Identifying Inverted Papilloma: An Important consideration in Nasal Polyposis

Abstract

Inverted papillomas comprises of only 0.4% to 7% among all sinonasal tumors and commonly presents as red, bulky, unilateral, vascular mass and sometimes associated with the presence of polyps. Though benign it is given special attention because of its increased incidence of recurrence, with a property to cause destruction locally and in long-standing cases its association with carcinoma. Its presentation can be very similar to chronic rhinosinusitis with nasal polyposis or an antro-choanal polyp therefore, it can be misdiagnosed if high clinical suspicion is not kept in mind. Out of the three cases in this series, one case was initially diagnosed as chronic rhinosinusitis with nasal polyposis, second case was diagnosed as antro-choanal polyp based on clinical, radiological and pre-operative biopsy reports and the third case was diagnosed as inverted papilloma with synchronous squamous cell carcinoma after the preoperative biopsy report. The need to bear in mind the possibility of inverted papilloma although rare in differential diagnosis of nasal polyposis is stressed because it necessitates a more complete surgical procedure to avoid recurrence and achieve better outcome.