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Clinical Problem Solving: Radiology
March 2013

Radiology Quiz Case 2: Diagnosis

JAMA Otolaryngol Head Neck Surg. 2013;139(3):310-311. doi:10.1001/archotol.139.3.310

Inverted papilloma is one of the most common benign sinonasal neoplasms and represents 0.5% to 4% of all sinonasal tumors.1 It arises from the Schneiderian membrane, the ectodermal epithelium in the nose and paranasal sinuses, and was named for its characteristic endophytic growth pattern in which finger-shaped projections of tumor erode into the stroma and bone underlying its site of origin.1,2 Inverted papilloma most often affect patients from 40 to 70 years old and occur 2 to 4 times more often in men than in women. The most common symptoms are epistaxis, rhinorrhea, nasal obstruction, anosmia, sinusitis, facial pain, and frontal headache.3 It can be locally aggressive, tends to recur after surgical resection, and has a significant malignant potential, with squamous cell carcinoma found either synchronously or at the time of recurrence.4 According to some meta-analyses, the recurrence rate is about 15% to 20%, and the rate of malignant association is approximately 10%.5,6

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