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Radiologic-Pathologic

Inverted James

of the Massachusetts

A 79-year-old showed a poorly heterogeneously sinus, thinning

man

had

a puffy

left

eyelid.

Radiographs

benign and malignant diseases.

tumors,

At

fungal infections,

surgery,

the

tumor

and

extended

from the nasal cavity into the left frontal sinus. The bony floor eroded

consisted

but the periosteum

of respiratory

the underlying

stroma,

final pathologic Inverted sinuses,

papilloma most

surface with

diagnosis

from the mucous

remained

intact

is a benign

commonly

The

type)

epithelium

by inversion

endophytic

amination squamous findings

rather

relate

to the bulkiness

circular

papilloma

that

arises

nasal

wall

in the region

or

stroma,

nasal

growth.

Microscopic

and slow growth

in patients

in their fifth with nasal ob-

REFERENCES

squamous

resulting

frequently

of primary

and sixth decades. Patients typically present struction, epistaxis, or nasal discharge. While the pathogenesis is unknown, the associated conditions include allergy, chronic sinusitis, environmental carcinogens, and viral infection. Malignant change occurs in fewer than 7% of cases [4]. The treatment is surgical; the recurrence rate is high if the lesion is not completely removed.

tumor

most

0.5-0.4%

The

epithelial

[3] and occurs

constitutes

membrane.

papilloma.

transitional,

in ex-

of the tumor.

may show an opacified nasal cavity. The tumor the nasal fossa and remodel the nasal septum bones. Opacification of the ipsilateral paranasal

1. Lund

VJ, Lloyd

G. Radiologicalchanges

associated

cavity

(A).

The

From the weekly radiologic-pathologic correlation conferences conducted by Jack wittenberg. Pathology editor: Andrew E. Rosenberg. S. Chew, William E. Palmer, Daniel P. Barboriak, Daniel I. Rosenthal. ‘Both authors: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 32 Fruit St., Boston, MA requests to F. S. Chew. 592-0278

© American

Roentgen

with inverted

papilloma

of the nose and paranasal sinuses. Br J Radiol 1984;57 :455-461 2. Som P, Shapiro MD, Biller HF, Sasaki C, Lawson W. Sinonasal tumors and inflammatory tissue: differentiation with MA imaging. Radiology 1988; 167:803-808 3. Lawson w, Lebenger J, Som P, Bernard PJ, Biller HF. Inverted papilloma: an analysis of 87 cases. Laryngoscope 1989;99: 1117-1123 4. PhillipsPP, Gustafson AD, Facer GW. The clinical behavior of inverting papilloma of the nose and paranasal sinuses: report of 112 cases and review of the literature. Laryngoscope 1990;100:463-469

Fig. 1.-Inverted papilloma. A and B, Coronal TI-weighted images show tumor (arrow) expanding and filling left frontal sinus and nasal infusion of gadopentetate dlmeglumine (B). Laterally in sinus is a fluid collection (arrow). C, Coronal CT scan shows expansion and thinning of bone adjacent to tumor. D, Photomicrograph shows respiratory epithelium with characteristic infolded papillary pattern of proliferation.

AJR 159:278, August 1992 0361 -803X/92/1

or

basement

reveals invaginated respiratory, transitional, or type epithelium with orderly maturation. Radiologic

Radiographs may enlarge and adjacent

linear,

tumors

the lateral

exophytic

nodular,

into

into the underlying than

in punctate,

invaginated

of the nasal cavity and paranasal

(respiratory,

calcify

[2].

Inverted

tumor

of the middle meatus. Paranasal involvement most frequently affects the maxillary and ethmoidal sinuses. The term inverted is derived from the characteristic proliferation of metaplastic surface

may

patterns [1]. MR imaging can be used to distinguish sinonasal tumors, which generally have intermediate T2 signal, from inflammatory tissue, which almost always has high T2 signal

epithelium

was inverted

membrane

intact.

sinuses may be due to obstruction or tumor extension. CT and MR imaging provide precise delineation of tumor extension, with CT preferable for showing bone remodeling. The tumor

enhancing mass occupying the left frontal its bony floor (Fig. 1). The differential diagnosis

granulomatous was

Hospital

and Felix S. Chew

aerated nasal cavity and an expanded and left frontal sinus. CT and MR images showed a

opacified

General

Papilloma

H. Brown1

included

Conferences

Ray Society

tumor

enhances

Radiology 02114.

editors: Address

after

Felix reprint