Case Report
Sinonasal inverted papilloma mimicking a pituitary macroadenoma

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Abstract

We report the rare entity of an inverted papilloma arising from the sphenoid sinus that we expected to be a pituitary tumour on the basis of history, examination and pre-operative investigations, especially MRI appearance. Inverted sinonasal papilloma should be considered in the differential diagnosis of pituitary macroadenoma invading the sphenoid sinus.

Introduction

Papillomas of the sinonasal mucosa, or Schneiderian membrane, account for fewer than 5% of tumours at this site. About 50% of these subtypes are inverted papillomas; the others comprising fungiform and cylindrical cell subtypes.1 Inverted papillomas are premalignant tumours, most commonly arising from the lateral nasal wall that can extend into adjacent structures including the orbit, cranial cavity, middle ear and Eustachian tube.2 It is rare for inverted papilloma of the sinonasal mucosa to extend into the pituitary fossa, mimicking a pituitary macroadenoma.

Section snippets

Case report

The patient was a 46-year-old woman who presented with a 6-month history of left-sided headaches and facial hypoaesthesia. Her past history included hypertension, obesity (body mass index 44 kg/m2) and obstructive sleep apnoea. On clinical examination, visual fields and extraocular movements were normal. Her MRI (Fig. 1) and CT brain scans illustrated a 3.5 cm × 2.1 cm × 2.1 cm mass inferior to the sella contiguous with the pituitary gland, and sited largely within the sphenoid sinuses. There was also

Discussion

We report a rare inverted papilloma arising from the sphenoid sinuses, that was expected to be a pituitary tumour on the basis of history, examination and pre-operative investigations. Inverted papilloma is a relatively rare neoplasm, constituting 0.5% to 4% of all primary nasal tumours. Its incidence peaks when people are in their 50s and 60s, but it has been reported in all age groups. There is a male preponderance, with Caucasians being more commonly affected. There is a well-documented

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