Inverted Papilloma

An inverted papilloma is a precancerous growth that forms in the membrane lining your nasal cavity or paranasal sinuses. It gets its name from the way the cells look under a microscope — where nests of epithelial cells “invert,” or grow inward. These growths are also known as sinonasal inverted papillomas.

They’re “locally invasive.” This means they can grow into important structures in your face — like bone, eye socket, nerves and blood vessels. They can grow back after surgery to remove them. And in some cases, they become cancerous. Anywhere from 5 to 10 out of 100 transform into cancer called sinonasal squamous cell carcinoma.

This is why you’ll need surgery to remove an inverted papilloma. You’ll need long-term follow-up care so you can get treatment if it grows back.

Symptoms of an inverted papilloma

Small papillomas may not cause symptoms. Or they can cause symptoms that may be similar to other common conditions, like a sinus infection. Signs of an inverted papilloma include:

• Facial pain or pressure
• Having a weakened sense of smell
• Headaches
• Nasal congestion (usually only on one side)
• Postnasal drip
• Runny nose

Usually, symptoms are on just one side of your face, where the papilloma is. But sometimes, you’ll feel the effects on both sides of your face.

Inverted papilloma causes

Medical experts don’t know the cause. But there are possible connections between developing inverted papilloma and:

• HPV infections
• EBV infections
• Chronic inflammation
• Smoking
• Exposure to workplace pollutants like welding fumes, nickel compounds and certain types of solvents

Risk factors

Males are two to three times more likely to have them than females. Most people diagnosed are in their 40s or 50s.

Some studies show that papillomas that contain high-risk strains of the HPV virus are more likely to transform into cancer.

How doctors diagnose this condition

Sometimes, healthcare providers discover an inverted papilloma incidentally while checking on a different issue. Or they may find one while trying to figure out what’s causing your nasal symptoms.

You’ll likely need to see an otolaryngologist (ENT) for a diagnosis. They may order an imaging test, like a CT scan or MRI. These procedures allow your provider to see the growth inside your nose or sinuses.

A nasal endoscopy with a biopsy is the only way to know for sure that you have an inverted papilloma. This procedure uses a rigid telescope with a camera to see inside your nasal cavity and sinuses. Surgeons can sometimes remove a small portion of the growth in the office for lab testing.

How is it treated?

Your healthcare provider will do surgery to remove the inverted papilloma. Usually, they can do minimally invasive surgery that doesn’t involve making cuts to your face. Often, they can use the same rigid telescope used in the office and special instruments to remove it through your nostrils.

In very rare cases, you may need open surgery if they can’t remove all the tumor with the scope. If you’re not a candidate for surgery, your provider may use radiation therapy to destroy an inverted papilloma.

When should I see my healthcare provider?

You’ll see your healthcare provider regularly after surgery to check whether the papilloma comes back. They can grow back after surgery. Research shows that most that grow back do so within the first two years. But sometimes, they grow back 10 to 15 years later.

Your provider will suggest a checkup schedule to detect any growths as soon as possible so there are no treatment delays.

What can I expect if I have this condition?

Inverted papillomas don’t just go away on their own. Since there’s a chance they could transform into cancer, it’s important to have surgery to remove them as soon as possible.

If one does grow back, it may return as another papilloma. Sometimes, it returns as cancer. Either way, you’ll need surgery again. With cancer, you’ll likely get radiation therapy afterward to reduce the likelihood that it’ll return.

The five-year survival rate for a cancerous inverted papilloma following surgery and radiation is 84%. This means that treatment often gets rid of the cancer.

What is the difference between a polyp and an inverted papilloma?

Nasal polyps form because of inflammation in your nasal cavity or sinuses. This is different from inverted papillomas, where growth seems related to lots of potential causes, including HPV. While you may need surgery to remove a nasal polyp, there’s no risk of it transforming into cancer.