Abstract

Introduction: Inverted papilloma (IP) is a benign but locally aggressive lesion of the paranasal sinuses (PS) that’s well known for its invasive capacity, high potential for local recurrence and propensity to evolve to malignancy. Unilateral nasal obstruction, hyposmia and recurrent epistaxis are the most common presenting symptoms. We present a case report about an atypical presentation of IP, emphasizing that some patients may present unusual inaugural symptoms, which makes IP more difficult to diagnose.

Case Report: We present an IP case of a 71-year-old female reported to an ophthalmologist with a chief complaint of a diplopia, progressive left exophthalmia and palpebral ptosis for 3 months, with no rhinology symptoms. An orbital computed tomography (CT) scan performed showed an opacification of the left frontal sinus (FS), associated with a bone erosion of FS roof and left ethmoidal cells opacification. A magnetic resonance imaging (MRI) confirmed the presence of a proliferative lesion involving left nasal structures associated with secondary left FS mucocele. A lesion histopathological analysis showed the presence of IP and the mass was then surgically excised by a combined endonasal and external frontal sinus approach.

Conclusion: IP is a locally destructive lesion with potential to malignancy that requires an aggressive surgical attitude to improve the chances of a complete resection, minimizing the recurrence rates. It’s important to remind that not every patient is typical and a high suspicion level’s essential for a timely diagnosis and treatment.