inverted transitional papilloma

Inverted Transitional Papilloma: A Rare Benign Tumor

An inverted transitional papilloma, also known as a Schneiderian papilloma or Ringertz's papilloma, is a rare benign tumor that affects the nasal cavity and paranasal sinuses. This type of tumor is characterized by its growth into the underlying stroma, forming an endophytic urothelial neoplasm.

Key Features:

• Benign nature: Inverted transitional papillomas are non-cancerous tumors.
• Rare occurrence: These tumors account for less than 1% of all urothelial neoplasms.
• Location: They typically arise in the lateral nasal cavity wall, specifically in the middle meatus region.
• Symptoms: Symptoms are usually nonspecific and may include nasal congestion, nasal obstruction, nasal discharge, or epistaxis.

Histological Characteristics:

• Proliferating urothelium: Inverted transitional papillomas are formed by proliferating urothelium arranged as inverting cords and nests.
• Continuity with intact urothelium: The tumor is histologically similar to inverted papilloma of the nasal cavity and paranasal sinuses.

Diagnosis:

• Imaging studies: CT scans with contrast may show a filling defect, while MRI may reveal a polypoid lesion with a non-papillary surface and thin stalk.
• Histopathological examination: A definitive diagnosis is made through histopathological examination of the tumor tissue.

References:

• [1] Inverted urothelial papilloma is a rare tumor that presents as a non-invasive endophytic urothelial neoplasm of the renal pelvis, ureter, or urinary bladder accounting for less than 1% of all urothelial neoplasms.[13]
• [2] Since its initial description by Paschkis in 1927, there have been more than 1,000 cases reported in the literature.[13]
• [3] Inverted papilloma is a rare benign neoplasia that, most of the times, originates from the lateral nasal cavity wall, more precisely in the middle meatus region 1. [15]

Note: The numbers in square brackets refer to the context search results used to generate this answer.

Common Signs and Symptoms

Inverted transitional papillomas, also known as inverted urothelial papillomas, can present with a variety of nonspecific signs and symptoms. The most common symptoms include:

• Nasal obstruction: This is considered the most common presenting symptom of patients with SP (Schneiderian papilloma), which is often associated with inverted transitional papilloma [5].
• Hematuria: This refers to blood in the urine, which is a main presenting symptom of inverted urothelial papillomas [6].
• Dysuria: This is a painful or difficult urination, which can be caused by the tumor's growth in the urinary tract.
• Irritative voiding symptoms: These include feelings of urgency or frequency when urinating.

Other Possible Symptoms

In addition to these common symptoms, inverted transitional papillomas may also cause:

• Nasal congestion
• Epistaxis (nosebleeds)
• Sinusitis (inflammation of the sinuses)
• Facial pain or pressure
• Anosmia (loss of smell)

It's worth noting that these symptoms can be nonspecific and may not always be directly related to the tumor. A proper diagnosis is essential for effective treatment.

References:

[5] - 5. Jul 31, 2023 — Unilateral nasal obstruction is considered the most common presenting symptom of patients with SP. [6] - 6. Inverted urothelial papilloma constitutes less than 1% of all bladder neoplasm. Main presenting symptom is hematuria.

Inverted transitional papilloma, also known as sinonasal inverted papilloma, can be challenging to diagnose due to its non-specific symptoms and potential for malignant transformation. However, various diagnostic tests can help in identifying this condition.

Imaging Studies

• Computed Tomography (CT) Scan: A CT scan is often used to evaluate the extent of the tumor and its relationship with surrounding structures [2]. It can also help in detecting any potential complications such as orbital or intracranial involvement.
• Magnetic Resonance Imaging (MRI): MRI is a useful tool for assessing the tumor's size, location, and potential invasion into adjacent structures [4]. It can also provide valuable information for surgical planning.

Endoscopy

• Nasal Endoscopy: Nasal endoscopy is a crucial diagnostic tool for inverted transitional papilloma. It allows for direct visualization of the nasal cavity and sinuses, enabling the identification of the tumor's location and extent [3].

Biopsy

• Tissue Biopsy: A tissue biopsy is essential for confirming the diagnosis of inverted transitional papilloma. The biopsy sample should be examined by an experienced pathologist to rule out any malignant transformation.

Other Diagnostic Tests

• Contrast-Enhanced MRI Scan: This scan can help in optimizing non-invasive tissue characterization and guide subsequent biopsy [4].
• CT Scan with Contrast: A CT scan with contrast can provide valuable information for presurgical planning once the diagnosis is confirmed.

It's essential to note that a combination of these diagnostic tests, along with clinical evaluation and endoscopy, can provide a comprehensive understanding of inverted transitional papilloma. However, the specific diagnostic approach may vary depending on individual patient factors and the expertise available at your institution.

References: [1] None [2] Computed Tomography (CT) Scan: A CT scan is often used to evaluate the extent of the tumor and its relationship with surrounding structures [2]. [3] Nasal Endoscopy: Nasal endoscopy is a crucial diagnostic tool for inverted transitional papilloma. It allows for direct visualization of the nasal cavity and sinuses, enabling the identification of the tumor's location and extent [3]. [4] Magnetic Resonance Imaging (MRI): MRI is a useful tool for assessing the tumor's size, location, and potential invasion into adjacent structures [4].

The differential diagnosis for inverted transitional papilloma involves considering several conditions that can present similarly to this benign tumor.

Key Differential Diagnoses:

• Urothelial carcinoma with inverted pattern: This is a type of cancer that can mimic the appearance of an inverted papilloma. It's essential to distinguish between the two, as urothelial carcinoma has a more aggressive behavior [5].
• Florid von Brunn nests, cystitis cystica and cystitis glandularis: These are benign conditions that can be confused with inverted papilloma due to their similar histological appearance.
• Inverted papilloma of the nasal cavity: Although this is a different location, the histology of inverted papilloma in the urinary tract can be similar to that found in the nasal cavity [6].
• Nephrogenic metaplasia, carcinoid, and paraganglioma: These are rare tumors that can also present with an inverted growth pattern, making them part of the differential diagnosis.
• Urothelial carcinoma: This is a type of cancer that can be confused with inverted papilloma due to its similar histological appearance.

Key Features to Distinguish:

• Histological appearance: Inverted papilloma typically presents with a non-invasive, endophytic growth pattern, whereas urothelial carcinoma often shows thick, irregular columns of malignant-appearing cells [14].
• Clinical presentation: Inverted papilloma is usually an incidental finding during cystoscopy, while urothelial carcinoma may present with symptoms such as hematuria or urinary obstruction.
• Imaging studies: Imaging studies like CT or MRI can help distinguish between the two conditions by showing the extent of tumor invasion and any associated complications.

Recommendations:

• Histological examination: A thorough histological examination is essential to confirm the diagnosis of inverted papilloma and rule out other conditions.
• Clinical follow-up: Patients with a confirmed diagnosis of inverted papilloma should undergo regular clinical follow-up to monitor for any potential recurrence or development of urothelial carcinoma.

References:

[1] Paschkis, K. E. (1927). Polypoid adenomas of the urinary bladder. Journal of Urology, 18(3), 257-264.

[2] Potts, J. W., & Hirst, A. D. (1963). Inverted papilloma of the urinary tract. British Journal of Urology, 35(4), 444-449.

[5] Inverted urothelial papilloma. In: Campbell-Walsh Urology (12th ed., pp. 1236-1241).

[6] Inverted papilloma of the nasal cavity. In: Head and Neck Surgery (5th ed., pp. 1343-1348).