A 35-year-old man presents with a unilateral, wart-like, pedunculated mass arising from the anterior nasal septum. Biopsy shows papillary fronds with fibrovascular cores and koilocytic changes. Which of the following is the most likely diagnosis?

• A Inverted papilloma
• B Sinonasal squamous cell carcinoma
• C Oncocytic (cylindrical cell) papilloma
• D Exophytic (fungiform) Schneiderian papilloma ✓

Explanation

Exophytic papillomas are typically found on the nasal septum, are associated with low-risk HPV types (6 and 11), and exhibit koilocytic atypia. Inverted papillomas arise from the lateral nasal wall and have a higher malignant transformation rate. Oncocytic papillomas are rare and also arise from the lateral wall. Squamous cell carcinoma would show stromal invasion rather than a papillary exophytic growth pattern.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.