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. 2025 Jun 27;15(13):1645.
doi: 10.3390/diagnostics15131645.

Differences in Imaging and Histology Between Sinonasal Inverted Papilloma with and Without Squamous Cell Carcinoma

Niina Kuusisto  1 , Jaana Hagström  1   2 , Goran Kurdo  3 , Aaro Haapaniemi  4 , Antti Markkola  3 , Antti Mäkitie  4   5 , Markus Lilja  4
Affiliations

Differences in Imaging and Histology Between Sinonasal Inverted Papilloma with and Without Squamous Cell Carcinoma

Niina Kuusisto et al. Diagnostics (Basel). .

Abstract

Objectives: Sinonasal inverted papilloma (SNIP) is a rare benign tumor that has potential for malignant transformation, usually into squamous cell carcinoma (SCC). The pre-operative differentiation between SNIP and SNIP-SCC is essential in determining the therapeutic strategy, but it is a challenge, as biopsies may fail to recognize the malignant part of the tumor. Further, a SNIP can also be locally aggressive and thus mimic a malignant tumor. This retrospective study compares the pre-operative differences in computed tomography (CT) and histologic findings between patients with a benign SNIP and those with a SNIP-SCC. Methods: Eight patients with SNIP-SCC were selected from the hospital registries of the Department of Otorhinolaryngology, Helsinki University Hospital (Helsinki, Finland). For each case a comparable SNIP case without malignancy was selected. Five histopathologic samples of both the SNIP and SNIP-SCC tumors were retrieved. CT images and the histopathologic samples were re-evaluated by two observers. Results: The nasal cavity and ethmoid and maxillary sinuses were the most common sites for both tumor types. The SNIP tumors were mostly unilateral, and the SNIP-SCC tumors were both unilateral and bilateral. Only SNIP-SCC tumors demonstrated bone defects and orbital or intracranial invasion. Dysplastic findings such as dyskeratosis, nuclear atypia, and maturation disturbances were seen only in the SNIP-SCC tumors. Conclusions: Bony destruction and invasion of adjacent structures in pre-operative CT images seem to be pathognomonic signs of SNIP-SCC based on this series. To differentiate between SNIP and SNIP-SCC tumors all available pre-operative investigations are warranted.

Keywords: computed tomography; inverted papilloma; sinonasal; squamous cell carcinoma.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Selection process of the SNIP and SNIP-SCC cases.
Figure 2
Figure 2
(a–d) Axial (left) and coronal (right) slices of two CT images of SNIP-SCC (case 1 (a,b) and case 2 (c,d)). Intracranial defects are observed in (a) posterior wall of frontal sinus and (b) skull base. Both tumors are bilateral (extending to both sides).
Figure 3
Figure 3
(a–d) Axial (left) and coronal (right) slices of two CT images of SNIP without SCC (case 1 (a,b) and case 2 (c,d)). Both tumors are unilateral (affecting only one side) without clear bone defects.
See this image and copyright information in PMC

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