Inverted Papilloma against a Background of Bilateral Rhinosinusitis Polyposa with Viscous Mucin (Clinical Case)

Abstract

Introduction. Rhinosinusitis polyposa consists in a chronic inflammation of the mucous membrane of the nose and paranasal sinuses, followed by recurrent growth of polyps and characterised by a high prevalence. Nasal polyps may be associated with the presence of viscous mucin; their characteristic CT signs are hyperostosis of the walls of the affected sinuses and thinning cavity walls until the bone is destroyed, this being a sign of aseptic osteomyelitis. The same sign is typical for inverted papilloma, the most common benign tumour of the nose and sinuses.Materials and methods. The present article presents a clinical observation. What makes it interesting is that a benign tumour was diagnosed against the background of bilateral rhinosinusitis polyposa. The clinical picture did not have nasal bleeding, which is typical for inverted papilloma; this was most likely due to the initial growth of the tumour. Thickening bone structures (hyperostosis) was balanced due to the pathogenetic peculiarities of the rhinosinusitis polyposa development with viscous mucin. Inverted papilloma was suspected during rhinoscopy, which revealed asymmetric growth of polyps. Final verification of the clinical diagnosis was carried out following computerised tomography of the nose and paranasal sinuses and histological examination of biopsy material.Results and discussion. This clinical case is of interest due to rhinocytogram data suggesting a viral and inflammatory etiology of the development of inverted papilloma. Therefore, the observed nucleoli of the nuclei of the columnar epithelium are characteristic of intracellular infection — in particular, viral. Remodelling of cells of the cylindrical epithelium is a sign of chronic inflammatory process.Conclusion. Thus, accurate performance of the diagnostic algorithm with histological verification of all removed material allows the identification of a neoplasm of the nasal cavity even in difficult cases, along with other diseases of the nasal cavity. Rhinocytogram data can help suggest the etiology of the intracellular type of infection in the epithelial cell and pathogenesis of inverted papilloma in a particular case.