A Rare Case of Sinonasal Oncocytic Papilloma

Article information

J Rhinol. 2025;32(2):117-119

Publication date (electronic) : 2025 July 22

doi : https://doi.org/10.18787/jr.2025.00017

Nikita Miriam John, MBBS, MS, Ramesh Kumar E, MS, DNB

Department of Otorhinolaryngology, Jubilee Mission Medical College and Research Institute, Thrissur, India

Address for correspondence: Ramesh Kumar E, MS, DNB, Department of Otorhinolaryngology, Jubilee Mission Medical College and Research Institute, Thrissur 680005, India Tel: +91-9495247884, E-mail: drerk@rediffmail.com

Received 2025 March 19; Revised 2025 April 16; Accepted 2025 April 29.

Abstract

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).

Fig. 1.

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

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).

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.

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.

Article information Continued