Presentation (12) copy copy.pptxndjahxgchc

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1. Introduction Inverted papilloma (also known as transitional cell papilloma,Ringertz tumour , Schneiderian tumour ) is a tumour of the non olfactory mucosa of nose ( schneiderian membrane) and paranasal sinuses. Their characteristic inverted mucosal surface extending into the stroma of the papilloma leads to the term inverted for these lesions. They are locally aggressive, have a tendency to recur and are associated with malignancy. Clinically males are affected more than females (3:1) in age group of 40-70 years and mostly presents with nasal obstruction ,nasal discharge and epistaxis . The most common site is the lateral nasal wall around the middle turbinate and is usually unilateral. HPV has been implicated in the pathogenesis particularly HPV types 6,11,16,18. Preoperative investigations include CT sca n , which may be complemented by MRI for more detailed soft tissue definition.

2. Result Follow up Postoperative HPE report was conclusive of Inverted Papilloma . Positive diagnosis was made on the basis of clinical examination ,nasal endoscopy ,imaging and Histopathological examination.

3. Case report A 44 year old female patient came to ENT OPD with a chief complaints of left nasal blockage associated with nasal discharge and occasional nasal bleed since 6months • Nasal e ndoscopic examination typically revealed an irregular fleshy polypoidal lesion in left nasal cavity with deviation of septum to right . On probing, mass was attached to lateral wall of left nasal cavity and mass did not bleed on touch. Mass was surgically excised by transnasal endoscopic method and excised tissue was sent for HPE.

4. Conclusion Based on the extent of lesions surgery can be either open/external approach or endoscopic. The aim of surgery is complete resection of tumour . Endoscopic treatment is preferred, whereas for lesions less accessible endoscopically, or in those with peripheral extension, open surgery is indicated like medical maxillectomy (MM) and lateral rhinotomy (LR), midfacial degloving and Caldwell-Luc approach. Postoperatively patients should be followed up by endoscopy for up for 3years . MRI or biopsies should be performed when recurrence is suspected . Prognosis – Inverted papillomas are known for their recurrence . In 10-15% cases they convert into squamous cell carcinoma .

5. Methodology CECT PNS was advised and it revealed that there is large soft tissue density heterogeneously enhancing polypoidal lesion noted involving entire left maxillary sinus . The lesion is seen causing widening of left Ostio-meatal complex and erosion of medial wall of left maxillary sinus, bony nasal septum & lamina papyracea . There is subtle erosion of posterolateral wall of left maxillary sinus. After routine preanesthetic check up patient was posted for left FESS with excision under general Anesthesia . Based on the clinical features and radiographic findings, a provisional diagnosis of papilloma was given.