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Long-term follow-up of a patient with malignant transformation of inverted papilloma into sinonasal undifferentiated carcinoma

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Inverted papillomas (IP) are benign sinonasal neoplasms, which account for 0.5‐4% of all nasal tumors. IPs have been known to transform into squamous cell carcinoma in 5‐15% of cases. Rarely, transformations to other malignancies have been reported. Here we report a unique case of malignant transformation of an IP into sinonasal undifferentiated carcinoma (SNUC).


A case report with a literature review; institutional review board exempted. The clinical presentation, radiographic features, surgical intervention, histopathologic analysis, treatment, and outcome of the case were examined.


A 62-year-old man presented with a 3-month history of nasal airway obstruction, rhinorrhea, and postnasal drip refractory to medical therapy. He had a long history of exposure to fumes, chemicals, dusts, and solvents as a professional painter as well as a 45 pack-year history of smoking and alcohol abuse. The patient was ultimately found to have a left ethmoidal IP with a focus of malignant transformation into SNUC. Endoscopic resection was performed, followed by concurrent chemoradiation and adjuvant chemotherapy. After surgery, he had no evidence of recurrent disease after 9 years of follow-up.


IP is known to transform into squamous cell carcinoma. Here we report a rare case of malignant transformation into SNUC, a much more uncommon and aggressive lesion. Although traditionally associated with a poorer prognosis, the positive outcome for SNUC observed in this patient may potentially be attributed to early detection and timely therapeutic intervention.
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Keywords: Chemotherapy; endoscopic sinus surgery; inverted papilloma; long term follow up; malignant transformation; radiation therapy; sinonasal undifferentiated carcinoma

Document Type: Research Article

Affiliations: 1: Orange County Sinus Institute, Department of Otolaryngology, Southern California Permanente Medical Group, Irvine, California 2: Department of Pathology, Southern California Permanente Medical Group, Woodland Hills, California

Publication date: 01 October 2017

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