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Sinonasal Papillomas - Radiology

last modified on: Tue, 04/16/2024 - 08:50

updated by Piper Wenzel, BS April 2024

  • Benign neoplasm arising in the nasal mucosa derived from "ectodermal Schneiderian" epithelial cells of the nasal cavity and paranasal sinuses (Archang et al. 2022)
  • Most common involvement of sinuses include maxillary and ethmoid (Kasbekar et al. 2018)
  • Occurs in three subtypes: inverted, exophytic, and oncocytic (Archang et al. 2022)
  • Most common in older patients and males (Weindorf et al. 2019)
  • Etiology is unclear; some associated factors include HPV infection, COX-2, EGFR, and exposure to welding fumes and organic solvents (Archang et al. 2022)
  • Generally carries a good prognosis, but may frequently recur or be locally destructive of structures including orbit and skull base (Weindorf et al. 2019, Archang et al. 2022)
  • Around 10% risk of transformation to dysplasia and squamous cell carcinoma (Archang et al. 2022)
  • On CT:
    • Non-contrast: use coronal imaging; soft tissue mass at the middle meatus; larger tumors increase odds of bone remodeling; +/- calcifications
    • Contrast: enhancing mass with non-enhancing obstructed sinus fluid
  • On MR:
    • T1: Iso- to hyperintense lesion
    • T2: Hyperintense lesion with notable cerebriform markings
    • T1 post-contrast: Enhancing mass, if invasion is noted consider squamous cell carcinoma conversion
  • MRI provides advantage over CT in ability to differentiate between papilloma and inflammatory disease (Kasbekar et al. 2018)

References

Archang M, Chew L, Han AY, Sajed D, Vorasubin N, Wang M. Sinonasal Papillomas: 10-Year Retrospective Analysis of Etiology, Epidemiology, and Recurrence. Am J Rhinol Allergy. 2022;36(6):827-834. doi:10.1177/19458924221116441

Weindorf SC, Brown NA, McHugh JB, Udager AM. Sinonasal Papillomas and Carcinomas: A Contemporary Update With Review of an Emerging Molecular Classification. Arch Pathol Lab Med. 2019;143(11):1304-1316. doi:10.5858/arpa.2019-0372-RA

Kasbekar AV, Swords C, Attlmayr B, Kulkarni T, Swift AC. Sinonasal papilloma: what influences the decision to request a magnetic resonance imaging scan?. J Laryngol Otol. 2018;132(7):584-590. doi:10.1017/S0022215118000804