Abstract

Introduction:

Inverted papillomas are benign neoplasm with local aggressive behavior and potential for destructive invasion. Pathologic examination is required for diagnosis. Inverted papilloma shows endophytic growth pattern of surface epithelium to the stroma. Mixed type inflammatory cells can be seen in the tumor stroma. We present a case of Inverted papilloma with fibrinoid necrotizing granulomatous inflammation, which has not reported in the English literature before.

Case:

A 47-year-old woman was admitted to our hospital with complaints of nasal obstruction continuing for 3 years. Imaging methods revealed massive lesion about 3 cm in diameter in the right nasal passages originating from the medial lateral concha. Excision had been made with clinical suspicion for inverted papilloma. Microscopically, the lesion consisted of the tumor islands with transitional epithelium extending from the surface epithelium into the stroma. There were fibrinoid necrosis and granulomas, which consisted of histiocytes in palisading pattern. No specific microorganisms were detected in PAS, GMS and EZN histochemical examinations. The case was reported as inverted papilloma with fibrinoid necrotizing granulomas. The clinical, microbiological and laboratory analysis, which were performed by Department of Infectious Diseases and Division of Rheumatology, had not revealed any additional findings.

Discussion

Histologically, a mixed type of inflammatory cells consisting of neutrophils, eosinophils, lymphocytes and plasma cells can be observed in the stroma of inverted papillomas. Inverted papilloma with stromal necrotizing granulomatous inflammation has not reported in the English literature.