Inverted Papilloma
Meta Description:
Inverted papilloma is a nasal and sinus tumor that presents with unilateral nasal congestion, discharge, bleeding, and loss of smell, has a high probability of recurrence, and rarely can transform into cancer. Diagnosis uses endoscopy, CT, and MRI; treatment is based on complete endoscopic surgery and regular follow-up.
Brief Summary
Inverted papilloma is a benign tumor that develops from the mucosa lining the nose and sinuses.
It typically presents with unilateral nasal congestion, discharge, bleeding, and loss of smell.
Although it is “benign,” it has a high risk of recurrence and rarely malignant transformation can occur.
According to scientific studies, the recurrence rate is 10–35%, and the rate of malignant transformation is around 5–15%.
What is Inverted Papilloma?
Inverted papilloma is a type of tumor formed by the inward growth of nasal tissues (epithelium).
It is usually unilateral and can spread toward the sinuses over time.
It is not malignant but can progress toward surrounding tissues and distort the nasal structure.
Therefore, early diagnosis and correct surgical approach are of great importance.
Symptoms
Inverted papilloma typically presents with unilateral findings:
- Nasal congestion (mostly unilateral)
- Nasal or postnasal discharge
- Nosebleeds
- Fullness, pain, or pressure sensation in the facial area
- Loss or decrease of smell
These findings can be confused with simple sinusitis or polyps.
However, in case of unilateral polyp appearance, an endoscopic examination must be performed by an ENT specialist.
Who Does It Affect?
The disease is more common in middle-aged and older men.
It can also occur in women but at a lower rate.
It is rare in the population but forms a significant group among sinonasal (nose and sinus) tumors.
How is the Diagnosis Made?
1-) Endoscopic Examination:
A cauliflower-like mass can be seen inside the nose.
2-) Computed Tomography (CT):
Shows the area where the tumor has spread, bone erosion, or sinus involvement.
3-) Magnetic Resonance Imaging (MRI):
The “convoluted (cerebriform)” appearance typical for inverted papilloma supports the diagnosis.
4-) Biopsy:
Definitive diagnosis is made by pathological examination of the tissue taken.
Why is it Important?
- Risk of recurrence:
If not completely removed by surgery, the disease can recur.
This risk is generally between 10–35%. - Risk of malignant transformation:
In approximately 5–15 out of 100 patients, squamous cell carcinoma may develop in the long term.
Therefore, regular follow-up after surgery is very important.
Gold Standard in Treatment
Today, endoscopic nasal surgery is the standard in inverted papilloma treatment.
The aim is complete removal of the entire tumor and especially its point of origin.
If necessary, during this procedure:
- Endoscopic medial maxillectomy (removal of the inner wall of the sinus),
- Navigation system or advanced surgical equipment can be used.
If the tumor has progressed toward the orbit or skull base, a combined intervention with open surgical methods may be necessary.
If malignancy (malignant transformation) is detected, additional treatments such as surgery and radiotherapy are planned.
Post-Surgery Process
- First weeks: Nasal cleaning, crust control, and regular check-ups are important.
- Long term: The first 2–3 years are the most critical period in terms of recurrence risk.
During this process, regular endoscopic examination and if necessary CT/MRI controls should be performed.
Frequently Asked Questions
1-) Does inverted papilloma transform into cancer?
Although rare, yes. According to literature, there is a 5–15% risk of malignant transformation.
Therefore, long-term follow-up after surgery is required.
2-) Does it recur?
Yes. The recurrence rate is between 10–35%.
Complete and experienced endoscopic surgery reduces this risk.
3-) Is there a connection with HPV?
Some studies have shown a relationship with HPV (human papillomavirus).
However, it is not determinant on the course of the disease and treatment success.
4-) Is the surgery the same for every patient?
No. The surgical plan varies according to the location of the tumor.
For example, surgical margins are different in maxillary sinus (cheek sinus), ethmoid, or frontal sinus involvement.
Conclusion
Inverted papilloma is a tumor that is benign but should not be neglected.
When completely removed with successful surgery, it usually does not recur.
However, regular follow-up is vital for early detection of recurrence or possible malignant transformation.
