Exophytic sinonasal papilloma
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Exophytic sinonasal papillomas (ESP) or fungiform sinonasal papillomas are a form of Schneiderian papillomas and benign sinonasal tumours arising from the Schneiderian epithelium of the nasal septum.
Epidemiology
Exophytic sinonasal papillomas are the second most common form of sinonasal papillomas and can occur at any age range with a peak in the third to fifth decade 1,2. They have a strong male predilection 1.
Diagnosis
The diagnosis of exophytic sinonasal papillomas is made by its septal location, endoscopic appearance and histological features 3.
Clinical presentation
Clinical symptoms are similar to the other variants and include nasal obstruction, rinorrhearhinorrhea, epistaxis and the presence of a mass lesion. They might be also found incidentally on imaging studies 3.
Pathology
Aetiology
Low-risk human papilloma viruspapillomavirus, in particular, type 6 and 11 are considered to have arolea role in their aetiology 1,2.
Location
Exophytic sinonasal papillomas are typically located in the nasal septum in particular anteriorly 1-4. Rarely do they arise from the middle turbinate or the nasal vestibule 3.
Subtypes
Subtypes of exophytic sinonasal papillomas includeref
- transitional cell papilloma
- fungiform papilloma
- squamous papilloma
- Ringertz tumour
- everted papilloma
Macroscopic appearance
Macroscopically exophytic sinonasal papillomas display the following features 1-4:
- exophytic, papillary or verrucoid,
caulifowercauliflower-like growth - fleshy, pink to a tannish colour
- firm consistency
- stalk
Microscopic appearance
Histologically primary exophytic sinonasal papillomas are resemble squamous papillomas of other organs 1-4:
- papillary or exophytic frond-like growth pattern around fibrovascular cores
- most often well-differentiated squamous epithelium
varaibly - variably transitional or columnar epithelium
- hyperchromasia
- some keratinization
- fewer mucocytes and intraepithelial mucous cysts
- variable koilocytic changes
Radiographic features
Exophytic sinonasal papillomas are characterised by a rather nonspecific appearance and are usually seen arising from the nasal septum 5.
CT
On CT they appear isointense and do not have any calcifications.
MRI
Exophytic sinonasal papillomas might show striations within the mass 3.
Signal characteristics
- T1: iso to hyperintense
- T2: hyperintense
- T1 C+(Gd): homogeneous enhancement (less than surrounding mucosa)
Radiology report
The radiological report should include a description of the following features:
- location and size of the lesion
- presence of a stalk
- associated focal hyperostosis
Treatment and prognosis
Treatment includes resection with clear margins. If there is no evidence of carcinoma long term prognosis is even better than with the other two variants 1,3. Recurrences can happen in cases of incomplete exsisionsexcisions but are less common than with the other two variants 3,4.
History and etymology
AThe first histological-based classification of sinonasal papillomas into inverted, fungiform and cylindicalcylindrical cell 'fungiform papillomas' was undertaken by VJ Hyams in 1971 1,6.
Differential diagnosis
The differential diagnosis of exophytic sinonasal papillomas include the following 6:
- inverted papillomas
onkocytic - oncocytic sinonasal papillomas
- cutaneous squamous papilloma
-<p><strong>Exophytic sinonasal papillomas </strong>or<strong> fungiform sinonasal papillomas </strong>are a form of Schneiderian papillomas and benign sinonasal tumours arising from the Schneiderian epithelium of the nasal septum.</p><h4>Epidemiology</h4><p>Exophytic sinonasal papillomas are the second most common form of sinonasal papillomas and can occur at any age range with a peak in the third to fifth decade <sup>1,2</sup>. They have a strong male predilection <sup>1</sup>.</p><h4>Diagnosis</h4><p>The diagnosis of exophytic sinonasal papillomas is made by its septal location, endoscopic appearance and histological features <sup>3</sup>.</p><h4>Clinical presentation</h4><p>Clinical symptoms are similar to the other variants and include nasal obstruction, rinorrhea, epistaxis and the presence of a mass lesion. They might be also found incidentally on imaging studies <sup>3</sup>.</p><h4>Pathology</h4><h5>Aetiology</h5><p>Low-risk human papilloma virus, in particular type 6 and 11 are considered to have arole in their aetiology <sup>1,2</sup>.</p><h5>Location</h5><p>Exophytic sinonasal papillomas are typically located in the nasal septum in particular anteriorly <sup>1-4</sup>. Rarely they arise from the middle turbinate or the vestibule <sup>3</sup>.</p><h5>Subtypes</h5><p>Subtypes of exophytic sinonasal papillomas include <sup>ref</sup>:</p><p>transitional cell papilloma</p><p>fungiform papilloma</p><p>squamous papilloma</p><p>Ringertz tumour</p><p>everted papilloma</p><h5>Macroscopic appearance</h5><p>Macroscopically exophytic sinonasal papillomas display the following features <sup>1-4</sup>:</p><p>exophytic, papillary or verrucoid, caulifower-like growth</p><p>fleshy, pink to tannish colour</p><p>firm consistency</p><p>stalk</p><h5>Microscopic appearance</h5><p> </p><p>Histologically primary exophytic sinonasal papillomas are resemble squamous papillomas of other organs <sup>1-4</sup>:</p><p>papillary or exophytic frond-like growth pattern around fibrovascular cores</p><p>most often well-differentiated squamous epithelium</p><p>varaibly transitional or columnar epithelium</p><p>hyperchromasia</p><p>some keratinization</p><p>fewer mucocytes and intraepithelial mucous cysts</p><p>variable koilocytic changes</p><h4>Radiographic features</h4><p>Exophytic sinonasal papillomas are characterised by a rather nonspecific appearance and are usually seen arising from the nasal septum <sup>5</sup>.</p><h5>CT</h5><p>On CT they appear isointense and do not have any calcifications.</p><h5>MRI</h5><p>Exophytic sinonasal papillomas might show striations within the mass <sup>3</sup>.</p><h6>Signal characteristics</h6><p>T1: iso to hyperintense</p><p>T2: hyperintense</p><p>T1 C+(Gd): homogeneous enhancement (less than surrounding mucosa)</p><h4>Radiology report</h4><p>The radiological report should include a description of the following features:</p><p>location and size of the lesion</p><p>presence of a stalk</p><p>associated focal hyperostosis</p><h4>Treatment and prognosis</h4><p>Treatment includes resection with clear margins. If there is no evidence of carcinoma long term prognosis is even better than with the other two variants <sup>1,3</sup>. Recurrences can happen in cases of incomplete exsisions but are less common than with the other two variants <sup>3,4</sup>.</p><h4>History and etymology</h4><p>A histological classification of sinonasal papillomas into inverted, fungiform and cylindical cell papillomas was undertaken by VJ Hyams in 1971 <sup>1,6</sup>.</p><h4>Differential diagnosis</h4><p>The differential diagnosis of exophytic sinonasal papillomas include the following <sup>6</sup>:</p><p>inverted papillomas</p><p>onkocytic sinonasal papillomas</p><p>cutaneous squamous papilloma</p><p> </p>- +<p><strong>Exophytic sinonasal papillomas (ESP) </strong>or<strong> fungiform sinonasal papillomas </strong>are a form of <a href="/articles/schneiderian-papilloma">Schneiderian papillomas</a> and benign <a href="/articles/sinonasal-disease">sinonasal tumours</a> arising from the <a href="/articles/schneiderian-epithelium">Schneiderian epithelium</a> of the <a href="/articles/nasal-septum">nasal septum</a>.</p><h4>Epidemiology</h4><p>Exophytic sinonasal papillomas are the second most common form of sinonasal papillomas and can occur at any age range with a peak in the third to fifth decade <sup>1,2</sup>. They have a strong male predilection <sup>1</sup>.</p><h4>Diagnosis</h4><p>The diagnosis of exophytic sinonasal papillomas is made by its septal location, endoscopic appearance and histological features <sup>3</sup>.</p><h4>Clinical presentation</h4><p>Clinical symptoms are similar to the other variants and include nasal obstruction, rhinorrhea, epistaxis and the presence of a mass lesion. They might be also found incidentally on imaging studies <sup>3</sup>.</p><h4>Pathology</h4><h5>Aetiology</h5><p>Low-risk human papillomavirus, in particular, type 6 and 11 are considered to have a role in their aetiology <sup>1,2</sup>.</p><h5>Location</h5><p>Exophytic sinonasal papillomas are typically located in the nasal septum in particular anteriorly <sup>1-4</sup>. Rarely do they arise from the <a href="/articles/middle-nasal-concha">middle turbinate</a> or the <a href="/articles/nasal-vestibule">nasal vestibule</a> <sup>3</sup>.</p><h5>Subtypes</h5><p>Subtypes of exophytic sinonasal papillomas include:</p><ul>
- +<li>transitional cell papilloma</li>
- +<li>fungiform papilloma</li>
- +<li>squamous papilloma</li>
- +<li>Ringertz tumour</li>
- +<li>everted papilloma</li>
- +</ul><h5>Macroscopic appearance</h5><p>Macroscopically exophytic sinonasal papillomas display the following features <sup>1-4</sup>:</p><ul>
- +<li>exophytic, papillary or verrucoid, cauliflower-like growth</li>
- +<li>fleshy, pink to a tannish colour</li>
- +<li>firm consistency</li>
- +<li>stalk</li>
- +</ul><h5>Microscopic appearance</h5><p>Histologically primary exophytic sinonasal papillomas resemble squamous papillomas of other organs <sup>1-4</sup>:</p><ul>
- +<li>papillary or exophytic frond-like growth pattern around fibrovascular cores</li>
- +<li>most often well-differentiated squamous epithelium</li>
- +<li>variably transitional or columnar epithelium</li>
- +<li>hyperchromasia</li>
- +<li>some keratinization</li>
- +<li>fewer mucocytes and intraepithelial mucous cysts</li>
- +<li>variable koilocytic changes</li>
- +</ul><h4>Radiographic features</h4><p>Exophytic sinonasal papillomas are characterised by a rather nonspecific appearance and are usually seen arising from the nasal septum <sup>5</sup>.</p><h5>CT</h5><p>On CT they appear isointense and do not have any calcifications.</p><h5>MRI</h5><p>Exophytic sinonasal papillomas might show striations within the mass <sup>3</sup>.</p><h6>Signal characteristics</h6><ul>
- +<li>
- +<strong>T1:</strong> iso to hyperintense</li>
- +<li>
- +<strong>T2: </strong>hyperintense</li>
- +<li>
- +<strong>T1 C+(Gd):</strong> homogeneous enhancement (less than surrounding mucosa)</li>
- +</ul><h4>Radiology report</h4><p>The radiological report should include a description of the following features:</p><ul>
- +<li>location and size of the lesion</li>
- +<li>presence of a stalk</li>
- +<li>associated focal hyperostosis</li>
- +</ul><h4>Treatment and prognosis</h4><p>Treatment includes resection with clear margins. If there is no evidence of carcinoma long term prognosis is even better than with the other two variants <sup>1,3</sup>. Recurrences can happen in cases of incomplete excisions but are less common than with the other two variants <sup>3,4</sup>.</p><h4>History and etymology</h4><p>The first histological-based classification of sinonasal papillomas into inverted, cylindrical cell 'fungiform papillomas' was undertaken by VJ Hyams in 1971 <sup>1,6</sup>.</p><h4>Differential diagnosis</h4><p>The differential diagnosis of exophytic sinonasal papillomas include the following <sup>6</sup>:</p><ul>
- +<li><a href="/articles/inverted-papilloma">inverted papillomas</a></li>
- +<li><a href="/articles/oncocytic-sinonasal-papilloma">oncocytic sinonasal papillomas</a></li>
- +<li>cutaneous squamous papilloma</li>
- +</ul>
References changed:
- 1. Bishop J. OSPs and ESPs and ISPs, Oh My! An Update on Sinonasal (Schneiderian) Papillomas. Head and Neck Pathol. 2017;11(3):269-77. <a href="https://doi.org/10.1007/s12105-017-0799-9">doi:10.1007/s12105-017-0799-9</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28321771">Pubmed</a>
- 2. Weindorf S, Brown N, McHugh J, Udager A. Sinonasal Papillomas and Carcinomas: A Contemporary Update With Review of an Emerging Molecular Classification. Archives of Pathology & Laboratory Medicine. 2019;143(11):1304-16. <a href="https://doi.org/10.5858/arpa.2019-0372-ra">doi:10.5858/arpa.2019-0372-ra</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31661314">Pubmed</a>
- 3. Wieneke J & Koeller K. Head Neck Pathol Radiology Pathology Classics. Head and Neck Pathol. 2007;1(2):99-101. <a href="https://doi.org/10.1007/s12105-007-0019-0">doi:10.1007/s12105-007-0019-0</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/20614258">Pubmed</a>
- 4. Vorasubin N, Vira D, Suh J, Bhuta S, Wang M. Schneiderian Papillomas: Comparative Review of Exophytic, Oncocytic, and Inverted Types. Am J Rhinol Allergy. 2013;27(4):287-92. <a href="https://doi.org/10.2500/ajra.2013.27.3904">doi:10.2500/ajra.2013.27.3904</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23883810">Pubmed</a>
- 5. Eggesbo H. Imaging of Sinonasal Tumours. Cancer Imaging. 2012;12(1):136-52. <a href="https://doi.org/10.1102/1470-7330.2012.0015">doi:10.1102/1470-7330.2012.0015</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22571851">Pubmed</a>
- 6. Hyams V. Papillomas of the Nasal Cavity and Paranasal Sinuses. Ann Otol Rhinol Laryngol. 1971;80(2):192-206. <a href="https://doi.org/10.1177/000348947108000205">doi:10.1177/000348947108000205</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/4323842">Pubmed</a>
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- Head & Neck
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Image 1 MRI (T1 C+ fat sat) ( create )
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