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Presented by Dr. Lisa Rooper and prepared by Dr. Tatianna Larman.
A 70 year old woman with a nasal obstruction.
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1. Question
A 70 year old female with a nasal obstruction. Choose the correct diagnosis.
Correct
Answer: Sinonasal papilloma, oncocytic (cylindrical cell) type
Histology: The tumor demonstrates both inverted and exophytic growth. It consists of a proliferation of cuboidal to columnar oncocytic cells with abundant granular cytoplasm and round nuclei with variably prominent nucleoli. The cells are arranged in multiple layers with prominent intraepithelial mucous cysts and microabscesses. These findings are consistent with a sinonasal papilloma, oncocytic (cylindrical cell) type.
Discussion: Sinonasal papillomas, previously known as schneiderian papillomas, can be divided into three subtypes: inverted, exophytic, and oncocytic. Of these, the oncocytic subtype is the least common. Despite both inverted and exophytic growth, the prominent oncocytic cytology sets oncocytic papillomas apart from inverted and exophytic papillomas. Like inverted papillomas, oncocytic papillomas most commonly arise on the lateral nasal wall and are associated with an approximately 5% chance of malignant transformation. Although the role of HPV remains controversial in sinonasal papillomas in general, the oncocytic subtype is not thought to be associated with either low-risk or high-risk HPV. Recently, activating KRAS mutations have been reported in a large proportion of these tumors.
Incorrect
Answer: Sinonasal papilloma, oncocytic (cylindrical cell) type
Histology: The tumor demonstrates both inverted and exophytic growth. It consists of a proliferation of cuboidal to columnar oncocytic cells with abundant granular cytoplasm and round nuclei with variably prominent nucleoli. The cells are arranged in multiple layers with prominent intraepithelial mucous cysts and microabscesses. These findings are consistent with a sinonasal papilloma, oncocytic (cylindrical cell) type.
Discussion: Sinonasal papillomas, previously known as schneiderian papillomas, can be divided into three subtypes: inverted, exophytic, and oncocytic. Of these, the oncocytic subtype is the least common. Despite both inverted and exophytic growth, the prominent oncocytic cytology sets oncocytic papillomas apart from inverted and exophytic papillomas. Like inverted papillomas, oncocytic papillomas most commonly arise on the lateral nasal wall and are associated with an approximately 5% chance of malignant transformation. Although the role of HPV remains controversial in sinonasal papillomas in general, the oncocytic subtype is not thought to be associated with either low-risk or high-risk HPV. Recently, activating KRAS mutations have been reported in a large proportion of these tumors.
