Rare manifestation site of inverted papilloma: Supra-Agger-Frontal-Cell in the sinus frontalis - A Case Report

Introduction:

The inverted papilloma is a benign tumor that occurs exclusively in the nasal sinuses and can show a malignant transformation in up to 10% of the cases. Normally, there is a unilateral infestation of the maxillary sinuses and/or the ethmoid cells. These locations are the most common. Bilateral infestations as well as occurrences in the frontal and sphenoidal sinuses are rare. Due to high recurrence rates and a possible risk of malignant transformation surgical R0-resection with grinding of the affected bone should be sought.

Material and methods:

We present the case of a 51-year-old patient who complained about frontal headaches on the right site. The CT-scan showed a shadowing of the right sinus frontalis and the cranial ethmoid cells. Furthermore, a frontoethmoid cell inside the frontal sinus was distinguished. Due to the symptoms and the unilateral findings the indication for endoscopic transnasal sinus surgery was set.

Results:

Intraoperatively, an inhomogeneous tissue formation was found in the frontal recess. Histologically, parts of an inverted papilloma were detected, especially in the cranial part of the frontoethmoid cell. Due to the high cranial origin and to achieve a safe R0-resection an open frontal sinus revision was performed. The endoscopic follow-up examination two months after the resection revealed a regular postoperative situs.

Conclusion:

Despite the benign structure of the inverted papilloma a complete removal and abrasion of the affected bone is required due to high recurrence rates. Depending on the location an open access may be required in the frontal sinus. As the present case shows, an inverted papilloma can also arise within a rare anatomical variant such as the Supra-Agger-Frontal-Cell.

Publication History

Publication Date:
23 April 2019 (online)