Diagnosis and Treatment of Sinonasal Inverted Papilloma: Retrospective Study

Pedro Correia-Rodrigues, Mariana Sousa Calha, António Nicolau Fernandes, Aliya Nurdin, Paulo Martins, Leonel Luís


Introduction: Sinonasal inverted papilloma (SIP) are rare benign neoplasms characterized by their locally aggressive behaviour, expansive growth, high recurrence rates and potential for malignant transformation. Endonasal endoscopic surgery is nowadays the gold-standard approach for its treatment.

Aims: Review the experience of a university tertiary hospital in the diagnosis and surgical treatment of SIP, identifying potential predictive risk factors for disease recurrence.

Material and Methods: Observational, retrospective and descriptive study; literature revision.

Results: The study included 14 patients with a median age of 51,1±17,5 years and a slight predominance of males (64,3%). According to Krouse classification, 10 tumours were classified as stage II (71,4%) and 4 as stage III (28,6%). Eighteen procedures were performed (14 primaries; 4 revisions), including 11 exclusively-endoscopic approaches (61,1%) and 7 combined approaches (38,9%). Global recurrence rate was 28,6% and mean time to recurrence was 65±22 months. Bivariate analysis of potential risk factors for recurrence didn’t find any association with gender (p=0.095), age (p=0.066), Krouse stage (p=0,520) or surgical approach (p=1,000).

Conclusion: Endonasal endoscopic surgery allows for effective resections in selected tumours, with minimal morbidity and respecting oncologic safety principles. Our experience highlights the importance of endoscopic and imaging life-long surveillance during the post-operative follow-up period of SIN, in order to timely diagnose and treat recurrences and even malignant transformations.

Palabras clave

inverted papilloma; benign sinonasal tumour; nose neoplasm; endonasal endoscopic surgery

Texto completo:



Peng, P. Har-El, G. Management of Inverted Papillomas of the Nose and Paranasal Sinuses. American Journal of Otolaryngology – Head and Neck Medicine and Surgery. 2006.

Buchwald C, Franzmann MB, Tos S: Sinonasal papillomas: a report of 82 cases in Copenhagen County, including a longitudinal epidemiological and clinical study. Laryngoscope 105:72–79, 1995.

Outzen KE, Grontveld A, Jorgensen K, et al: Inverted papilloma: incidence and late results of surgical treatment. Rhinology 34:114– 118, 1996.

Lingen, MW, Kumar, V. Head and Neck. In Kumar, V, Abbas, AK, Fausto, N. (Eds) Robbins and Cotran Pathology. 7th Ed. Cap. 16.

Krouse JH. Development of a staging system for inverted papillomas. Laryngoscope. 2000; 110: 965-8.

Roh HJ, Mun SJ, Cho KS, Hong SL. Smoking, not human papilloma virus infection, is a risk factor for recurrence of sinonasal inverted papilloma. Am J Rhinol Allergy. 2016 Mar- Apr;30(2):79-82.

Jenko K, Kocjan B, Zidar N, Poljak M, Strojan P, Zargi M, Blatnik O, Gale N. In inverted papillomas HPV more likely represents incidental colonization than an etiological factor. Virchows Arch. 2011 Nov;459(5):529-38.

Govindaraj, S., Wang, H., Does human papilloma virus play a role in sinonasal inverted papilloma? Curr Opin Otolaryngol Head Neck Surg. 2014. 22: 47–51.

Lee DK, Chung SK, Dhong HJ, Kim HY, Kim HJ, Bok KH. Focal hyperostosis on CT of sinonasal inverted papilloma as a predictor of tumor origin. AJNR Am J Neuroradiol. 2007;28(4):618–21.

Jeon TY, Kim HJ, Chung SK, Dhong HJ, Kim HY, Yim YJ, Kim ST, Jeon P, Kim KH. Sinonasal inverted papilloma: value of convoluted cerebriform pattern on MR imaging. AJNR Am J Neuroradiol. 2008;29(8):1556–60.

Nicolai, P., Castelnuovo, P. Benign Tumors of the Sinonasal Tract. Flint, PW., Haughey, BH., Lund, VJ., Niparko, JK. (Eds.) Cummings Otolaryngology Head and Neck Surgery. 5th Ed. Elsevier. 2067-2075.

Melroy CT, Senior BA. Benign sinonasal neoplasms: a focus on inverting papilloma. Otolaryngol Clin N Am. 2006;39(3):601–617.

Murphy JT, Chandran A, Strachan DR, Sood S. Bilateral inverted papilloma: a report of two cases and review of the current literature. Indian J Otolaryngol Head Neck Surg. 2010;62(3):313–6.

Yu HX, Liu G. Malignant transformation of sinonasal inverted papilloma: a retrospective analysis of 32 cases. Oncol Lett. 2014;8(6):2637–41.

von Buchwald C, Bradley PJ. Risks of malignancy in inverted papilloma of the nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg. 2007;15(2):95–8.

Huang CC, Lee TJ, Chang PH, Lee YS, Chuang CC, Jhang YJ, et al. Desmoglein 3 is overexpressed in inverted papilloma and squamous cell carcinoma of sinonasal cavity. Laryngoscope. 2010;120:26–9.

Gras-Cabrerizo JR, Montserrat-Gili JR, Massegur-Solench H, Leon-Vintro X, De Juan J, Fabra-Llopis JM. Management of sinonasal inverted papillomas and comparison of classification staging systems. Am J Rhinol Allergy. 2010;24(1):66–9.

Healy DY Jr, Chhabra N, Metson R, Holbrook EH, Gray ST. Surgical risk factors for recurrence of inverted papilloma. Laryngoscope. 2016;126(4):796–801.

Xiao-Ting, W., Peng, L., Xiu-Qing, W., Hai-Bo, W. et al. Factors Affecting Recurrence of Sinonasal Inverted Papilloma. Eur Arch Otorhinolaryngol. 2013. 270: 1349-1353.

Batsakis JG, Suarez P. Schneiderian papillomas and carcinomas: A review. Adv Anat Pathol. 2001;8:53-64.

Carta, F., Verillaud, B., Herman, P., Role of Endoscopic Approach in the Management of Inverted Papilloma. Current Opinion in Otolaryngology and Head and Neck Surgery. 2011. 19: 21-24.

Busquets, JM., Hwang, PH., Endoscopic Resection of Sinonasal Inverted Papilloma: a meta-analysis. Otolaryngology Head and Neck Surg. 2006. 134: 476-482.

Lund, V., Stammberger, H., Nicolai, P., et al. European Position on Paper on Endoscopic Management of Tumours of the Nose, Paranasal Sinuses and Skull Base. Rhinol Suppl.

Strojan P, Jereb S, Borsos I, But-Hadzic J, Zidar N. Radiotherapy for inverted papilloma: a case report and review of the literature. Radiol Oncol. 2013;47(1):71–76.

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