Rare Concurrent Sinonasal Inverted Papilloma and Lymphoma: A Case Report

Introduction: Sinonasal inverted papilloma (IP) has a high rate of synchronous or metachronous malignancy ranging from 7 to 11% with squamous cell carcinoma predominance. The present case report illustrates an unusual presentation of synchronous IP with lymphoma, emphasizing the necessity of maintaining a high index of suspicion for malignancy in IPs and the inclusion of lymphoma in the differential diagnosis.

Case: A 44-year-old male patient presented with a soft tissue lesion on the floor of the oral cavity adjacent to his left upper third molar. Radiographic imaging revealed a heterogeneously enhancing mass filling the left nasal cavity a separate lesion was note in the hard palate. Biopsies of the sinonasal lesion and hard palate revealed IP and acute sialadenitis respectively. PET-CT scan showed intense metabolic activity in the lesion and cervical nodes, with a maximum standardized uptake value (SUV) of 17.5 and 9.7, respectively. Endoscopic resection of the IP revealed areas with a different character of tumor that revealed non-Hodgkin’s lymphoma.

Discussion: Sinonasal IPs may be correlated with epithelial atypia, dysplasia, carcinoma in situ, and invasive cancer. Early detection helps preserve function and minimize treatment. To our knowledge, this is the third case of non-Hodgkin lymphoma coexist with IP. Compared to IP, lymphoma typically has a higher rate of invasion, homogenous signal intensity on T2-weighted MRI and lower diffusion coefficient. Also, IP may show metabolic activity on PET-CT, but SUV usually not exceeding 10, while malignant entities like SCC and lymphoma exhibit higher SUV values greater than 10. Multiple and lower regional cervical lymphadenopathy highly suggest the presence of a malignancy.

Conclusion: The present case report describes a rare occurrence of the coexistence of lymphoma and inverted papilloma. The presence of a destructive lesion, lower-level cervical lymph node involvement, and a high SUV of ≥ 10 should arouse suspicion for the coexistence of malignancy ([Figs. 1], [2]).

Fig. 1

Fig. 2

Publikationsverlauf

Artikel online veröffentlicht:
05. Februar 2024