Inverted papilloma (Schneiderian papilloma) of the nasal cavity has an endophytic growth pattern where the epithelium inverts into the stroma. The clinical significance of this pattern relates to which of the following features?

• A Purely benign behavior with no malignant potential; recurrence only if incompletely excised
• B Always requires total rhinectomy as the primary treatment because of inevitable malignant transformation
• C Requires chemotherapy as primary treatment because of its chemosensitivity
• D Risk of malignant transformation to squamous cell carcinoma (5-15% synchronous/metachronous SCC), high recurrence rate after simple polypectomy (>50%), and strong association with HPV types 6/11 and EBV ✓

Explanation

Inverted Schneiderian papilloma arises most commonly from the lateral nasal wall (middle meatus/maxillary sinus region). Key clinical features: (1) 5-15% associated SCC (either synchronous at diagnosis or metachronous), making biopsy mandatory; (2) high recurrence rate (>50%) after simple polypectomy necessitating medial maxillectomy (endoscopic or open); (3) HPV types 6 and 11 (low-risk) are detected in ~50% of cases, and HPV 16 in cases transforming to SCC. EBV association is less established. Current treatment is endoscopic medial maxillectomy with complete mucous membrane stripping of involved sinuses.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.