Aim: The aim of this case report is to sensitize about the possibility of early malignant transformation in an inverted papilloma (IP) and presence of rare spindle cell carcinoma (SPCC) in IP, which can masquerade as a benign lesion.
Background: Inverted papillomas are benign tumors of sinonasal tract with characteristic histological features. Though benign, these lesions show recurrence, are locally aggressive, and have potential for malignant transformation.
Case report: A case of IP is described, which recurred following wide local excision and underwent malignant transformation into aggressive spindle cell variant of squamous cell carcinoma. A 48-year-old male presenting with unilateral nasal obstruction and serosanguinous discharge was detected to have reddishgray nasal mass arising from lateral wall of right nasal cavity. The histopathological examination was suggestive of IP. A medial maxillectomy and excision was done. However, recurrence was detected within 6 months. There was subsequent rapid malignant transformation into SPCC, which is a rare type of squamous cell carcinoma and even rarer in malignant transformation of IP.
Conclusion: The patient was managed promptly with radiotherapy after diagnosis of malignant transformation was made and is under follow-up. The case highlights the importance of follow-up care in IP, as early recurrence can be there. Moreover, malignant transformation, especially rarer type of SPCC, made the case more challenging.
Clinical significance: The diagnosis of SPCC required a high index of suspicion as it is a rare variety of squamous cell carcinoma arising as malignant transformation of IP and mimics many other reactive or mesenchymal lesions.
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