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Nasal papilloma

Last updated: March 26, 2021

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Nasal papillomas are benign epithelial tumors of the nasal cavity which mainly affect males between 40–60 years of age. The exact etiology is unknown, but human papillomavirus infection, smoking, and chronic sinusitis are predisposing factors for the development of nasal papillomas. There are three types of nasal papillomas. Inverted papilloma is the most common, arises from the lateral nasal wall and has the highest risk of malignant degeneration. Fungiform and oncocytic nasal papillomas are less common. Patients often present with unilateral nasal obstruction, anosmia, and intermittent epistaxis. On examination, nasal papillomas appear dull gray/pink and are friable. CT or MRI delineate the extent of the papilloma; diagnosis is established on biopsy. All nasal papillomas should be completely excised. Although benign, nasal papillomas are locally aggressive, have a malignant potential, and a high recurrence rate if incompletely excised.

  • Nasal papillomas are benign epithelial tumors of the nasal cavity mucosa, which can be locally aggressive, have malignant potential, and a high propensity for recurrence if incompletely excised. [1]
  • Incidence: rare; ∼ 1 case per 100,000 population per year [2] [3]
  • Sex: > (5:1)
  • Age: 40–60 years [4]

Epidemiological data refers to the US, unless otherwise specified.

References:[3][4]

Classification of nasal papilloma [4][5][6]
Types of nasal papillomas Frequency Site of attachment Gross appearance Histology [5]
Inverted papilloma
  • Most common
  • Dull pink/gray opaque masses with an irregular surface
  • Epithelium: nonkeratinizing cylindrical (transitional) cells with intracellular mucin
  • Endophytic growth
Fungiform papilloma
  • Uncommon
Oncocytic papilloma (cylindrical cell papilloma)
  • Rare
  • Oncocytic epithelium: columnar cells with dark nuclei
  • Mixed (exo- and endophytic) pattern of growth
  • Unilateral nasal obstruction (most common symptom) → unilateral anosmia; difficult nasal breathing
  • Epistaxis
  • Unilateral nasal discharge
  • Unilateral epiphora
  • On examination:
    • Unilateral dull pink/gray polypoid lesion which completely fills the nasal cavity → pushes the septum to the contralateral side
    • Friable (bleeds on touch)
  • Symptoms of chronic sinusitis

References:[3][7]

  • CT scan with contrast: Indicated in unilateral nasal masses to differentiate benign from malignant masses; findings include:
    • Nonspecific unilateral mass displacing or distorting the nasal septum/paranasal sinus (PNS)
    • Areas of calcification
    • Bony destruction
  • MRI: shows a cerebriform pattern
  • Nasal endoscopy: indicated in all unilateral nasal masses to confirm the site of origin and obtain a sample for histopathological examination
  • Biopsy: most important to confirm the diagnosis based on histology [4]

References:[4][7][8][9]

A patient with unilateral difficulty breathing through the nose may have a malignant tumor.

References:[6][10]

The differential diagnoses listed here are not exhaustive.

  • Complete surgical excision: treatment of choice for benign papilloma in good surgical candidates (because of high rates of recurrence if incompletely excised)
  • Radiation: considered only in inoperable disease with malignant transformation or in poor surgical candidates

References:[3][4]

References:[5][6][11][12]

We list the most important complications. The selection is not exhaustive.

  • High recurrence rates in incompletely resected nasal papillomas

References:[6]

  1. Finger S. Origins of Neuroscience. Oxford University Press, USA ; 2001
  2. Lin GC, Akkina S, Chinn S, et al. Sinonasal inverted papilloma: prognostic factors with emphasis on resection margins.. Journal of neurological surgery. Part B, Skull base. 2014; 75 (2): p.140-6. doi: 10.1055/s-0033-1363169 . | Open in Read by QxMD
  3. Nasal Papilloma. http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1254817761. Updated: January 1, 2016. Accessed: May 22, 2017.
  4. Barnes L. Schneiderian papillomas and nonsalivary glandular neoplasms of the head and neck. Mod Pathol. 2002; 15 (3): p.279-297. doi: 10.1038/modpathol.3880524 . | Open in Read by QxMD
  5. Vorasubin N, Vira D, Suh JD, Bhuta S, Wang MB. Schneiderian papillomas: comparative review of exophytic, oncocytic, and inverted types. Am J Rhinol Allergy. 2013; 27 (4): p.287-292. doi: 10.2500/ajra.2013.27.3904 . | Open in Read by QxMD
  6. Wenig BM. Atlas of Head and Neck Pathology. Elsevier Health Sciences ; 2015
  7. Barnes L. Pathology and Genetics of Head and Neck Tumours. International Agency for Research on Cancer ; 2005
  8. Yildirim D, Saglam O, Gurpinar B, Ilica T. Nasal cavity masses: clinico-radiologic collaborations, differential diagnosis by special clues. Open Journal of Medical Imaging. 2012; 2 : p.10-18. doi: 10.4236/ojmi.2012.21002 . | Open in Read by QxMD
  9. Abdullah B, Abdullah K, Khan S, Hamzah M. Surgical outcomes of inverted papilloma: a retrospective review of endoscopic and external approaches. The Internet Journal of Head and Neck Surgery. 2006; 1 (1).
  10. Pitak-Arnnop P, Bertolini J, Dhanuthai K, Hendricks J, Hemprich A, Pausch NC. Intracranial extension of Schneiderian inverted papilloma: a case report and literature review. Ger Med Sci. 2012; 10 . doi: 10.3205/000163 . | Open in Read by QxMD
  11. Lawson W, Kaufman MR, Biller HF. Treatment outcomes in the management of inverted papilloma: an analysis of 160 cases. Laryngoscope. 2003; 113 (9): p.1548-1556. doi: 10.1097/00005537-200309000-00026 . | Open in Read by QxMD
  12. Mendenhall WM, Hinerman RW, Malyapa RS, et al. Inverted papilloma of the nasal cavity and paranasal sinuses. Am J Clin Oncol. 2007; 30 (5): p.560-563. doi: 10.1097/COC.0b013e318064c711 . | Open in Read by QxMD