Inverting papilloma was first described by Ward in 1854 and by Billroth in 1855. Kramer and Som in 19356 distinguished the disease from inflammatory polyps.

Because of the infrequent occurrence of the lesion, an appropriate name has not yet been agreed upon. At least 20 different terms have been used in referring to this lesion.7 Such terms as papillary sinusitis or epithelial papilloma do not reflect the seriousness of the lesion. Conversely, such expressions as papillary carcinoma or villous cancer are perhaps overly threatening and can lead to overly aggressive treatment measures.8

Patients with inverting papilloma usually present with unilateral nasal obstruction, sinusitis, epistaxis, and rhinorrhea. Physical examination shows a unilateral mass, which frequently resembles a bleeding inflammatory polyp. Inflammatory polyps are usually bilateral; consequently, the presence of a unilateral polyp raises suspicion of the presence of an inverting papilloma. The diagnostic workup includes computed tomography (CT) or magnetic resonance imaging (MRI) of the sinuses as well as biopsy. CT delineates whether there is septal deviation, bone erosion, intracranial extension, or opacifica-tion of the nasal cavity and sinuses. MRI is useful for distinguishing tumor from mucosal inflammation and mucus secretions. Imaging studies should precede biopsy in patients suspected to have encephaloceles. Although clinical and

SC Spencer and Schaefer radiologic suspicion of an inverting papilloma may be high, an adequate biopsy for tissue diagnosis must be obtained before proceeding with definitive management. Biopsy serves not only to confirm the diagnosis, but also to rule out associated squamous cell carcinoma.

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