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Review
. 2022 Apr 28;14(9):2195.
doi: 10.3390/cancers14092195.

Sinonasal Inverted Papilloma and Squamous Cell Carcinoma: Contemporary Management and Patient Outcomes

Jacob G Eide  1 , Kevin C Welch  2 , Nithin D Adappa  1 , James N Palmer  1 , Charles C L Tong  1
Affiliations
Review

Sinonasal Inverted Papilloma and Squamous Cell Carcinoma: Contemporary Management and Patient Outcomes

Jacob G Eide et al. Cancers (Basel). .

Abstract

Inverted papillomas (IP) are the most common sinonasal tumor with a tendency for recurrence, potential attachment to the orbit and skull base, and risk of malignant degeneration into squamous cell carcinoma (SCC). While the overall rate of recurrence has decreased with the widespread adoption of high-definition endoscopic optics and advanced surgical tools, there remain challenges in managing tumors that are multiply recurrent or involve vital neurovascular structures. Here, we review the state-of-the-art diagnostic tools for IP and IP-degenerated SCC, contemporary surgical management, and propose a surveillance protocol.

Keywords: Schneiderian; endoscopic; open; papilloma; recurrence; sinonasal; tumor.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Biopsy-proven sinonasal inverted papilloma pedicled on the lateral nasal wall.
Figure 2
Figure 2
Coronal image of computed tomography showing a recurrent sinonasal inverted papilloma pedicled on the posterior maxillary sinus wall. There is significant hyperostosis at the origin of the lesion.
Figure 3
Figure 3
Alternating lines of high and low signal intensity (convoluted cerebriform pattern) seen in an inverted papilloma of the maxillary sinus.
Figure 4
Figure 4
IP-degenerated squamous cell carcinoma. (A) Non-contrasted CT sinus demonstrating a mass of the left sphenoid with erosion of the skull base at the sella. (B) STIR sequence contrasted MRI demonstrating an expansile mass originating from the left sphenoid lateral wall. (C) T1 sequence contrasted MRI with fat suppression demonstrating a mass of the left sphenoid and ethmoid cavity.
Figure 5
Figure 5
IP-degenerated squamous cell carcinoma. (A) Non-contrasted CT scan demonstrating an erosive mass in the right nasal cavity with invasion into the orbit. (B) T1 sequence contrasted MRI scan demonstrating the invasion of the mass into the medial orbit. (C,D) PET CT scan demonstrating avidity of the right nasal mass.
Figure 6
Figure 6
Krouse staging system [20].
Figure 7
Figure 7
Hematoxylin and eosin staining of an inverted papilloma demonstrating ribbons of hyperplastic respiratory epithelium that grow into the adjacent stroma.
Figure 8
Figure 8
IP outcomes stratified by attachment (unifocal vs. multifocal), primary or residual/recurrent disease by a single institution. Red arrow denotes optimal outcome after management of unifocal primary disease.
Figure 9
Figure 9
Treatment algorithm for the diagnosis, management, and surveillance of both IP and malignant SCC ex-IP.
See this image and copyright information in PMC

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