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Dr. Andrew Rynne

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Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8507 Questions

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Posted on Mon, 31 Dec 2018 in General Health
Question: Hi Dr. Kakkar! You helped me recently with a question I had pertaining to a nodule which was discovered in my left nasal vestibule, which had shown up on a CT acan of my paranasal sinuses. The CT report showed a soft tissue nodule in the left nasal vestibule abutting the septum and lateral wall, without evidence of erosions. I visited an ENT surgeon last week regarding the same, and he did a biopsy, for which I am waiting for the results. He did indicate that it appeared clinically to be benign and he suspects it is a papilloma. I had visited another ENT previously, who thought it was an inverting papillloma, and she actually referred me to this other ENT. He told me that the inverting type would not be in the area where mine is located. After googling (I know, that’s a bad thing to do!) I see that there are three rare types of nasal papilloma, including the inverting type, but those appear mostly in the mucousal epithelium located further back in the nasal cavity. I believe my ENT suspects that this is the more common squamous papilloma due to its location. In any respect, he said it could be caused by prior trauma and consist of granular (?) tissue, or it could be caused by HPV. You may recall I asked you a prior question about HPV, as I was concerned that a plantar wart implantation therapy which my podiatrist performed for some plantar warts I have may be connected (I asked the ENT and he said they are not). Since I have health anxiety and have googled these things, I have a few additional questions that I didn’t think of until after my appointment with the ENT:
1). The consensus seems to be that the plantar wart implantstion wouldn’t have caused the nasal lesion, but could I have possibly spread the virus by touching the plantar wart and then the inside of my nose? I know there are numerous types of HPV and I would think the plantar and nasal strains are different...
2). Am I at risk of spreading the HPV from my nasal papilloma (if it is viral in origin) to other areas? Now I’m paranoid every time I blow my nose. Also, last night I think I swallowed what was a piece of perhaps the dried up tissue or blood from the biopsy site and now I have anxiety induced visions of it spreading lesions in my esophagus ofnwherecer (yes, can you tell I’m just a little anxious and stressed over this lol?)
3) Finally, now that I have both plantar warts (that haven’t responded to treatment) and the nasal papilloma possibly caused by HPV, I’m paranoid that I’m going to have these warts and papillomas growing all over...yikes! Do you think it’s just a random occurrence that I have these existing ones and there’s no need to stress over the prospect of other ones? I’m essentially healthy and only have fibromyalgia, high blood pressure, and I did have mononucleosis decades ago...
Thank you for always being there and for any reassurances you can provide!!
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Answered by Dr. Kakkar S. 22 hours later
Brief Answer:
Regarding nasal papilloma

Detailed Answer:
Hello. thank you for putting your question.

Given that the location of the nasal papilloma is such and your ENT is reasonably sure about this not being an inverted papilloma, so this is most likely a squamous papilloma (pending biopsy result).
Though plantar warts and nasal papillomas usually would be from different HPV types but it is possible to autoinnoculate through hands from plantar infection to nasal vestibule. This is a more logical route than plantar autoinnoculation leading to nasal papilloma.
HPV only infects keratinized epithelium whereas oesophagus lining is not keratinized. So orsophageal infection is not possible.
Mostly HPV types are site specific. Moreover a healthy host would be able to prevent dissemination.

Take care.
Let me know if you need any more assistance
Above answer was peer-reviewed by : Dr. Nagamani Ng
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