Inverted papilloma of the sphenoid sinus: criteria of operability and algorithm of treatment

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Introduction. Sphenoid sinus (SS) is a very rare site of inverted papilloma (IP). Surgery of IP located in the SS is complicated due to close proximity of vital structures and high risk of their damage during the operation. Radical surgery involving resection of the primary site of tumor growth and adherence to oncological principles is very complex due to the risk of severe complications. Some authors consider SS IP to be unresectable. Therefore, there are very few publications on this topic in the scientific literature.

Aim. To analyze a case series of treatment of IP located in the SS and resected endoscopically endonasally, as well as compare our data with the results presented in literature.

Materials and methods. Literature data and our experience of treating patients with SS IP which previously were considered unresectable were analyzed. In 7 years, between 2019 and 2025, at the Burdenko National Medical Center of Neurosurgery and Center of Head and Neck Surgery of the Ilinskaya Hospital, 12 patients with this pathology (2 (16.7 %) women and 10 (83.3 %) men) received treatment. Mean patient age was 60 (26–76) years. In 2 (16.7 %) patients with multifocal SS IP growth and recurrence, who underwent multiple previous surgeries, with the initial growth sites in the area of the optic canal and posterior SS wall with its destruction in one case and in the area of lateral SS wall in the other case, squamous cell carcinoma was diagnosed.

Results. All patients underwent endoscopic IP resection. In 9 (75 %) cases, extended sphenoidotomy with resection of the initial IP growth site was performed, in 3 (25 %) of the cases, surgery was performed in 2 stages. Follow-up of 11 patients was 40.2 (26–68) months; 1 patient was lost to follow-up. Recurrence developed in 2 (18.2 %) patients with multicentric IP growth (with diagnosed squamous cell carcinoma). Both patients died (5 and 1.5 years after the surgery). No recurrences were observed in other patients.

Conclusion. Inverted papilloma of the SS is a very rare pathology. Its surgical treatment is complicated and associated with high risk of severe intraoperative complications. These surgeries should be performed by experienced surgeons using intraoperative navigation. The risk of recurrence after SS IP resection is significantly higher (18.2 %) than for IP in other sites. Conversely, high probability of malignant transformation of SS-located IP is present due to impossibility of its radical resection in some cases. For best results, we recommend extended endoscopic access to the SS using intraoperative navigation and multiple-stage surgical intervention in cases when IP cannot be resected in one step. Additionally, regular life-long follow-up of patients after surgery is necessary with frequency of once every 6 months for early detection of recurrence which can be resected endoscopically.

About the authors

M. V. Nersesyan

RUDN University; Department of Head & Neck Surgery, Ilyinskaya Hospital

Author for correspondence.
Email: nermarina@yahoo.com
ORCID iD: 0000-0003-2719-5031
Russian Federation, 6 Miklukho-Maklaya St., Moscow, 117198; Bld. 2, 2 Rublevskoye Predmestie, Glukhovo Village, Krasnogorsk City, Moscow Region, 143421

H. Ghazal

RUDN University; Department of Head & Neck Surgery, Ilyinskaya Hospital

Email: nermarina@yahoo.com
ORCID iD: 0009-0003-5924-1634
Russian Federation, 6 Miklukho-Maklaya St., Moscow, 117198; Bld. 2, 2 Rublevskoye Predmestie, Glukhovo Village, Krasnogorsk City, Moscow Region, 143421

G. A. Polev

Department of Head & Neck Surgery, Ilyinskaya Hospital

Email: nermarina@yahoo.com
ORCID iD: 0000-0002-7175-6417
Russian Federation, Bld. 2, 2 Rublevskoye Predmestie, Glukhovo Village, Krasnogorsk City, Moscow Region, 143421

V. I. Popadyuk

RUDN University

Email: nermarina@yahoo.com
ORCID iD: 0000-0003-3309-4683
Russian Federation, 6 Miklukho-Maklaya St., Moscow, 117198

References

  1. Som P.M., Curtin H.D. Head and neck imaging. 4th edn. Vol. 1. 2003.
  2. Walijee H., Sandeep B., Quine S. et al. Inverted papilloma originating primarily from the nasolacrimal duct: a case report and review of the pertinent literature. Case Rep Otolaryngol 2015;2015:123694. doi: 10.1155/2015/123694
  3. Lund V., Stammberger H., Nicolai P. et al. European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinology 2009;22:1–143.
  4. Sadeghi N., Al-Sebeih K. Sinonasal papillomas. 2015. Available at: https: emedicine.medscape.com/article/862677-overview
  5. Lawson W., Patel Z.M. The evolution of management for inverted papilloma: an analysis of 200 cases. Otolaryngol Head Neck Surg 2009;140(3):330–5. doi: 10.1016/j.otohns.2008.11.010
  6. Phillips P.P., Gustafson R.O., Facer G.W. The clinical behavior of inverting papilloma of the nose and paranasal sinuses: report of 112 cases and review of the literature. Laryngoscope 1990;100(5):463–9. doi: 10.1288/00005537-199005000-00004
  7. Velez J., Rato C., Miguéis A. Inverted papilloma of the sphenoid sinus – case report. Acta Otolaryngologica Case Rep 2025;10(1):125–32. doi: 10.1080/23772484.2025.2539316
  8. Эдже М.А., Овчинников А.Ю., Щербаков А.Ю. Инвертированная папиллома клиновидной пазухи. Российская оториноларингология 2020;19(1):105–9. doi: 10.18692/1810-4800-2020-1-105-109 Eje M.A., Ovchinnikov A.Yu., Shcherbakov A.Yu. Inverted papilloma of the sphenoid sinus. Rossiyskaya otorinolaringologiya = Russian Otorhinolaryngology 2020;19(1):105–9. (In Russ.). doi: 10.18692/1810-4800-2020-1-105-109
  9. Klimek T., Atai E., Schubert M., Glanz H. Inverted papilloma of the nasal cavity and paranasal sinuses: clinical data, surgical strategy and recurrence rates. Acta Otolaryngol (Stockh) 2000;120(2):267–72. doi: 10.1080/000164800750001071
  10. Han M.W., Lee B.-J., Jang Y.J., Chung Y.-S. Clinical value of office-based endoscopic incisional biopsy in diagnosis of nasal cavity masses. Otolaryngol Head Neck Surg 2010;143(3):341–7. doi: 10.1016/j.otohns.2010.05.019
  11. Woodworth B., Bhargave G., Palmer J. et al. Clinical outcomes of endoscopic and endoscopic-assisted resection of inverted papillomas: a 15-year experience. Am J Rhinol 2007;21(5):591–600. doi: 10.2500/ajr.2007.21.3086
  12. Busquets J., Hwang P. Endoscopic resection of sinonasal inverted papilloma: a meta-analysis Otolaryngol Head Neck Surg 2006;134(3):476–82. doi: 10.1016/j.otohns.2005.11.038
  13. Fokkens W.J., Lund V.J., Hopkins C. et al. European position paper on rhinosinusitis and nasal polyps. Rhinology 2020;58(S29):1–464. doi: 10.4193/Rhin20.600
  14. Suh J.D., Ramakrishnan V.R., Thompson C.F. et al. Inverted papilloma of the sphenoid sinus: risk factors for disease recurrence. Laryngoscope 2015;125(3):544–8. doi: 10.1002/lary.24929
  15. Guillemaud J.P., Witterick I.J. Inverted papilloma of the sphenoid sinus: clinical presentation, management, and systematic review of the literature. Laryngoscope 2009;119(12):2466–71. doi: 10.1002/lary.20718
  16. Sheth R.K., Choudhary D.A., Vishnurag A. et al. Unusual locations of inverted papilloma. Indian J Otolaryngol Head Neck Surg 2024;76(2):2057–61. doi: 10.1007/s12070-023-04398-6
  17. Som P., Lidov M. The signifcance of sinonasal radiodensities: ossif cation, calcif cation, or residual bone? AJNR 1994;15(5):917–22.
  18. Dammann F., Pereira P., Laniado M. et al. Inverted papilloma of the nasal cavity and the paranasal sinuses: using CT for primary diagnosisand follow-up. AJR 1999;172(2):543–8. doi: 10.2214/ajr.172.2.9930821
  19. Jeon T.Y., Kim H.J., Chung S.K. et al. Sinonasal inverted papilloma: value of convoluted cerebriform pattern on MR imaging. AJNR. Am J Neuroradiol 2008;29;8:1556–60. doi: 10.3174/ajnr.A1128
  20. Lisan Q., Laccourreye O., Bonfils P. Sinonasal inverted papilloma: from diagnosis to treatment. Eur Ann Otorhinolaryngol Head Neck Dis 2016;133(5):337–41. doi: 10.1016/j.anorl.2016.03.006
  21. Nygren A., Kiss K., von Buchwald C., Bilde A. Rate of recurrence and malignant transformation in 88 cases with inverted papilloma between 1998–2008. Acta Otolaryngol 2015;136(3)333–6. doi: 10.3109/00016489.2015.1116123
  22. Attlmayr B., Derbyshire S.G., Kasbekar A.V., Swift A.C. Management of inverted papilloma: review. J Laryngol Otol 2017;131(4):284–9. doi: 10.1017/S0022215117000172
  23. Kim J.S., Kwon S.H. Recurrence of sinonasal inverted papilloma following surgical approach: a meta-analysis. Laryngoscope 2017;127(1):52–8. doi: 10.1002/lary.26222
  24. Peng R., Thamboo A., Choby G. et al. Outcomes of sinonasal inverted papilloma resection by surgical approach: an updated systematic review and meta-analysis. Int Forum Allergy Rhinol 2019;9(6):573–81. doi: 10.1002/alr.22305
  25. Goudakos J.K., Blioskas S., Nikolaou A. et al. Endoscopic resection of sinonasal inverted papilloma: systematic review and meta-analysis. Am J Rhinol Allergy 2018;32(3):167–74. doi: 10.1177/1945892418765004
  26. Kuan E.C., Frederick J.W., Palma Diaz M.F. et al. Complete response of skull base inverted papilloma to chemotherapy: case report. Allergy Rhinol (Providence) 2017;8(2):105–8. doi: 10.2500/ar.2017.8.0201
  27. Almeyda R., Capper J. Is surgical debridement and topical 5 fluorouracil the optimum treatment for woodworkers’ adenocarcinoma of the ethmoid sinuses? A case-controlled study of a 20-year experience. Clin Otolaryngol 2008;33(5):435–41. doi: 10.1111/j.1749-4486.2008.01790.x
  28. Adriaensen G.F., Lim K.H., Georgalas C. et al. Challenges in the management of inverted papilloma: a review of 72 revision cases. Laryngoscope 2016;126(2):322–8. doi: 10.1002/lary.25522
  29. Zhang Y., Yang Y., Zou X. Efficacy of 5-aminolevulinic acid photodynamic therapy in treatment of nasal inverted papilloma. Photodiagnosis Photodyn Ther 2013;10(4):549–51. doi: 10.1016/j.pdpdt.2013.05.010
  30. Lombardi D., Tomenzoli D., Buttà L. et al. Limitations and complications of endoscopic surgery for treatment for sinonasal inverted papilloma: a reassessment after 212 cases. Head Neck 2011;33(8):1154–61. doi: 10.1002/hed.21589
  31. Wolfe S.G., Schlosser R.J., Bolger W.E. et al. Endoscopic and endoscope-assisted resections of inverted sinonasal papillomas. Otolaryngol Head Neck Surg 2004;131(3):174–9. doi: 10.1016/j.otohns.2004.05.011
  32. Khandekar S., Dive A., Mishra R., Upadhyaya N. Sinonasal inverted papilloma: A case report and mini review of histopathological features. J Oral Maxillofac Pathol 2015;19(3):405. doi: 10.4103/0973-029X.174644
  33. Li L., Zhao G.D., Shi Z. et al. The Ras/Raf/MEK/ERK signaling pathway and its role in the occurrence and development of HCC. Oncol Lett 2016;12(5):3045–50. doi: 10.3892/ol.2016.511
  34. Tong C.C.L., Patel N.N., Maina I.W. et al. Inverted papilloma with multifocal attachment is associated with increased recurrence. Int Forum Allergy Rhinol 2019;9(8):865–9. doi: 10.1002/alr.22342
  35. Kim D.-Y., Hong S.-L., Lee C.H. et al. Inverted papilloma of the nasal cavity and paranasal sinuses: a Korean multicenter study. Laryngoscope 2012;122(3):487–94. doi: 10.1002/lary.22495
  36. Philpott C.M., Dharamsi A., Witheford M., Javer A.R. Endoscopic management of inverted papillomas: long-term results – the St. Paul’s Sinus Centre experience. Rhinology 2010;48(3):358–63. doi: 10.4193/Rhin09.105
  37. Budu V., Schnaider A., Bulescu I. Endoscopic approach of sinonasal inverted papilloma – our 15 years’ experience on 162 cases. Romanian J Rhinol 2015;5(17):31–6. doi: 10.1515/rjr-2015-0004
  38. Yu H.X., Liu G. Malignant transformation of sinonasal inverted papilloma: A retrospective analysis of 32 cases. Oncol Lett 2014;8(6):2637–41. doi: 10.3892/ol.2014.2539
  39. Fakhri S., Citardi M.J., Wolfe S. et al. Challenges in the management of sphenoid inverted papilloma. Am J Rhinol 2005;19(2):207–13.
  40. Lawson W., Kaufman M.R., Biller H.F. Treatment outcomes in the management of inverted papilloma: an analysis of 160 cases. Laryngoscope 2003;113(9):1548–56. doi: 10.1097/00005537-200309000-00026
  41. Birkenbeuel J.L., Pang J.C., Lee A. et al. Long-term outcomes in sinonasal squamous cell carcinoma arising from inverted papilloma: systematic review. Head Neck 2022;44(4):1014–29. doi: 10.1002/hed.26995
  42. Barnes L., Tse L.L.Y., Hunt J.L. Schneiderian papillomas. In: World Health Organization classification of tumours. Pathology and genetics of head and neck tumours. Ed. by L. Barnes, J.W. Eveson, P. Reichert et al. Lyon: IARC Press, 2005. Pp. 28–32.
  43. Bugter O., Monserez D.A., van Zijl F.V.W.J. et al. Surgical management of inverted papilloma; a single-center analysis of 247 patients with long follow-up. J Otolaryngol Head Neck Surg 2017;46(1):67. doi: 10.1186/s40463-017-0246-7

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2026 ABV-Press

License URL: https://ogsh.abvpress.ru/jour/about/editorialPolicies
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-36990 от  21.07.2009.