SlideShare a Scribd company logo
1 of 43
Download to read offline
Dr Mohammed Nishad N
Papilloma of the nose
Definition
Benign locally aggressive neoplasm originating from the
schneiderian membrane of nasal cavity
Male : female 3:1
Age group –30-50
 Most common site – lateral wall (70%)
ethmoid complex
septum
Papilloma are of three types
 Fungiform/ papillary/exophytic/everted papilloma
 Inverted papilloma
 Cylindrical papilloma
Inverted papilloma
 Schneiderian papillomas
 Ringertz tumour
 Transitional cell papilloma
 Polyp with inverting metaplasia
 Epithelial papilloma
 Soft papilloma
 Papillary fibroma
 Squamous papillary epithelioma
DEFINITION
 A Benign epithelial neoplasm arising from
Schneiderian membrane of nose and paranasal
sinuses.
 The mucosal lining of nose and paranasal sinuses is
known as Schneiderian membrane .
 Papillomas arising from this membrane is very unique
in that they are found to be growing inwardly and
hence the term inverted papilloma .
 Inverted papillomas behave like neoplasms, arising
from reserve / replacement cells located at the
basement membrane of the mucosa due to
UNKNOWN stimulus .
 The resulting thickening of the epithelium assumes an
inverting, fungiform or combination growth pattern
 Depending on the degree of metaplasia varying
amounts of respiratory / cylindrical cells may be seen
in Schneiderian papillomas .
 Rarely the papilloma may be composed entirely of
cylindrical cells, and hence the term cylindrical cell
papillomas is used to describe this subtype.
ANATOMIC CLASSIFICATION OF SCHNEIDERIAN
PAPILLOMA
 Inverted papilloma can be classified according to its
site of occurrence i.e. Lateral wall and septal
papillomas .
 Septal papillomas remain confined to the nasal
septum and may very rarely involve the roof and floor
of the nasal cavity. Carcinomatous transformation is
rare in septal papillomas & Vice versa in lateral wall
papillomas
INCIDENCE
 M > F, 20 to 70 yrs .
 Mean age is 50 yrs .
ETIOLOGY
HPV (with mutation of genes) 6,11,16,57b
GROSS APPREARANCE
 1. Papillary and exophytic.
 2. Inverted with inwardly invaginating epithelial
growth into underlying stroma.
 A combination of both patterns also can occur
The papillary form/fungiform papilloma tends to
commonly occur in the nasal septum, while the
inverted form often occurs in the lateral wall of the
nose and sinuses
Inverted papilloma
MICROSCOPY
 Papillary form : epithelial proliferation over a thin core of
connective tissue. Inversion of epithelial masses is
usually not present .
In inverted papilloma of lateral wall –
 Proliferation of the covering epithelium & extensive
finger like inversion in to the underlying stroma of the
epithelium
 When they undergo malignant transformation the
stroma is found to be breached .
 The predominant cell type in these papillomas is
epidermoid in nature .

 Intercellular bridges can be clearly demonstrated.
 Microscopic mucous cysts can also be identified in
both these types.
 It shows complex ,arborescent exoendophytic growth
pattern with primary ,secondary & tertiary
ramifications in to underlying stroma
 Keratinisation is very minimal. Excessive
keratinisation is very rare, and should prompt the
pathologist to other diagnosis like malignant
transformation
Inverted papilloma
Clinical features
 Unilateral nasal mass .
 Commonly fleshy in nature .
 Sometimes it may occur behind a sentinel nasal polyp
 It commonly involves the nasal cavity, erodes the
medial wall of maxilla and may present inside the
maxillary sinus
Symptoms:
 Unilateral nasal obstruction .
 Nasal bleeding .
 Nasal discharge .
 Hyposmia/anosmia
 Proptosis , diplopia ,if lamina papyracea is breached
Reddish ,firm , solitary,friable and granular mulberry
/knobby type
KROUSE STAGING SYSTEM
 (1) Tumour confined to nasal cavity with no evidence
of malignancy.
 (2) Tumour involving the ostiomeatal complex,
ethmoid sinuses, and/or medial portion of maxillary
sinus ,with no evidence of malignancy .
 (3) Tumour involving the lateral, inferior, superior,
anterior, or posterior walls of maxillary sinus, the
sphenoid sinus, and/or the frontal sinus with or
without involvement of the nasal cavity.
 (4) All malignant tumours and those tumours with
extra nasal and extra sinus extension.
Schwals staging
 T1 –Confined to nasal cavity
 T2 &T3– Progressive involvement of PNS
 T4– Tumour extended in to orbit or intra cranial cavity
Skolnick et al
 T1 – Tumour confined to one anatomical site with in
the nose
 T2 – Tumour involves two sites with in the nose
 T3– Involvement of sinuses
 T4—Extension outside the nose and sinuses
Can get transformed to
 Transitional cell carcinoma
 Squamous cell carcinoma
Inverted papilloma can coexist with squamous cell
carcinoma in 27% (synchronous)
Endoscopic view
Differential diagnosis
 Antrochoanal polyp
 AFRS
 Esthesionueroblastoma
 Malignancy
Investigation
 Biopsy –For definite diagnosis
 CT Scan with contrast –hyper dense areas and
calcification (linear). Bony destruction & Erosion of
the lateral wall
 MRI .. Intracranial & extra cranial extension .
Enhancing mass with heterogeneous conveluted
cerebriform appearance -- characteristic
Inverted papilloma
TREATMENT
 Medial maxillectomy – TOC
Approches by 1)endoscopic
2) lateral rhinotomy
3) sublabial midfacial degloving
Treatment
 Choice –surgery with marginal clearance
Endoscopic medial maxillectomy
Recurrance ..Lateral rhinotomy (moure”s incision) &
Medial maxillectomy+ with spheno ethmoidal
clearance (en-bloc dissection) depending on extent of
tumour
Endoscopic medial maxillectomy
Indications
 Inverted Papilloma (Schneiderian Papilloma)
 Benign sinonasal neoplasms arising from the lateral
nasal wall or maxillary sinus
Highlights:
 Sinonasal landmarks are identified, including the
maxillary sinus ostium, middle & inferior turbinates,
and ethmoid roof
 Attachment of the tumor (stalk) is identified and
transected
 Bulk of the tumor is excised
 Bone at the base of the tumor (stalk attachment site) is
drilled and/or resected in order to clear microscopic
disease
 The entire lateral nasal wall, including the inferior
turbinate, is resected
 At the completion of surgery the maxillary sinus and
nose should be a common cavity, enhancing
postoperative surveillance for tumor recurrence
 Keep in mind:
 If the nasolacrimal duct is transected during surgery, a
lacrimal stent is placed to decrease the likelihood of
postoperative epiphora. This stent is removed one
week after surgery.
 Postoperative nasal saline irrigations are helpful to
clear crusts which commonly form after this surgery
Inverted papilloma
Inverted papilloma
Inverted papilloma
 Sub cranial approach Lateral rhinotomy is generally
reserved if exenteration of the orbit is needed
simultaneously
 BEST Endoscopic Resection
 Caldwell-Luc or the “limited open approach” was
initially used but has fallen out of favour , given the
poor visualization and higher rates of recurrence
associated with this technique
Inverted papilloma
Inverted papilloma
Inverted papilloma
Inverted papilloma
Bone removed & tumor exposed
Tumour removed & inicision closed
Midfacial degloving approach
Thank you

More Related Content

What's hot (20)

Glomus Tumour
Glomus TumourGlomus Tumour
Glomus Tumour
 
Granulomatous conditions of larynx
Granulomatous conditions of larynxGranulomatous conditions of larynx
Granulomatous conditions of larynx
 
Angiofibroma
AngiofibromaAngiofibroma
Angiofibroma
 
Phonosurgery
PhonosurgeryPhonosurgery
Phonosurgery
 
Thyroplasty
ThyroplastyThyroplasty
Thyroplasty
 
Glomus tumors
Glomus tumorsGlomus tumors
Glomus tumors
 
Phonosurgery
PhonosurgeryPhonosurgery
Phonosurgery
 
Mastoidectomy (by drdhiru456)
Mastoidectomy (by drdhiru456)Mastoidectomy (by drdhiru456)
Mastoidectomy (by drdhiru456)
 
Fungal sinusitis
Fungal sinusitis Fungal sinusitis
Fungal sinusitis
 
surgical approaches to frontal sinus ppt
surgical approaches to frontal sinus pptsurgical approaches to frontal sinus ppt
surgical approaches to frontal sinus ppt
 
Fess
FessFess
Fess
 
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
JUVENILE NASOPHARYNGEAL ANGIOFIBROMAJUVENILE NASOPHARYNGEAL ANGIOFIBROMA
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
 
Ca maxilla
Ca maxillaCa maxilla
Ca maxilla
 
Cortical mastoidectomy
Cortical mastoidectomy Cortical mastoidectomy
Cortical mastoidectomy
 
Cholesteatoma
CholesteatomaCholesteatoma
Cholesteatoma
 
Glomus Tumour
Glomus TumourGlomus Tumour
Glomus Tumour
 
Myringotomy and grommet insertion
Myringotomy and grommet insertionMyringotomy and grommet insertion
Myringotomy and grommet insertion
 
Total laryngectomy
Total laryngectomyTotal laryngectomy
Total laryngectomy
 
Facial nerve decompression
Facial nerve decompressionFacial nerve decompression
Facial nerve decompression
 
Cavity obliteration @ sayan
Cavity obliteration  @ sayanCavity obliteration  @ sayan
Cavity obliteration @ sayan
 

Similar to Inverted papilloma

Inverted papilloma of nose
Inverted papilloma of noseInverted papilloma of nose
Inverted papilloma of noseshaamikhalid
 
Neoplasms of nasal cavity and nasal polypi
Neoplasms of nasal cavity and nasal polypiNeoplasms of nasal cavity and nasal polypi
Neoplasms of nasal cavity and nasal polypiVinay Bhat
 
Neoplasms of nose and pns
Neoplasms of nose and pnsNeoplasms of nose and pns
Neoplasms of nose and pnsMd Roohia
 
The frontal sinus(osteoma, inverted papilloma, fibrous dysplasia)
The frontal sinus(osteoma, inverted papilloma, fibrous dysplasia)The frontal sinus(osteoma, inverted papilloma, fibrous dysplasia)
The frontal sinus(osteoma, inverted papilloma, fibrous dysplasia)Shekhar Krishna Debnath
 
The Nose and Paranasal Sinuses
The Nose and Paranasal SinusesThe Nose and Paranasal Sinuses
The Nose and Paranasal SinusesAmeenaAjam1
 
Radiological approach to PNS (Paranasal sinus) Masses
Radiological approach to PNS (Paranasal sinus) MassesRadiological approach to PNS (Paranasal sinus) Masses
Radiological approach to PNS (Paranasal sinus) MassesDr Anuj Aggarwal
 
Imaging of paranasal sinuses (including anatomy and varaints)pk1 pdf ppt
Imaging of paranasal sinuses (including anatomy and varaints)pk1 pdf  pptImaging of paranasal sinuses (including anatomy and varaints)pk1 pdf  ppt
Imaging of paranasal sinuses (including anatomy and varaints)pk1 pdf pptDr pradeep Kumar
 
E.N.T 5th year, 4th/cont. & 5th lectures (Dr. Yousif Chalabi)
E.N.T 5th year, 4th/cont. & 5th lectures (Dr. Yousif Chalabi)E.N.T 5th year, 4th/cont. & 5th lectures (Dr. Yousif Chalabi)
E.N.T 5th year, 4th/cont. & 5th lectures (Dr. Yousif Chalabi)College of Medicine, Sulaymaniyah
 
BENIGN NEOPLASMS OF THE NOSE AND PNS.pptx
BENIGN NEOPLASMS OF THE NOSE AND PNS.pptxBENIGN NEOPLASMS OF THE NOSE AND PNS.pptx
BENIGN NEOPLASMS OF THE NOSE AND PNS.pptxSayan Banerjee
 
Sinonasal polyposis
Sinonasal polyposisSinonasal polyposis
Sinonasal polyposisShaista Amir
 
Tumours of nasopharynx (2) itp class dr.davis - 03.06.16
Tumours of nasopharynx (2) itp class   dr.davis - 03.06.16Tumours of nasopharynx (2) itp class   dr.davis - 03.06.16
Tumours of nasopharynx (2) itp class dr.davis - 03.06.16ophthalmgmcri
 
Granulomatous disease of nose
Granulomatous disease of noseGranulomatous disease of nose
Granulomatous disease of noseRITURAJANMBBS
 
Maxillary sinus.pptx gaurav
Maxillary sinus.pptx gauravMaxillary sinus.pptx gaurav
Maxillary sinus.pptx gauravGaurav Salunkhe
 

Similar to Inverted papilloma (20)

Inverted papilloma of nose
Inverted papilloma of noseInverted papilloma of nose
Inverted papilloma of nose
 
Neoplasms of nasal cavity and nasal polypi
Neoplasms of nasal cavity and nasal polypiNeoplasms of nasal cavity and nasal polypi
Neoplasms of nasal cavity and nasal polypi
 
Nasal polyps
Nasal polypsNasal polyps
Nasal polyps
 
Neoplasms of nose and pns
Neoplasms of nose and pnsNeoplasms of nose and pns
Neoplasms of nose and pns
 
Sino-nasal malignancy
Sino-nasal malignancySino-nasal malignancy
Sino-nasal malignancy
 
The frontal sinus(osteoma, inverted papilloma, fibrous dysplasia)
The frontal sinus(osteoma, inverted papilloma, fibrous dysplasia)The frontal sinus(osteoma, inverted papilloma, fibrous dysplasia)
The frontal sinus(osteoma, inverted papilloma, fibrous dysplasia)
 
The Nose and Paranasal Sinuses
The Nose and Paranasal SinusesThe Nose and Paranasal Sinuses
The Nose and Paranasal Sinuses
 
Radiological approach to PNS (Paranasal sinus) Masses
Radiological approach to PNS (Paranasal sinus) MassesRadiological approach to PNS (Paranasal sinus) Masses
Radiological approach to PNS (Paranasal sinus) Masses
 
Salivary tumors
Salivary tumorsSalivary tumors
Salivary tumors
 
Imaging of paranasal sinuses (including anatomy and varaints)pk1 pdf ppt
Imaging of paranasal sinuses (including anatomy and varaints)pk1 pdf  pptImaging of paranasal sinuses (including anatomy and varaints)pk1 pdf  ppt
Imaging of paranasal sinuses (including anatomy and varaints)pk1 pdf ppt
 
angiofibroma.pptx
angiofibroma.pptxangiofibroma.pptx
angiofibroma.pptx
 
E.N.T 5th year, 4th/cont. & 5th lectures (Dr. Yousif Chalabi)
E.N.T 5th year, 4th/cont. & 5th lectures (Dr. Yousif Chalabi)E.N.T 5th year, 4th/cont. & 5th lectures (Dr. Yousif Chalabi)
E.N.T 5th year, 4th/cont. & 5th lectures (Dr. Yousif Chalabi)
 
BENIGN NEOPLASMS OF THE NOSE AND PNS.pptx
BENIGN NEOPLASMS OF THE NOSE AND PNS.pptxBENIGN NEOPLASMS OF THE NOSE AND PNS.pptx
BENIGN NEOPLASMS OF THE NOSE AND PNS.pptx
 
Bharat pns1
Bharat pns1Bharat pns1
Bharat pns1
 
Sinonasal polyposis
Sinonasal polyposisSinonasal polyposis
Sinonasal polyposis
 
Maxillary Sinus
Maxillary SinusMaxillary Sinus
Maxillary Sinus
 
Tumours of nasopharynx (2) itp class dr.davis - 03.06.16
Tumours of nasopharynx (2) itp class   dr.davis - 03.06.16Tumours of nasopharynx (2) itp class   dr.davis - 03.06.16
Tumours of nasopharynx (2) itp class dr.davis - 03.06.16
 
Granulomatous disease of nose
Granulomatous disease of noseGranulomatous disease of nose
Granulomatous disease of nose
 
Maxillary sinus.pptx gaurav
Maxillary sinus.pptx gauravMaxillary sinus.pptx gaurav
Maxillary sinus.pptx gaurav
 
Maxillary Sinus
Maxillary SinusMaxillary Sinus
Maxillary Sinus
 

More from Mohammed Nishad N

More from Mohammed Nishad N (20)

Endoscopic DCR
 Endoscopic DCR  Endoscopic DCR
Endoscopic DCR
 
Anatomy of inner ear
Anatomy of inner earAnatomy of inner ear
Anatomy of inner ear
 
Symptomatology and examination of ear
Symptomatology and examination of earSymptomatology and examination of ear
Symptomatology and examination of ear
 
Physiology of nose and pns
Physiology of nose and pnsPhysiology of nose and pns
Physiology of nose and pns
 
Hypopharynx anatomy
Hypopharynx anatomyHypopharynx anatomy
Hypopharynx anatomy
 
History taking and examination of nose and pns
History taking and examination of nose and pnsHistory taking and examination of nose and pns
History taking and examination of nose and pns
 
Anatomy of oesophagus
Anatomy of oesophagusAnatomy of oesophagus
Anatomy of oesophagus
 
Anatomy of lateral wall of nose
Anatomy of lateral wall of noseAnatomy of lateral wall of nose
Anatomy of lateral wall of nose
 
Antomy of pharynx
Antomy of pharynx Antomy of pharynx
Antomy of pharynx
 
Nasal and facial fractures
Nasal and facial fracturesNasal and facial fractures
Nasal and facial fractures
 
Physiology of balance
Physiology of balance Physiology of balance
Physiology of balance
 
Otosclerosis
OtosclerosisOtosclerosis
Otosclerosis
 
Anatomy of nose& PNS
Anatomy of nose& PNSAnatomy of nose& PNS
Anatomy of nose& PNS
 
Nasal Polyposis.
Nasal Polyposis.Nasal Polyposis.
Nasal Polyposis.
 
Non Allergic Rhinitis
Non Allergic RhinitisNon Allergic Rhinitis
Non Allergic Rhinitis
 
Allergic rhinitis
Allergic rhinitisAllergic rhinitis
Allergic rhinitis
 
PHYSIOLOGY OF NOSE & PARANASAL SINUSES
PHYSIOLOGY OF NOSE & PARANASAL SINUSESPHYSIOLOGY OF NOSE & PARANASAL SINUSES
PHYSIOLOGY OF NOSE & PARANASAL SINUSES
 
National programme for prevention and control of deafness - NPPCD
National programme for prevention and control of deafness - NPPCDNational programme for prevention and control of deafness - NPPCD
National programme for prevention and control of deafness - NPPCD
 
Menieres disease
Menieres disease Menieres disease
Menieres disease
 
Complications of rhinosinusitis
Complications of rhinosinusitisComplications of rhinosinusitis
Complications of rhinosinusitis
 

Recently uploaded

AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfDolisha Warbi
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 

Recently uploaded (20)

AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 

Inverted papilloma

  • 2. Papilloma of the nose Definition Benign locally aggressive neoplasm originating from the schneiderian membrane of nasal cavity Male : female 3:1 Age group –30-50
  • 3.  Most common site – lateral wall (70%) ethmoid complex septum
  • 4. Papilloma are of three types  Fungiform/ papillary/exophytic/everted papilloma  Inverted papilloma  Cylindrical papilloma
  • 5. Inverted papilloma  Schneiderian papillomas  Ringertz tumour  Transitional cell papilloma  Polyp with inverting metaplasia  Epithelial papilloma  Soft papilloma  Papillary fibroma  Squamous papillary epithelioma
  • 6. DEFINITION  A Benign epithelial neoplasm arising from Schneiderian membrane of nose and paranasal sinuses.  The mucosal lining of nose and paranasal sinuses is known as Schneiderian membrane .  Papillomas arising from this membrane is very unique in that they are found to be growing inwardly and hence the term inverted papilloma .
  • 7.  Inverted papillomas behave like neoplasms, arising from reserve / replacement cells located at the basement membrane of the mucosa due to UNKNOWN stimulus .  The resulting thickening of the epithelium assumes an inverting, fungiform or combination growth pattern
  • 8.  Depending on the degree of metaplasia varying amounts of respiratory / cylindrical cells may be seen in Schneiderian papillomas .  Rarely the papilloma may be composed entirely of cylindrical cells, and hence the term cylindrical cell papillomas is used to describe this subtype.
  • 9. ANATOMIC CLASSIFICATION OF SCHNEIDERIAN PAPILLOMA  Inverted papilloma can be classified according to its site of occurrence i.e. Lateral wall and septal papillomas .  Septal papillomas remain confined to the nasal septum and may very rarely involve the roof and floor of the nasal cavity. Carcinomatous transformation is rare in septal papillomas & Vice versa in lateral wall papillomas
  • 10. INCIDENCE  M > F, 20 to 70 yrs .  Mean age is 50 yrs . ETIOLOGY HPV (with mutation of genes) 6,11,16,57b
  • 11. GROSS APPREARANCE  1. Papillary and exophytic.  2. Inverted with inwardly invaginating epithelial growth into underlying stroma.  A combination of both patterns also can occur The papillary form/fungiform papilloma tends to commonly occur in the nasal septum, while the inverted form often occurs in the lateral wall of the nose and sinuses
  • 13. MICROSCOPY  Papillary form : epithelial proliferation over a thin core of connective tissue. Inversion of epithelial masses is usually not present . In inverted papilloma of lateral wall –  Proliferation of the covering epithelium & extensive finger like inversion in to the underlying stroma of the epithelium  When they undergo malignant transformation the stroma is found to be breached .  The predominant cell type in these papillomas is epidermoid in nature .
  • 14.
  • 15.  Intercellular bridges can be clearly demonstrated.  Microscopic mucous cysts can also be identified in both these types.  It shows complex ,arborescent exoendophytic growth pattern with primary ,secondary & tertiary ramifications in to underlying stroma  Keratinisation is very minimal. Excessive keratinisation is very rare, and should prompt the pathologist to other diagnosis like malignant transformation
  • 17. Clinical features  Unilateral nasal mass .  Commonly fleshy in nature .  Sometimes it may occur behind a sentinel nasal polyp  It commonly involves the nasal cavity, erodes the medial wall of maxilla and may present inside the maxillary sinus
  • 18. Symptoms:  Unilateral nasal obstruction .  Nasal bleeding .  Nasal discharge .  Hyposmia/anosmia  Proptosis , diplopia ,if lamina papyracea is breached Reddish ,firm , solitary,friable and granular mulberry /knobby type
  • 19. KROUSE STAGING SYSTEM  (1) Tumour confined to nasal cavity with no evidence of malignancy.  (2) Tumour involving the ostiomeatal complex, ethmoid sinuses, and/or medial portion of maxillary sinus ,with no evidence of malignancy .  (3) Tumour involving the lateral, inferior, superior, anterior, or posterior walls of maxillary sinus, the sphenoid sinus, and/or the frontal sinus with or without involvement of the nasal cavity.  (4) All malignant tumours and those tumours with extra nasal and extra sinus extension.
  • 20. Schwals staging  T1 –Confined to nasal cavity  T2 &T3– Progressive involvement of PNS  T4– Tumour extended in to orbit or intra cranial cavity
  • 21. Skolnick et al  T1 – Tumour confined to one anatomical site with in the nose  T2 – Tumour involves two sites with in the nose  T3– Involvement of sinuses  T4—Extension outside the nose and sinuses
  • 22. Can get transformed to  Transitional cell carcinoma  Squamous cell carcinoma Inverted papilloma can coexist with squamous cell carcinoma in 27% (synchronous)
  • 24. Differential diagnosis  Antrochoanal polyp  AFRS  Esthesionueroblastoma  Malignancy
  • 25. Investigation  Biopsy –For definite diagnosis  CT Scan with contrast –hyper dense areas and calcification (linear). Bony destruction & Erosion of the lateral wall  MRI .. Intracranial & extra cranial extension . Enhancing mass with heterogeneous conveluted cerebriform appearance -- characteristic
  • 27. TREATMENT  Medial maxillectomy – TOC Approches by 1)endoscopic 2) lateral rhinotomy 3) sublabial midfacial degloving
  • 28. Treatment  Choice –surgery with marginal clearance Endoscopic medial maxillectomy Recurrance ..Lateral rhinotomy (moure”s incision) & Medial maxillectomy+ with spheno ethmoidal clearance (en-bloc dissection) depending on extent of tumour
  • 29. Endoscopic medial maxillectomy Indications  Inverted Papilloma (Schneiderian Papilloma)  Benign sinonasal neoplasms arising from the lateral nasal wall or maxillary sinus Highlights:  Sinonasal landmarks are identified, including the maxillary sinus ostium, middle & inferior turbinates, and ethmoid roof  Attachment of the tumor (stalk) is identified and transected  Bulk of the tumor is excised
  • 30.  Bone at the base of the tumor (stalk attachment site) is drilled and/or resected in order to clear microscopic disease  The entire lateral nasal wall, including the inferior turbinate, is resected  At the completion of surgery the maxillary sinus and nose should be a common cavity, enhancing postoperative surveillance for tumor recurrence
  • 31.  Keep in mind:  If the nasolacrimal duct is transected during surgery, a lacrimal stent is placed to decrease the likelihood of postoperative epiphora. This stent is removed one week after surgery.  Postoperative nasal saline irrigations are helpful to clear crusts which commonly form after this surgery
  • 35.  Sub cranial approach Lateral rhinotomy is generally reserved if exenteration of the orbit is needed simultaneously  BEST Endoscopic Resection  Caldwell-Luc or the “limited open approach” was initially used but has fallen out of favour , given the poor visualization and higher rates of recurrence associated with this technique
  • 40. Bone removed & tumor exposed
  • 41. Tumour removed & inicision closed