Author(s)
Kevin Choi, MD, MS
Matthew Crowson, MD
David Jang, MD
John F. Madden, MD, PhD
Ralph Abi-Hachem, MD
Affiliation(s)
Duke University Medical Center
Abstract:
Introduction: Schneiderian papillomas are benign neoplasms divided in three subtypes: inverted, exophytic and oncocytic, each with unique clinical and histologic features. Surgical resection with histological analysis and postoperative surveillance is recommended. Schneiderian papillomas classically present as a single subtype with a distinct attachment site within the sinonasal cavity. The inverted and exophytic subtypes are the most common, arising from the lateral nasal wall and the nasal septum respectively, and both are associated with the Human Papilloma Virus. The oncocytic subtype is rare and emanates from the ethmoid sinus and lateral nasal wall.This is the first reported case of a synchronously occurring inverted and expophytic papillomas treated with endoscopic resection.Methods: Case report and review of literature.Results: A 65 year-old female presented with nasal obstruction, anosmia and epistaxis. Rigid endoscopy demonstrated an exophytic mass with complete bilateral nasal obstruction. Preoperative biopsies were significant for exophytic papilloma. MRI revealed a bilateral sinonasal mass with cerebriform pattern. CT showed pansinus opacification with hyperostosis of the left anterior ethmoid, left medial maxillary wall and the anterior nasal septum. Intraoperative findings included an inverted papilloma based off the left medial maxillary wall and a synchronous exophytic papilloma emanating from the right anterior septum. Multiples additional focis of inverted papillomas were identified in the fossa of Rosenmüller, posterior septum, and lateral nasal wall nasal floor. Dysplasia or carcinoma was not identified on final pathology.Conclusion: Synchronous lesions with separate attachments should be considered in those undergoing surgery for extensive schneiderian papillomas.