Sinonasal Inverted Papilloma Presenting as Nasal Polyposis: A Two-Case Series from KIMS Narketpally

Background: Sinonasal inverted papilloma is an uncommon benign epithelial tumour of Schneiderian mucosa. Despite its benign histology, it is clinically important because of local aggressiveness, risk of recurrence and potential for malignant transformation. It may closely mimic inflammatory nasal polyposis, especially when the presentation is nonspecific. Case Series: This study describe two histopathologically confirmed cases of sinonasal inverted papilloma managed in the Department of Otorhinolaryngology, KIMS Narketpally, Telangana, India. The first patient was a 16-year-old male who presented with progressive left-sided nasal obstruction for six months and one episode of left-sided nasal bleeding. Nasal endoscopy revealed a pale polypoidal mass in the left middle meatus. Computed tomography showed polypoidal mucosal thickening, more prominent in the left ethmoid air cells, extending into the left nasal cavity with patchy osteolytic change. Functional endoscopic sinus surgery with microdebrider-assisted excision was performed, and histopathology confirmed inverted papilloma. The second patient was a 33-year-old male farmer with recurrent, progressive bilateral nasal obstruction, postnasal drip and mouth breathing. He had undergone functional endoscopic sinus surgery seven years earlier for inflammatory polyposis. Endoscopy and computed tomography demonstrated bilateral sinonasal polyposis with greater left-sided disease burden. Microdebrider-assisted bilateral functional endoscopic sinus surgery was performed, and histopathology showed endophytic-type sinonasal inverted papilloma. Conclusion: These cases highlight that inverted papilloma can present in a young patient and may also masquerade as recurrent bilateral nasal polyposis. A high index of suspicion, careful endoscopic assessment, radiological mapping, adequate biopsy and complete endoscopic excision are essential. Long-term endoscopic surveillance is required because recurrence may be delayed or clinically silent.

Keywords: Inverted papilloma; Sinonasal papilloma; Nasal polyps; Functional endoscopic sinus surgery; Histopathology.