Potentially Distinctive Features of Sinonasal Inverted Papilloma on MR Imaging

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Potentially Distinctive Features of Sinonasal Inverted Papilloma on MR Imaging

Hiroya Ojiri¹, Masuo Ujita, Shimpei Tada and Kunihiko Fukuda

^¹ All authors: Department of Radiology, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461 Japan.

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Fig. 1A. —45-year-old man with inverted papilloma. Unenhanced spin-echo T1-weighted coronal MR image (TR/TE, 470/17) shows intermediate-signal-intensity mass that is relatively nondescript in internal architecture and involves right-sided maxillary antrum, nasal cavity, and ethmoidal sinus.

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Fig. 1B. —45-year-old man with inverted papilloma. Unenhanced fast spin-echo T2-weighted coronal MR image (4600/120) reveals convoluted cerebriform pattern throughout mass. Pattern consists of low-signal-intensity (arrowheads) and relatively high-signal-intensity (small arrows) striations that probably represent metaplastic squamous epithelium and edematous stroma, respectively. Note mucous-filled gaps between folds of tissue that are difficult to identify with certainty. Secretions after obstruction in lateralmost portion of right-sided maxillary antrum are of extremely high signal intensity (large arrow).

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Fig. 1C. —45-year-old man with inverted papilloma. Contrast-enhanced spin-echo T1-weighted coronal MR image (470/17) shows well-enhancing stroma (small arrows) and less-enhancing epithelium (arrowheads) that create convoluted cerebriform pattern correlating with that seen in B. Trapped secretions (large arrow) in lateralmost portion of right-sided maxillary antrum do not enhance.

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Fig. 1D. —45-year-old man with inverted papilloma. Photomicrograph of histopathologic specimen shows characteristic inverted morphologic features. Note hyperplastic squamous epithelium (E) protruding into (arrows) stroma (S) producing grossly convoluted cerebriform appearance. G = tissue gap. (H and E, x 5)

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Fig. 2. —47-year-old man with concomitant inverted papilloma and focal squamous cell carcinoma (pathologic group 2). Contrast-enhanced spin-echo T1-weighted axial MR image (TR/TE, 500/19) reveals inhomogeneously enhancing tumor destroying medial and anterior walls of left-sided maxillary antrum (small arrows). Tumor also directly invades retromaxillary fat pad (arrowhead). Poorly enhancing area (large arrow) in lesion represents gross central necrosis. Because this patient had predominantly squamous cell carcinoma with only small component of inverted papilloma, cerebriform pattern was not identified throughout entire mass as in other patients (Figs. 1A,1B,1C,1D and 3), who had inverted papilloma with or without small foci of coexisting squamous cell carcinoma not identified in this tumor.

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Fig. 3. —47-year-old man with concomitant inverted papilloma and squamous cell carcinoma (pathologic group 1). Unenhanced fast spin-echo T2-weighted coronal MR image (TR/TE, 4600/120) discloses intermediate-signal-intensity mass centered in right-sided nasal cavity and maxillary antrum. Convoluted cerebriform pattern is present throughout entirety of mass. Multifocal in situ squamous cell carcinoma was present diffusely in mucosa of this inverted papilloma but did not disturb basic morphologic inverted papilloma pattern. Secondary frontal and ethmoidal obstructive changes are easily differentiated from inverted papilloma.

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