Squamous cell carcinoma arising from inverted Schneiderian papilloma: a case report

Background Sinonasal inverted papilloma or Schneiderian papilloma is a rare benign tumor of paranasal sinuses and nasal cavities. It can cause bone remodeling and has a significant malignant potential. Hence, it is very important to diagnose and treat the tumor at the earliest. Recurrence can occur even after surgical extensive resection. Case presentation This case report highlights a case of a 36-year-old male patient who presented with right-sided reduced vision, nasal blockage, headache, and occasional blood-tinged nasal discharge. CT scan of paranasal sinuses revealed chronic sinonasal polyposis with secondary fungal colonization. MRI of the brain with orbit and PNS was suspicious for aggressive neoplastic disease with encasement of the cavernous sinuses and involvement of orbital fissure. The patient was operated for extended functional endoscopic sinus surgery. Histopathology revealed moderately differentiated invasive squamous cell carcinoma associated with Schneiderian (inverted) papilloma. Post-operatively, the patient received radiation for 4 weeks. Post-operative check nasal endoscopy was done 3 and 6 months after completion of radiotherapy which showed no evidence of recurrent disease with good healing and mucosalization of all the sinuses. Conclusions Sinonasal inverted papilloma, though a benign tumor, may turn malignant. Diagnosis is based on radiological investigations (in order to know the extent of the disease) and biopsy (to check if it is benign or additional malignancy present). Staging of the tumor helps in outlining the treatment protocol in each case. Post-surgery radiotherapy is indicated in cases where there is malignancy or complete resection of the tumor cannot be achieved. Meticulous follow-up of the post-operative patients is vital to check for recurrence.

Schneiderian Carcinoma

Latar Belakang: Squamous Cell Carcinoma (SCC) adalah keganasan paling umum dari kepala dan leher (sekitar 3%), tetapi hanya <1% dari seluruh jenis keganasan (insidensi jarang), yang dibagi menjadi jenis keratinizing dan non-keratinizing. Nonkeratinizing squamous cell carcinoma mempunyai berbagai nama lain, salah satunya Schneiderian carcinoma. Dahulu, Schneiderian carcinoma disebut sebagai Carcinoma Ex-Schneiderian Papilloma (malignant transformation). Atas kelangkaan dan keberagaman penamaan kasus ini, maka penulis tertarik untuk menyajikan kasus ini. Laporan Kasus: Seorang laki-laki 68 tahun datang dengan keluhan utama benjolan di leher kanan. Dilakukan tindakan wide eksisi dan rekontruksi, kemudian dikirimkan sampel untuk pemeriksaan histopatologi, didapatkan gambaran kelompok-kelompok sel epithelial ganas, dengan inti bulat oval, pleomorfik, hiperkromatik, berkromatin kasar, sitoplasma eosinofilik, mitosis dapat ditemukan, tumbuh papilifer, infiltratif diantara dalam stroma jaringan ikat fibrous. Dilakukan pemeriksaan lanjutan dengan pengecatan imunohistokimia yang memberikan hasil: CK5/6 positif, P63 positif, dan Ki67 positif > 80%. Diskusi: Ciri dan gejala pada pasien ini sesuai dengan kekhasan epidemiologi berdasarkan literatur. Berdasarkan pemeriksaan histopatologis dan pulasan imunohistokimia menyokong diagnosis Squamous cell carcinoma, transisional differenteated (Schneiderian carcinoma) regio colli sisi dekstra. Kesimpulan: Pemeriksaan histopatologi dan imunohistokimia pada kasus Schneiderian carcinoma ini menjadi penting serta harus dibedakan dengan jenis lainnya karena masing-masing manajemen dan prognosisnya pun berbeda. Kata Kunci: Schneiderian carcinoma, nonkeratinizing squamous cell carcinoma, transisional differenteated, Carcinoma Ex-Schneiderian Papilloma. Background: Squamous Cell Carcinoma (SCC) is rare, accounting for <1% of malignant tumours and only about 3% of malignancies of the head and neck, that includes a keratinizing and a non keratinizing type. Nonkeratinizing squamous cell carcinoma has various other names, which one is Schneiderian carcinoma. In the past, Schneiderian carcinoma was referred to as Carcinoma Ex Schneiderian Papilloma (Malignant Transformation). Based on the scarcity and diversity of naming these cases, the authors are interested to presenting this case. Case Description: A 68-year-old man comes with a complaint of a lump in the right neck. Wide excision and reconstruction were carried out, then samples were sent for histopathology, a description of malignant epithelial cell groups, with oval, pleomorphic, hyperchromatic, coarse chromatin nuclei, eosinophilic cytoplasm, mitosis can be found, papilliferous growth, infiltrative within the tissue fibrous stroma. Follow-up examination with immunohistochemical staining that gave results: CK5/6 positive, P63 positive, and Ki67 >80%. Discussion: Characteristics and symptoms in these patients are consistent with epidemiological characteristics based on literature. Based on histopathological and immunohistochemical examination support to diagnosis Squamous cell carcinoma, transitional differenteated (Schneiderian carcinoma) in colli region right side. Conclusion: Histopathology and immunohistochemistry examination in the case of Schneiderian carcinoma are important and must be distinguished from other types because each management and prognosis are different. Keywords: Schneiderian carcinoma, nonkeratinizing squamous cell carcinoma, transisional differenteated, Carcinoma Ex-Schneiderian Papilloma.

Sinonasal inverted schneiderian papilloma presenting as a large intraoral lesion

Sinonasal inverted schneiderian papilloma (ISP) is a rare tumour, which almost exclusively arises from the mucosa lining, the nasal cavity and the paranasal sinuses. The tumour in its early stages presents as an asymptomatic mass, which may be discovered during routine examination. Large lesions usually measure a few millimetres to centimetres in size and show symptoms such as nasal blockade, recurrent sinusitis, postnasal drip, anosmia, epistaxis, facial pain and headache. Lesion presenting as a large oral mass is extremely rare and may cause diagnostic dilemma, resulting in misdiagnosis. This report describes a rare case of ISP presenting as large intraoral lesion, with wide area of facial skeletal involvement. Diagnosis and management of the pathology has also been highlighted.