Inverted papilloma (Schneiderian papilloma, endophytic type) of the nasal cavity is associated with which of the following clinical concerns that necessitate complete surgical excision with clear margins?

• A High rate of transformation into adenocarcinoma if HPV-18 positive
• B Frequent bilateral presentation requiring bilateral medial maxillectomy
• C High local recurrence rate (up to 70% if inadequately excised) and synchronous or metachronous SCC in 10–15% of cases ✓
• D Invariable malignant potential requiring adjuvant radiotherapy after resection

Explanation

Inverted papilloma has three major clinical concerns: (1) high recurrence rate up to 70% with simple polypectomy due to its endophytic (inverting) growth pattern into underlying stroma, requiring wide surgical resection with clear margins (medial maxillectomy endoscopic or open); (2) association with synchronous or metachronous SCC in approximately 10–15% of cases; and (3) HPV subtypes 6 and 11 (not 18) are found in a minority of cases but malignant transformation is not directly HPV-driven. Bilateral presentation is uncommon. Adjuvant radiation is not routinely given after complete resection.

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.