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Clinical Note |

Bilateral Cavernous Sinus Involvement by Perineural Spread of Inverted Papilloma

Fred Y. Lin, MD; Chan W. Park, MD; Peter Som, MD; William Lawson, MD, DDS
Arch Otolaryngol Head Neck Surg. 2010;136(9):920-922. doi:10.1001/archoto.2010.144.
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Inverted papilloma is a benign tumor of upper respiratory epithelium that is slow growing but has a propensity for local invasion and recurrence. It not only can involve the nose and paranasal sinuses, but it also can extend into the orbit, nasolacrimal duct, pterygoid fossa, and anterior cranial fossa. Bone invasion can occur with both benign tumors and tumors that have undergone malignant transformation. We describe the first reported case (to our knowledge) of an inverted papilloma with benign and malignant elements that extended by perineural spread to cause bilateral cavernous sinus invasion. Furthermore, retrograde extension to Meckel cave developed bilaterally, with perineural spread along the third division of the trigeminal nerve into the masticator space and the skull base.

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Figure 1.

Histologic features of inverted papilloma. A, Rounded squamous epithelium of inverted papilloma encroaching onto the pink stroma (hematoxylin-eosin, original magnification ×4). B, Inverted papilloma with perineural extension along the left infraorbital nerve (hematoxylin-eosin, original magnification ×10).

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Figure 2.

Coronal T1-weighted, fat-suppressed, contrast-enhanced magnetic resonance images. A, Tumor is seen in the right maxillary nerve, left maxillary nerve, and left cavernous sinus (arrows). B, Tumor is seen in both cavernous sinuses and both Gasserian ganglia; tumor spread is also seen along the left mandibular nerve. There is suspected tumor in the upper right mandibular nerve (arrows). C, There is tumor in the left cavernous sinus, with widening of the left foramen ovale (arrows).

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