A papilloma is a benign epithelial tissue overgrowth within the intranasal mucosa. Inverted papillomas grow into the underlying tissue, usually at the junction of the antrum and the ethmoidal sinus; they generally occur singly but in 5% to 10% of cases are associated with squamous cell cancer.
Exophytic papillomas, which also tend to occur singly, arise from epithelial tissue, commonly on the surface of the nasal septum. Both types of papillomas are most prevalent in males. Recurrence is likely, even after surgical excision.
A papilloma may arise as a benign precursor of a neoplasm or as a response to tissue injury or viral infection, but its cause is unknown.
Signs and symptoms
Both inverted and exophytic papillomas typically produce symptoms related to unilateral nasal obstruction—stuffiness, postnasal drip, headache, shortness of breath, dyspnea and, rarely, severe respiratory distress, nasal drainage, and infection. Epistaxis is most likely to occur with exophytic papillomas.
On examination of the nasal mucosa, inverted papillomas usually appear large, bulky, highly vascular, and edematous. Color varies from dark red to gray; consistency, from firm to friable. Exophytic papillomas are commonly raised, firm, and rubbery pink to gray and securely attached by a broad or pedunculated base to the mucous membrane. Histologic examination of excised tissue confirms the diagnosis.