The patient is a 79 year old male who had an inverted papilloma resected in the past. He now has worsening headaches and sinus problems. one piece of soft tissue, representing the posterior wall of the frontal sinus came for study. What is the diagnosis.

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First 3 Images : Inverted Squamous Papilloma. Last 4 Images : Verrucous Carcinoma.

Inverted sino nasal papilloma

Verrucous Carcinoma is the final diagnosis. Thanx for your comment.
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Numerous intraepithelial microcysts containing polymorphonuclear leukocytes are present.

The base of the lesion shows rounded or bulbous rete pegs with broad pushing borders. The underlying stroma shows only minimal inflammation and in some areas myxomatous change.
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Verrucous carcinoma

Yes Verrucous Carcinoma is the final diagnosis. Thanx for your comment.
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Inverted papilloma, recurrent.

Verrucous Carcinoma is the final diagnosis. Thanx for your comment.
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recurrent inverted papilloma

Verrucous Carcinoma is the final diagnosis. Thanku Mam for your comment.
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Section shows a neoplastic lesion composed of inward growth of ribbons of squamous epithelium. Epithelium shows intra epithelial neutrophils singly and in clusters, few mucin filled microcysts. No increased mitotic activity, necrosis or nuclear atypia.

Inverted papilloma

Verrucous Carcinoma is the final diagnosis. Thanx for your comment.
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Inverted papilloma

Verrucous Carcinoma is the final diagnosis. Thanx for participating
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Image 1,2 and 3 show morphology of an inverted papilloma ( which was the previous lesion as described in the history) But images 4 and 5 have a different morphology Markedly acanthotic stratified squamous epithelium showing minimal nuclear atypia with hyperkeratosis and broad bulbuous rete ridges with pushing borders into the underlying stroma - Morphology favouring - Verrucous hyperplasia / Verrucous Carcinoma? Recurrent lesion developing as verrucous carcinoma with inverted papilloma

Verrucous Carcinoma is the final diagnosis. Thanx for your comment.
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