Nasal papilloma

Nasal papillomas are benign epithelial tumors of the nasal cavity which mainly affect males between 40–60 years of age. The exact etiology is unknown, but human papillomavirus infection, smoking, and chronic sinusitis are predisposing factors for the development of nasal papillomas. There are three types of nasal papillomas. Inverted papilloma is the most common, arises from the lateral nasal wall and has the highest risk of malignant degeneration. Fungiform and oncocytic nasal papillomas are less common. Patients often present with unilateral nasal obstruction, anosmia, and intermittent epistaxis. On examination, nasal papillomas appear dull gray/pink and are friable. CT or MRI delineate the extent of the papilloma; diagnosis is established on biopsy. All nasal papillomas should be completely excised. Although benign, nasal papillomas are locally aggressive, have a malignant potential, and a high recurrence rate if incompletely excised.

• Nasal papillomas are benign epithelial tumors of the nasal cavity mucosa, which can be locally aggressive, have malignant potential, and a high propensity for recurrence if incompletely excised. ^[1]

• Incidence: rare; ∼ 1 case per 100,000 population per year ^{[2] [3]}
• Sex: ♂ > ♀ (5:1)
• Age: 40–60 years ^[4]

Epidemiological data refers to the US, unless otherwise specified.

• Uncertain
• Possible predisposing factors
  • Viral infections (e.g., human papillomavirus infection)
  • Cigarette smoking
  • Air pollution

References:^[3][4]

• Unilateral nasal obstruction (most common symptom) → unilateral anosmia; difficult nasal breathing
• Epistaxis
• Unilateral nasal discharge
• Unilateral epiphora
• On examination:
  • Unilateral dull pink/gray polypoid lesion which completely fills the nasal cavity → pushes the septum to the contralateral side
  • Friable (bleeds on touch)
• Symptoms of chronic sinusitis

References:^[3][7]

• CT scan with contrast: Indicated in unilateral nasal masses to differentiate benign from malignant masses; findings include:
  • Nonspecific unilateral mass displacing or distorting the nasal septum/paranasal sinus (PNS)
  • Areas of calcification
  • Bony destruction
• MRI: shows a cerebriform pattern
• Nasal endoscopy: indicated in all unilateral nasal masses to confirm the site of origin and obtain a sample for histopathological examination
• Biopsy: most important to confirm the diagnosis based on histology ^[4]

References:^[4][7][8][9]

• Nasal polyps
• Choanal polyp
• Cutaneous papilloma/verruca vulgaris of the nasal cavity
• Juvenile nasopharyngeal angiofibroma
• Carcinoma of the paranasal sinuses and/or nasal cavity

A patient with unilateral difficulty breathing through the nose may have a malignant tumor.

References:^[6][10]

The differential diagnoses listed here are not exhaustive.

• Complete surgical excision: treatment of choice for benign papilloma in good surgical candidates (because of high rates of recurrence if incompletely excised)
• Radiation: considered only in inoperable disease with malignant transformation or in poor surgical candidates

References:^[3][4]

• Chronic sinusitis
• Malignant deterioration (mostly squamous cell carcinoma)
• Intracranial extension (rare)

References:^{[5][6][11][12]}

We list the most important complications. The selection is not exhaustive.

• High recurrence rates in incompletely resected nasal papillomas

References:^[6]