Long-term follow-up of a patient with malignant transformation of inverted papilloma into sinonasal undifferentiated carcinoma
Introduction:
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).
Methods:
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.
Results:
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.
Conclusions:
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.
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).
Methods:
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.
Results:
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.
Conclusions:
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.
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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