain and PNS (coronal section) showing enhancing lesion involving frontal and ethmoid sinuses with erosion of floor and orbital extension.

Fig. 3a

Intra-operative picture showing tumour (black arrow) in frontal sinus and defect in the posterior wall of frontal sinus with exposed dura (white arrow).

Fig. 3b

Intra-operative picture showing retroconal orbital fat (OF) with dehiscent lamina, tumour was removed from the posterior part around the optic nerve (white arrow).

Fig. 4a

H & E section (400X) showing frequent mitosis (black arrows).

Fig. 4b

Post-operative picture showing well healed nasal cavity and medial orbit.