Rare case of inverted papilloma with single insertion of the nasal septum and no local destruction

Abstract

Introduction: Inverted papilloma (IP) is the second most common benign lesion in the sinonasal region, and the most common surgical indication for benign tumors of the sinonasal tract. The lesion is estimated to represent 0.4% to 4.7% of all surgically removed nasal tumors, with an incidence ranging from 0.74 to 2.3 new cases per 100,000 inhabitants per year. The most common insertion site of the IP is the lateral nasal cavity, and the maxillary or frontal sinus(up to 30%). The septal insertion in progressive IP is extremely rare.

Case Presentation: A 68 year old male patient visited our institution with difficulties in nasal breathing that were worsening in the last 2 years. Basic ENT exam was performed including otoscopy and oropharyngoscopy being without any notable pathology. Fiberendoscopic evaluation of the nose showed tumor mass that macroscopically looked like papilloma, filling the entire left nasal cavum and blocking the posterior part of the right nasal cavity. CT scan was performed indicating that the tumor mass fills the entire left nasal cavum, the larger portion of the epipharynx, blocking both the choanal openings. Functional Endoscopic Sinus Surgery was performed, during which the tumor mass was totally removed with its insertion on the nasal septum in the left nasal cavum. Hystopathological analisys confirmed the macroscopic findings and showed that the mass is inverted papilloma.

Conclusion: The preoperative diagnostics and planning of an operation are crucial for the outcome of the treatment. Detecting and radically removing the insertion of the IP is the main challenge intraoperatively. Unusual sites of origin must not diverge us from the total and radical removal of the tumor. Histopathologic confirmation of the whole operative specimen is concluding the successful treatment. Keywords: Inverted Papilloma, Endoscopic nasal surgery, Sinonasal Tumors, Human Papilloma Virus (HPV)