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An unusual presentation of inverted papilloma: case report and literature review

  • V Visvanathan (a1), H Wallace (a1), P Chumas (a2) and Z G G Makura (a1)

Inverted papilloma is a rare but locally aggressive tumour with the potential for malignant transformation. Intracranial extension or complications secondary to inverted papilloma are extremely rare. We report a case of inverted papilloma with a large frontal sinus mucocele eroding the frontal sinus, which presented with sudden neurological compromise. A literature review on intracranial extension of such tumours is also included.


A Medline search of articles, using the terms ‘inverted papilloma’, ‘Ringertz tumour’, ‘intracranial extension’ and ‘complication’. Suitable references from the collected articles were also reviewed. Articles published in English were selected and reviewed.


A total of 10 cases was identified. Intracranial spread was more commonly seen in recurrent cases, especially if the recurrence involved the cribriform plate, fovea ethmoidalis or orbits. Cases with extradural disease seemed to have a better prognosis than those with intradural spread.


Intracranial involvement of inverted papilloma is extremely rare, and is usually seen in recurrent cases. This case report highlights an unusual but serious case of inverted papilloma presenting with acute neurological deterioration secondary to a large frontal sinus mucocele eroding the frontal sinus. A literature review on intracranial extension of inverted papilloma indicated that common sites of intracranial spread include the cribriform plate, fovea ethmoidalis and orbits. The prognosis for patients with such tumours depends on the type of dural involvement, with intradural extension carrying a poorer prognosis.

Corresponding author
Address for correspondence: Mr V Visvanathan, Clinical Fellow, Department of ENT – Head and Neck Surgery, Leeds General Infirmary, Leeds, West Yorkshire, LS1 3EX, UK. E-mail:
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1 Lawson W, LeBenger J, Bernard PJ, Biller HF, Som P. Inverted papilloma: an analysis of 87 cases. Laryngoscope 1989;99:1117–24
2 Batsakis JG, Suarez P. Schneiderian papillomas and carcinomas: a review. Adv Anat Pathol 2001;8:5364
3 Dolgin SR, Zaveri VD, Casiano RR, Maniglia AJ. Different options for treatment of inverting papilloma of the nose and paranasal sinuses: a report of 41 cases. Laryngoscope 1992;102:231–6
4 Lawson W, Ho BT, Shaari CM, Biller HF. Inverted papilloma: a report of 112 cases. Laryngoscope 1995;105:282–8
5 Bertrand B, Eloy P, Jorissen M, Rombaux P, Daele J, Boniver V et al. Surgery of inverted papillomas under endoscopic control. Acta Otorhinolaryngol Belg 2000;54:139–50
6 Hyams VJ. Papillomas of the nasal cavity and paranasal sinuses: A clinicopathological study of 315 cases. Ann Otol Rhinol Laryngol 1971;80:192206
7 Kraft M, Simmen D, Casas R, Pfaltz M. Significance of human papillomavirus in sinonasal papillomas. J Laryngol Otol 2001;115:709–14
8 Mortuaire G, Arzul E, Darras JA, Chevalier D. Surgical management of sinonasal inverted papillomas through endoscopic approach. Eur Arch Otorhinolaryngol 2007;264:1419–24
9 Myers EN, Fernau JL, Johnson JT, Tabet JC, Barnes LE. Management of inverted papilloma. Laryngoscope 1990;100:481–90
10 Lyons BM, Donald PJ, Sykes JM, Boggan JE. Craniofacial resection for intracranial inverting papilloma and frontal sinus mucocoele. Skull Base Surgery 1992;2:92–7
11 Cagigal BP, Lezcano JB, Blanco RF, Cantera JM, Cuéllar LA, Hernández VA. Frontal sinus mucocoele with intracranial and intraorbital extension. Med Oral Patol Oral Cir Bucal 2006;11:E527–30,[uid]
12 Koike Y, Tokoro K, Chiba Y, Suzuki S, Murai M, Ito H. Intracranial extension of paranasal sinus mucocele: two case reports. Surg Neurol 1996;45:44–8
13 Delfini R, Missori P, Lannetti G, Giappetta P, Cantore G, Chandler WF et al. Mucoceles of the paranasal sinuses with intracranial and intraorbital extension: report of 28 cases. Neurosurgery 1993;32:901–6
14 Van Olphen AF, Lubsen H, Van't Verlaat JW. An inverted papilloma with intracranial extension. J Laryngol Otol 1988;102:534–7
15 Miller PJ, Jacobs J, Roland JT Jr, Mizrachi HH. Intracranial inverting papilloma. Head Neck 1996;18:450–3
16 Guedea F, Mendenhall WM, Parsons JT, Million RR. The role of radiation therapy in inverted papilloma of the nasal cavity and paranasal sinuses. Int J Radiat Oncol Biol Phys 1991;20:777–80
17 Vural E, Suen JY, Hannah E. Intracranial extension of inverted papilloma. An unusual and potentially fatal complication. Head Neck 1999;21:703–6
18 Peterson IM, Heim C. Inverted squamous papilloma with neuro-ophthalmic features. J Clin Neuroophthalmol 1991;11:35–8,
19 Lewis WJ, Richter HA, Jabourian Z. Craniofacial resection for large tumours of the paranasal sinuses. Ear Nose Throat J 1989;68:539–47,
20 Vrabec DP. The inverted Schneiderian papilloma: a 25-year study. Laryngoscope 1994;104:582605
21 Wormald PJ, Ooi E, van Hasselt CA, Nair S. Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy. Laryngoscope 2003;113:867–73
22 Busquets JM, Hwang PH. Endoscopic resection of sinonasal inverted papillomas. Otolaryngol Head Neck Surg 2006;134:476–82
23 Tomenzoli D, Castelnuovo P, Pagella F, Berlucchi M, Pianta L, Delù G et al. Different endoscopic surgical strategies in the management of inverted papilloma of the sinonasal tract: experience with 47 patients. Laryngoscope 2004;114:193200
24 Hug EB, Wang CC, Montgomery WW, Goodman ML. Management of inverted papilloma of the nasal cavity and paranasal sinuses: importance of radiation therapy. Int J Radiat Oncol Biol Phys 1993;26:6772
25 Eggers G, Eggers H, Sander N, Kössling F, Chilla R. Histological features and malignant transformation of inverted papilloma. Eur Arch Otorhinolaryngol 2005;262:263–8
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
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