A 55 year old male presented with right side unilateral nasal obstruction and rhinorrhea

1. What is the diagnosis?

2. What is the classic finding (s) for the tumor?

3. What is classic “buzzword” finding?

4. Hidden within 10-15% of inverting papillomas is?

2. Correct answer:

1. What is the diagnosis?

 Inverting Papilloma

2. What is the classic finding (s) for the tumor?

The middle turbinate

3. What is classic “buzzword” finding?

 Cerebriform pattern

4. Hidden within 10-15% of inverting papillomas is?

 A squamous cell cancer

                        Inverting Papilloma

This is a benign sinonasal tumor, with distinctive imaging features (making it testable).

KEY FEATURES

- The most testable fact (probably) is the 10-15% conversion to squamous cell CA.

- The typical location is the lateral wall of the nasal cavity, associated with the middle turbinate.

- On MRI - They have the classic “cerebriform pattern” of alternating high and low signal (supposedly looks like cortical gyrations). This is seen on both T2 and Tl+C. The sign is pretty good, found in at least 50% of these, and fairly unique to the tumor. 

- On CT - These look like lobulated masses containing fragments of destroyed bone.

- When I say" frequent local recurrence despite adequate resection", you say Schneiderian CA. This is a rare form of malignancy that has histology indistinguishable from the usual inverting papilloma.

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