Cylindrical Schneiderian papilloma

Resected cylindrical papillomas pictured here commonly arise from the lateral nasal wall and less frequently from the paranasal sinus.

Cylindrical cell papilloma shows extensive papillary epithelial proliferation with esosinophilic to granular cytoplasm (top left).  It also consists of multiple intraepithelial mucin cysts (top right, bottom left and right).  The cysts often contain PMNs (bottom right).  Cilia can also be visualized at the outer surface ot the epithelial proliferation (bottom right).

Papillomas are benign neoplasm arising from the sinonasal or Schneiderian mucosa. Squamous or columnar epithelial proliferations characterize these lesions. They are categorized into: 1) septal 2) inverted or 3) cylindrical. Septal and inverted papillomas are the most common – each comprising of about ~45-50% of all papillomas. They are rarely seen in pediatric population, but septal papillomas tend to occur in younger age group (20-50s). Patients typically present with unilateral nasal obstruction, epistaxis, and pain. The etiology remains unclear, but HPV types 6/11 have been implicated in the pathogenesis. Malignant transformation occurs in about 10% of inverted and cylindrical papilloma. However, the propensity for malignant transformation is rare with septal papilloma. Treatment is complete surgical excision of the mass with negative margins. Lateral rhinotomy or medial maxillectomy may be performed to ensure complete resection of the tumor. Incomplete removal of the lesion results in recurrence of the tumor with potential invasion of surrounding tissue. Other complications include malignant transformation.