Mantle Cell Lymphoma Rising in Association with Inverted Papilloma

Introduction: Inverted papilloma (IP) is a benign sinonasal tumor with a tendency for locally aggressive behavior and the potential for malignant transformation. Malignant transformation occurs in less than 10% of IP cases and is most commonly associated with squamous cell carcinoma. Mantle cell lymphoma arising in association with IP has not been previously reported.

Methods: Case report of mantle cell lymphoma in association with IP and review of the literature.

Case Report: A 60-year-old male with history of chronic rhinosinusitis with nasal polyposis was found to have synchronous lesions of inverted papilloma and mantle cell lymphoma. The patient had a prior endoscopic polypectomy 13 years ago by his referring physician. His symptoms of nasal obstruction and drainage had returned, with new complaints of epistaxis and anosmia. Notably, he is morbidly obese and he has been self-medicating with oxymetazoline sprays 4 times a day. He underwent an endoscopic sinus surgery with findings of polyposis and suspicious lesions in the sphenoid sinus that were sent separately. Final surgical pathology report revealed inverted papilloma without dysplasia and mantle cell lymphoma. His postoperative PET-CT further identified disease in the right lacrimal gland and right upper lip. He is currently undergoing rituximab monotherapy.

Conclusion: IP is a benign tumor with known association with malignant transformation, usually in the form of squamous cell carcinoma. This case report discusses a 60-year-old male diagnosed with mantel cell lymphoma arising in association with IP, the first reported in the English literature. Although exceedingly rare, synchronous or metachronous lesions can occur with inverted papilloma and surgical specimens should always be sent separately if clinical suspicion is high.