Exophytic Papilloma


Exophytic papilloma, also known as "everted" or "fun-giform" papilloma, is a single, warty tumour measuring up to 1.5 cm in diameter, arising most frequently at the nasal septum and only very rarely in the lateral nasal walls or in paranasal sinuses [122]. Males are predominantly affected. Patients tend to be younger than with other types of schneiderian papilloma. Exophytic papillomas are almost always unilateral [54]. No side is preferred and bilaterality is exceptional. The tumour is composed of branching papillary structures, with papillae covered by stratified non-keratinising squamous epithelium, admixed with intermediate or transitional cells and with ciliated respiratory epithelium that contains interspersed mucin-secreting cells. Koilocytosis is not infrequently found in the squamous epithelium. Seromucinous glands are abundantly found when the underlying submucosa is removed.

The two main differential diagnoses are inverted papilloma and oncocytic papilloma. Neither the invagi-nated pattern of growth of inverted papillomas nor the oncocytic columnar epithelium of oncocytic papillomas are found in exophytic papillomas [173]. Cylindrical cell carcinoma can be easily ruled out by the lack of atypia and invasion. Wide surgical excision is the best choice of treatment to avoid recurrences. Recurrences occur in about 20-40% of cases, which is less than in inverted papillomas. Malignant transformation almost never occurs in exophytic papillomas.

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