Exophytic Papilloma

Case Report

Austin J Otolaryngol. 2023; 9(1): 1127.

Exophytic Papilloma

Tantry D¹, Tantry G² and Shriyan AJ³

1Associate Professor, Department of ENT, AJIMS, Mangalore

2Professor, Department of Anesthesia, AJIMS, Mangalore

3Postgraduate, Department of ENT, AJIMS, Mangalore

*Corresponding author: Abhinandan J Shriyan 3rd Year Postgraduate, Department of ENT, AJIMS, Kuntikana, Mangalore, Karnataka, India

Received: January 03, 2023; Accepted: February 09, 2023; Published: February 16, 2023

Abstract

Schneiderian papillomas are papillomas arising in the sinonasal tract, which is lined with Schneiderian epithelium, ectodermally derived respiratory mucosa [1,2]. This distinctive epithelium can give rise to three histologically unique types of papillomas: exophytic (fungiform, septal, and squamous), inverted (inverting), and oncocytic (cylindrical cell and columnar) papillomas. Exophytic papillomas almost exclusively arise from the nasal septum with rare cases arising from the vestibule or middle turbinate. In this paper a case of Exophytic papilloma in 52 year old male is presented.

Keywords: Sinonasal Papilloma; Exophytic Papilloma

Introduction

Sinonasal papillomas represent 0.5%-4% of all sinonasal tumors [1-5]. The first real distinction between papillomas and polyps was made by Kramer and Som [6] in 1935. To date, 3 types of sinonasal papillomas, also known as Schneiderian papillomas, have been described histologically: inverted, exophytic, and oncocytic. The exophytic papilloma is usually diagnosed after nasal obstruction or epistaxis. The macroscopic appearance is that of a whitish papillomatous tumor with a wide implantation base. The most common localization is the anterior wall of the septum, a transition zone between a cylindrical pseudostratified squamous epithelium and mucosal respiratory type. Microscopically, they are composed of papillary fronds with a fibrovascular core covered by epithelium of various aspects: squamous to transitional, ciliated, and pseudostratified columnar. The involvement of the Human Papilloma Virus (HPV) types 6 and 11 in the pathogenesis of exophytic papilloma is suggested by the presence of koilocytes on pathological examination, whereas Polymerase Chain Reaction (PCR) analysis of samples exhibit different HPV genotypes [3,7-9]. Although inverted papillomas have been codified and treatment approaches standardized, the treatment of pure exophytic papilloma is poorly described [1,4]. They are generally removed by endonasal surgery under endoscopic guidance with a recurrence rate of 22% [1,10]. The purpose of this retrospective study is to describe the clinical and pathological features of exophytic papillomas and to report our experience in their management.

Case Report

A 52 year old male patient came with complaints of left sided nasal obstruction and postnasal drip since 2 years and occasional headache. DNE showed greyish mass arising from left middle meatus extending into left nasal cavity.

HPE Report

Sections show multiple polypoidal tissue bits lined by hyperplastic respiratory epithelium with squamous metaplasia and transitional epithelium. The stroma is edematous with mixed inflammatory infiltrate composed of lymphocytes, plasma cells and eosinophils. At places papillary arrangement is noted with exophytic growth pattern and with focal areas displaying downward endophytic growth . Impression :- Features are of Schneiderian papilloma (exophytic papilloma)-left nasal polyp.

Treatment: FESS( left middle meatal antrostomy) + septoplasty was done.


    


    

    


    


    Treatment: FESS( left middle meatal antrostomy) + septoplasty was done.

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    (Post-Op image)

Discussion

Sinonasal papillomas account for 0.5–4% of all nasal tumors [7]. IP and exophytic papillomas are the most commonly diagnosed subtypes, each accounting for almost one-half of all sinonasal papillomas, and oncocytic papillomas are the rarest type, found only in 3–5% of all papillomas [2,8]. Exophytic papillomas almost exclusively arise from the nasal septum with rare cases arising from the vestibule or middle turbinate. The Human Papilloma Virus (HPV) types 6, 11, 16, and 18 have been implicated as a leading factor in the development of IP and exophytic papillomas, although HPV does not seem to be related to the formation of OSP [1-11]. Exophytic papillomas grossly appear as gray–tan, exophytic, “mushroom-shaped” verrucous papillary proliferations classically arising from the anterior nasal septum attached to the underlying mucosa by a narrow stalk [7,10,19]. Histologically, exophytic papillomas have a cellular composition like IP with branching, exophytic proliferations with a fibrovascular core lined by well-differentiated stratified squamous epithelium .Unlike IP, keratin formation can be present in the surface epithelium, seen as hyper- and parakeratosis, and chronic inflammatory cells are uncommon. Koilocytosis may be seen in the superficial cells.

Conclusion

It is rare for an exophytic nasal papilloma to arise from maxillary sinus.

Patient Perspective

Satisfactory

Informed Consent

Separate informed consent was taken prior to CT scan and surgery.

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Citation: Tantry D, Tantry G, Shriyan AJ. Exophytic Papilloma. Austin J Otolaryngol. 2023; 9(1): 1127.