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2025, Number 6

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Rev Fac Med UNAM 2025; 68 (6)

Sinonasal Inverted Papilloma: Clinical, Radiological, and Surgical Features for Comprehensive Patient Management

Quezada-Martínez JR, Vargas-Aguayo A

Language: Spanish
References: 41
Page: 31-39
PDF size: 208.14 Kb.


ABSTRACT

The sinonasal inverted papilloma (SNIP) is a benign tumor that represents about 5% of sinus neoplasms; it typically shows a locally aggressive growth pattern that tends to erode bone, be recurrent, and on average 5-15% of these cases may have a malignant transformation to squamous cell carcinoma (SCC). Although it is usually unilateral, up to 30% can be of multicentric origin. Its importance lies in the fact that, retrospectively, patients diagnosed with rhinosinusal polyposis actually had inverted papilloma, hence the importance of suspecting the tumor when there is unilateral rhinosinusal polyposis.
Despite the existence of a complex and multifactorial etiology, there are several associations with SNIP. Some of these are human papillomavirus (HPV), smoking, welding smoke and organic solvents used in occupational exposures, as well as mutations in the epidermal growth factor receptor (EGFR), which could be involved, although the information is still controversial.
The most commonly recorded symptomatology has been unilateral nasal obstruction, epistaxis, rhinorrhea and pain, with nasal obstruction being the predominant symptom. Imaging studies are fundamental, especially computed axial tomography (CT) with millimetric slices, since it allows identification of the site of origin (osteitis or hyperostosis) of the tumor, as well as surgical planning. Magnetic resonance imaging (MRI) is unnecessary as a routine study. Comprehensive diagnosis involves meticulous clinical examination, endoscopic examination and histopathology to confirm the diagnosis.
The main treatment is endoscopic surgery, as this has been shown to have lower recurrence rates compared to an open approach. Surgical resection must imperatively be aggressive. It is important to emphasize postoperative follow-up, since late recurrences have been reported; follow-up should be at least 5 years, and adequately documented.


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