A Rare Case of Sinonasal Oncocytic Papilloma

Nikita Miriam John; Ramesh Kumar E

doi:10.18787/jr.2025.00017

Abstract

Oncocytic papilloma is the rarest type of sinonasal papilloma observed in the sinonasal cavity. It commonly arises from the lateral nasal wall, particularly involving the maxillary and ethmoid sinuses. It rarely originates in the middle ear cavity, nasopharynx, or lacrimal sac. This is a case report of a 61-year-old male patient who presented with complaints of epistaxis since 1 month, describing a rare case of sinonasal oncocytic papilloma located in the nasopharynx. This report explains the diagnostic evaluation and subsequent management. Early recognition and complete surgical excision contribute to effective treatment and reduced risk of recurrence.

KEY WORDS: Oncocytic papilloma; Oncocytic cells; Papilloma; Schneiderian membrane; Nasopharynx; Recurrence

INTRODUCTION

Papillomas arising from Schneiderian epithelium within the sinonasal tract are termed Schneiderian papillomas [1]. The first documented case of papilloma within the sinonasal cavity was described by Ward in 1854 [2]. In 1991, the World Health Organization classified sinonasal papillomas into three distinct histopathological types: exophytic, inverted, and oncocytic [3]. Among these, exophytic and inverted papillomas are the most frequently diagnosed types, whereas oncocytic papillomas represent the rarest subtype, comprising approximately 3%–5% of all sinonasal papillomas [4]. This report presents an unusual instance of oncocytic papilloma located in the nasopharynx, detailing its clinical evaluation and management strategy.

CASE REPORT

A 61-year-old male patient presented with complaints of epistaxis from the right side for 1 month. The patient reported no associated nasal blockage, trauma, postnasal drip, headache, or ear symptoms. Despite using a nasal spray for 3 weeks, there was no symptomatic improvement. The patient had a known history of hypertension for the past 10 years, managed with regular medication.

Diagnostic nasal endoscopy (DNE) revealed a reddish lesion located on the right nasopharyngeal wall near the fossa of Rosenmüller (Fig. 1).

A provisional diagnosis of nasopharyngeal malignancy was established, and the patient was scheduled for DNE-guided biopsy under local anesthesia for further characterization of the lesion. Histopathological examination revealed a papillary neoplasm composed of multilayered oncocytic cells with round, vesicular nuclei, abundant eosinophilic cytoplasm, and inflammatory cells within the stromal tissue. No evidence of cellular atypia was noted. A diagnosis of sinonasal oncocytic papilloma was confirmed by histopathology (Fig. 2).

After a preanesthetic evaluation, the patient underwent surgical excision of the nasopharyngeal mass under general anesthesia. The patient was positioned supine with a slight elevation of the head. The lesion was completely excised from the right fossa of Rosenmüller and sent for further histopathological examination. The lesion base was cauterized with monopolar cautery, achieving hemostasis. Nasal packing was placed on the right side and subsequently removed after 24 hours. Postoperatively, the patient received antibiotics and analgesics and was discharged the following day.

The patient returned for follow-up after 1 week, at which time DNE demonstrated no residual lesion and the patient reported no symptoms. A 3-month follow-up confirmed no recurrence of the lesion, as verified through DNE.

DISCUSSION

Sinonasal oncocytic papilloma, also known as cylindrical cell papilloma, is a rare subtype of epithelial neoplasm originating from the Schneiderian membrane. Exophytic, inverted, and oncocytic papillomas most commonly arise from the lateral nasal cavity, including the maxillary sinus, nasal cavity, ethmoid sinus, and rarely, the frontal and sphenoid sinuses (5%) [5]. Schneiderian papillomas can also originate outside the sinonasal tract, with occurrences reported in the middle ear cavity, mastoid, nasopharynx, pharynx, and lacrimal sac [6].

These papillomas are predominantly diagnosed in middle-aged adults, exhibiting a slight male predominance (male-to-female ratio of 2:1). Kochhar et al. [7] reported a case of cylindrical papilloma in the nasopharynx of a 27-year-old patient. Additionally, literature has documented another instance of nasopharyngeal cylindrical papilloma in a 56-year-old patient, described by Chrysovergis et al. [8]. Although the exact etiology of these tumors remains unclear, chronic irritation, human papillomavirus (HPV) infection, and genetic mutations have been suggested as potential contributing factors. It has been reported that HPV infections are more commonly associated with exophytic and inverted papillomas compared to oncocytic papillomas [9].

The nasal pits form around the 5th week of embryonic development, lined by ectodermal epithelium, which constitutes the Schneiderian membrane. This membrane may come into contact with the endodermal-lined pharynx when the bucconasal membrane, comprising both ectodermal and endodermal components, breaks down, thus permitting communication between the two structures. Such communication can lead to the migration or incorporation of Schneiderian mucosa into areas where it is not typically present [10]. Ectopic migration of the ectodermal lining has been suggested as a potential mechanism underlying the unusual occurrence of inverted papilloma in atypical locations, such as the nasopharynx [11].

Malignant transformation has been documented in inverted and oncocytic papillomas but not in exophytic papillomas. Approximately 4%–17% of oncocytic papilloma cases have been associated with malignancy. Squamous cell carcinoma is the most common malignancy identified in association with oncocytic papilloma. Other malignancies reported include mucoepidermoid carcinoma, epidermoid carcinoma, and sinonasal undifferentiated carcinoma [12].

Macroscopically, oncocytic papillomas appear as soft, fleshy, pink-colored papillary masses. Histologically, they exhibit both exophytic and endophytic growth patterns, composed of multiple layers of pseudostratified columnar (cylindrical) cells. These cells have uniform, small, round, dark nuclei and abundant eosinophilic cytoplasm [13].

Computed tomography typically reveals a sinonasal mass with heterogeneous contrast enhancement and unilateral sinus opacification. Enlargement of the lesion may lead to thinning or bowing of adjacent bony structures. The presence of bony erosion should raise suspicion for an associated malignancy. Magnetic resonance imaging is useful for delineating lesion extent and evaluating for any intraorbital or intracranial extension [14].

Management involves complete surgical excision, preferably via an endoscopic approach, contingent on lesion location and extent. Incomplete or limited resections may result in recurrence. To further prevent recurrence, the bone at the lesion attachment site should be drilled [15]. Radiotherapy is indicated for cases associated with malignancy or for recurrent papillomas. Approximately 25%–35% of sinonasal oncocytic papilloma cases recur within five years post-resection [16].

In conclusion, sinonasal oncocytic papillomas are rare tumors characterized by distinctive histopathological features. Although generally benign, their tendency toward local invasion and recurrence underscores the critical importance of early diagnosis and complete surgical removal. Given their relatively high recurrence rate, long-term follow-up is necessary to achieve optimal patient outcomes.

Notes

Ethics Statement

This study has received Institutional Ethics Committee approval (30/24/IEC/JMMC&RI) Jubilee Mission Medical College Hospital and Research Institute Thrissur. Written informed consent has been taken from the patient.

Availability of Data and Material

The datasets generated or analyzed during the study are available from the corresponding author on reasonable request.

Conflicts of Interest

The authors have no potential conflicts of interest to disclose.

Author Contributions

Investigation: Nikita Miriam John, Ramesh Kumar E. Methodology: Nikita Miriam John, Ramesh Kumar E. Project administration: Nikita Miriam John. Resources: Nikita Miriam John. Supervision: Ramesh Kumar E. Validation: Ramesh Kumar E. Visualization: Nikita Miriam John. Writing—original draft: Nikita Miriam John. Writing—review & editing: Ramesh Kumar E.

Funding Statement

None

Acknowledgments

None

Fig. 1.

Circled marking shows the reddish lesion at the right Fossa of Rosenmüller.

Fig. 2.

Hematoxylin and eosin stain (low magnification-10×) showing oncocytic papilloma exhibiting both exophytic and endophytic patterns with several layers of pseudostratified columnar (cylindrical) cells containing uniform small dark round vesicular.

References

1) Cheng TY, Ueng SH, Chen YL, Chang KP, Chen TM. Oncocytic schneiderian papilloma found in a recurrent chronic paranasal sinusitis. Chang Gung Med J 2006;29(3):336–41.

2) Ward N. A mirror of the practice of medicine and surgery in the hospitals of London: London Hospital. Lancet 1854;64(1632):480–482.

3) Shanmugaratnam K, Sobin LH. The World Health Organization histological classification of tumours of the upper respiratory tract and ear. A commentary on the second edition. Cancer 1993;71(8):2689–97.

4) Barnes L, Bedetti C. Oncocytic Schneiderian papilloma: a reappraisal of cylindrical cell papilloma of the sinonasal tract. Hum Pathol 1984;15(4):344–51.

5) Lee JT, Bhuta S, Lufkin R, Castro DJ. Isolated inverting papilloma of the sphenoid sinus. Laryngoscope 2003;113(1):41–4.

6) Busquets JM, Hwang PH. Endoscopic resection of sinonasal inverted papilloma: a meta-analysis. Otolaryngol Head Neck Surg 2006;134(3):476–82.

7) Kochhar L, Choudhary S. Cylindrical papilloma of nasopharynx (a case report). Med J Armed Forces India 1997;53(3):233–4.

8) Chrysovergis A, Paschalidis J, Michaels L, Bibas A. Nasopharyngeal cylindrical cell papilloma. J Laryngol Otol 2011;125(1):86–8.

9) Wood JW, Casiano RR. Inverted papillomas and benign nonneoplastic lesions of the nasal cavity. Am J Rhinol Allergy 2012;26(2):157–63.

10) Sulica RL, Debo RF, Wenig BM, Sessions RB. Schneiderian papillomas of the pharynx. Ann Otol Rhinol Laryngol 1999;108(4):392–7.

11) Radcliffe A. Transitional cell papilloma of the post-pharyngeal wall. J Laryngol Otol 1953;67(11):682–8.

12) Nudell J, Chiosea S, Thompson LD. Carcinoma ex-Schneiderian papilloma (malignant transformation): a clinicopathologic and immunophenotypic study of 20 cases combined with a comprehensive review of the literature. Head Neck Pathol 2014;8(3):269–86.

13) Hyams VJ. Papillomas of the nasal cavity and paranasal sinuses. A clinicopathological study of 315 cases. Ann Otol Rhinol Laryngol 1971;80(2):192–206.

14) Perez-Ordoñez B. Hamartomas, papillomas and adenocarcinomas of the sinonasal tract and nasopharynx. J Clin Pathol 2009;62(12):1085–95.

15) Chiu AG, Jackman AH, Antunes MB, Feldman MD, Palmer JN. Radiographic and histologic analysis of the bone underlying inverted papillomas. Laryngoscope 2006;116(9):1617–20.

16) Kaufman MR, Brandwein MS, Lawson W. Sinonasal papillomas: clinicopathologic review of 40 patients with inverted and oncocytic schneiderian papillomas. Laryngoscope 2002;112(8):1372–7.