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Review
. 2017 Sep;11(3):269-277.
doi: 10.1007/s12105-017-0799-9. Epub 2017 Mar 20.

OSPs and ESPs and ISPs, Oh My! An Update on Sinonasal (Schneiderian) Papillomas

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Free PMC article
Review

OSPs and ESPs and ISPs, Oh My! An Update on Sinonasal (Schneiderian) Papillomas

Justin A Bishop. Head Neck Pathol. .
Free PMC article

Abstract

Sinonasal (Schneiderian) papillomas are benign neoplasms that arise in the sinonasal tract. Since their initial descriptions, sinonasal papillomas have triggered debate regarding their classification, etiology, rate or predictors of malignant transformation, and other issues. While significant strides have been made in recent years, there are still aspects of sinonasal papillomas that remain unclear even now. This review will serve to update the practicing pathologist on the current understanding of sinonasal papillomas.

Keywords: Cylindrical cell papilloma; Fungiform papilloma; Inverted papilloma; Oncocytic papilloma; Schneiderian papilloma; Sinonasal papilloma.

Conflict of interest statement

Conflict of interest

Justin Bishop declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Normal sinonasal (Schneiderian) mucosa. When discussing sinonasal papillomas, it is useful to keep the appearance (particularly the thickness) of the normal sinonasal epithelium in mind
Fig. 2
Fig. 2
Inverted sinonasal papillomas appear clinically as a lobulated mucosal mass with a cerebriform appearance and prominent vasculature. (Courtesy of Dr. Andrew Lane)
Fig. 3
Fig. 3
Inverted sinonasal papilloma. At low power, the inverted growth pattern is apparent, with broad interconnecting ribbons of epithelium in the submucosa. Seromucinous glands are not seen. a Inverted sinonasal papillomas can exhibit locally aggressive behavior, here eroding into bone. This, by itself, should not be interpreted as carcinomatous transformation. b The classic epithelium of inverted sinonasal papilloma is thickened and permeated by neutrophils, often with microabscesses (arrows). In this case, the epithelium is transitional with a row of retained ciliated columnar epithelium superficially (c). This example of inverted sinonasal papilloma has more mature, glycogenated squamous epithelium with fewer transmigrating neutrophils (d)
Fig. 4
Fig. 4
Carcinoma ex-inverted sinonasal papilloma. In this unusual example, an invasive mucin-producing adenosquamous carcinoma (bottom) is arising in association with an inverted sinonasal papilloma (top). This figure underscores that while squamous cell carcinomas are most common, unusual carcinomas can arise from inverted sinonasal papillomas. a Squamous cell carcinoma ex-inverted sinonasal papilloma (top) exhibits increased nuclear pleomorphism, prominent nucleoli and increased mitotic activity when compared to the inverted sinonasal papilloma (bottom). The papilloma component exhibits increased cellular atypia in the basal layer, a change that may be regarded as squamous dysplasia (b)
Fig. 5
Fig. 5
Exophytic sinonasal papilloma consists of finger-like growths of squamous epithelium lining delicate fibrovascular cores (a). The lining epithelium of exophytic sinonasal papilloma resembles that of inverted sinonasal papilloma (i.e., squamous with intraepithelial neutrophils) but also demonstrates koilocytic changes superficially. These cells are typically positive for low-risk HPV types by in situ hybridization (inset) (b)
Fig. 6
Fig. 6
Oncocytic sinonasal papilloma at low power demonstrates both inverted and exophytic growth (a). The lining epithelium is oncocytic, with cells that have abundant granular eosinophilic cytoplasm and small round nuclei. Like other types of sinonasal papilloma, transmigrating neutrophils and microabscesses are commonly seen (b). Oncocytic sinonasal papillomas frequently exhibit numerous pink microcysts in the oncocytic epithelium. (c) This example of carcinoma ex-oncocytic sinonasal papilloma has a very abrupt transition (arrow) between benign (right) and malignant (left) epithelium (d)
Fig. 7
Fig. 7
In papillary rhinosinusitis, the surface is vaguely papillary, but the lining epithelium (inset) is not thickened and does not exhibit the changes of sinonasal papilloma (a). Respiratory epithelial adenomatoid hamartoma, like inverted sinonasal papilloma, exhibits downward epithelial growth. However, the lesional epithelium lacks the characteristic features of sinonasal papillomas, and the nests are often surrounded by a rim of hyalinized basement membrane (arrowheads) (b). Low-grade sinonasal adenocarcinoma grows as a complex proliferation of fused glands of only one cell layer. This appearance is dissimilar to that of oncocytic sinonasal papilloma (see Fig. 6a–c). (c) Rhinosporidiosis is characterized by numerous spores within the sinonasal submucosa. This is in contrast to oncocytic sinonasal papilloma where microcysts are seen in the epithelium only

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