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Dr. Andrew Rynne

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Hi Dr. Kumar! Your were wonderful helping me in the

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Dr. Naveen Kumar

ENT Specialist

Practicing since :2001

Answered : 2408 Questions

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Posted on Wed, 23 Jan 2019 in General Health
Question: Hi Dr. Kumar! Your were wonderful helping me in the past with regard to a soft tissue nodule which showed up on a CT scan of my sinuses, the location of it was in my left nasal vestibule abutting the nasal septum and lateral wall. I’m attaching a copy of a pathology report for the biopsy of the mass. I just visited my ENT and scheduled surgery for him to remove the balance of the papilloma (which he indicated is quite small now). I inderstand that there are three types of Schneiderian papillomas...inverting, exophytic and oncocytic. My ENT told me that mine is not the inverting thpe...can you review the report and let me know which of the other types it is (along with any other words of wisdom and reassurance you can give me that this is nothing to be super concerned over...). I’m confused because the report seems to show both inward and outward growth, yet the ENT said it was not inverting. I guess I’m interested because I understand the are differences in terms of whether HPV is a causative factor, and also there are differences in the chances of the different types turning cancerous. Thank you!!
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Follow up: Dr. Naveen Kumar 0 minute later
Hi Dr. Kumar! Your were wonderful helping me in the past with regard to a soft tissue nodule which showed up on a CT scan of my sinuses, the location of it was in my left nasal vestibule abutting the nasal septum and lateral wall. I’m attaching a copy of a pathology report for the biopsy of the mass. I just visited my ENT and scheduled surgery for him to remove the balance of the papilloma (which he indicated is quite small now). I inderstand that there are three types of Schneiderian papillomas...inverting, exophytic and oncocytic. My ENT told me that mine is not the inverting thpe...can you review the report and let me know which of the other types it is (along with any other words of wisdom and reassurance you can give me that this is nothing to be super concerned over...). I’m confused because the report seems to show both inward and outward growth, yet the ENT said it was not inverting. I guess I’m interested because I understand the are differences in terms of whether HPV is a causative factor, and also there are differences in the chances of the different types turning cancerous. Thank you!!
doctor
Answered by Dr. Naveen Kumar 26 hours later
Brief Answer:
Presence of different variants, surgical excision would be wiser

Detailed Answer:
Hi

Thanks for posting the query. My sincere apologies for the delayed reply.

I have gone through the histopathology report thoroughly and my opinion is as below.

1. There has been mixed cellularity of the tissues examined associated with a low grade dysplasia. The dysplasia is due to the presence of abnormal cells, wherein, there are more immature cells and less mature cells belonging to the same epithelium.

2. As you have rightly pointed out that, there are two variants of papilloma seen in the histopathology. It would be wiser to get it excised completely, rather than waiting and watching.

3. Also, there is only mild dysplastic changes which is of low grade, the chances of papilloma turning out to become malignant is very remote. Once the lesion is excised completely, then, we would be able to confirm HPV.

Hope this answers your query; revert back to me for any follow up queries.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Naveen Kumar 0 minute later
Brief Answer:
Presence of different variants, surgical excision would be wiser

Detailed Answer:
Hi

Thanks for posting the query. My sincere apologies for the delayed reply.

I have gone through the histopathology report thoroughly and my opinion is as below.

1. There has been mixed cellularity of the tissues examined associated with a low grade dysplasia. The dysplasia is due to the presence of abnormal cells, wherein, there are more immature cells and less mature cells belonging to the same epithelium.

2. As you have rightly pointed out that, there are two variants of papilloma seen in the histopathology. It would be wiser to get it excised completely, rather than waiting and watching.

3. Also, there is only mild dysplastic changes which is of low grade, the chances of papilloma turning out to become malignant is very remote. Once the lesion is excised completely, then, we would be able to confirm HPV.

Hope this answers your query; revert back to me for any follow up queries.

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Naveen Kumar 23 minutes later
Oh Dr. XXXXXXX ..thank you so very very much for your expertise and reassurances! You are always so wonderful!! You indicated that there are two variants of papilloma seen in the pathology report...can you tell me which two it appears to be...the inverted type and exophytic? Again, I suppose it doesn’t necessarily matter as my surgeon will ideally remove it in its entirety, but I googled the various types of schneiderian papilloma and now I’m curious, as the possible causes and odds of malignant transformation differ between the types, as I understand.

And two last questions (I promise!): would you say this papilloma is just a random occurrence in my body and I don’t necessarily need to worry about developing more? And would you say I shouldn’t worry too much about this, as my surgeon will ideally remove all of it and monitor me for reoccurrence?

Thank you again immensely!!
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Follow up: Dr. Naveen Kumar 0 minute later
Oh Dr. XXXXXXX ..thank you so very very much for your expertise and reassurances! You are always so wonderful!! You indicated that there are two variants of papilloma seen in the pathology report...can you tell me which two it appears to be...the inverted type and exophytic? Again, I suppose it doesn’t necessarily matter as my surgeon will ideally remove it in its entirety, but I googled the various types of schneiderian papilloma and now I’m curious, as the possible causes and odds of malignant transformation differ between the types, as I understand.

And two last questions (I promise!): would you say this papilloma is just a random occurrence in my body and I don’t necessarily need to worry about developing more? And would you say I shouldn’t worry too much about this, as my surgeon will ideally remove all of it and monitor me for reoccurrence?

Thank you again immensely!!
doctor
Answered by Dr. Naveen Kumar 14 hours later
Brief Answer:
The chances of this lesion turning out to become malignant is almost nil

Detailed Answer:
Hi

Welcome back

1. can you tell me which two it appears to be...the inverted type and exophytic?
A: The biopsied lesion has both the elements of inverted and exophytic variants. Due to the presence of an inverted papilloma variant, there are minor dysplastic changes. Hence, I opined that it would be wiser for us to remove the lesion in total. If the papilloma were to be of the single variant such as the exophytic type, then, I would have recommended you to wait and watch.

The transformation of sinonasal papillomas into malignancy has been described with Inverted Papilloma and Oncocytic papillomas involving the sinuses, but not in Exophytic papillomas of the septum.

2. would you say this papilloma is just a random occurrence in my body and I don’t necessarily need to worry about developing more?
A: The mere presence of HPV may not be enough to support the viral etiology of these papillomas. Chronic inflammation and Chronic sinusitis have also been hypothesized as a precursor for the development of sinonasal papillomas. Hence, it could be a random occurrence in the nose and not related to any other papillomatous lesions in the body.

3. And would you say I shouldn’t worry too much about this, as my surgeon will ideally remove all of it and monitor me for reoccurrence?
A: Yes, removal of the lesion in total would get rid of you from this problem. And, the recurrence rate following the removal of this lesion is almost nil. Hence, do not worry about this issue. Be cheerful...

I wish you good health

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Naveen Kumar 0 minute later
Brief Answer:
The chances of this lesion turning out to become malignant is almost nil

Detailed Answer:
Hi

Welcome back

1. can you tell me which two it appears to be...the inverted type and exophytic?
A: The biopsied lesion has both the elements of inverted and exophytic variants. Due to the presence of an inverted papilloma variant, there are minor dysplastic changes. Hence, I opined that it would be wiser for us to remove the lesion in total. If the papilloma were to be of the single variant such as the exophytic type, then, I would have recommended you to wait and watch.

The transformation of sinonasal papillomas into malignancy has been described with Inverted Papilloma and Oncocytic papillomas involving the sinuses, but not in Exophytic papillomas of the septum.

2. would you say this papilloma is just a random occurrence in my body and I don’t necessarily need to worry about developing more?
A: The mere presence of HPV may not be enough to support the viral etiology of these papillomas. Chronic inflammation and Chronic sinusitis have also been hypothesized as a precursor for the development of sinonasal papillomas. Hence, it could be a random occurrence in the nose and not related to any other papillomatous lesions in the body.

3. And would you say I shouldn’t worry too much about this, as my surgeon will ideally remove all of it and monitor me for reoccurrence?
A: Yes, removal of the lesion in total would get rid of you from this problem. And, the recurrence rate following the removal of this lesion is almost nil. Hence, do not worry about this issue. Be cheerful...

I wish you good health

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Naveen Kumar 7 minutes later
Dr. XXXXXXX ..I’ve said it before, and I’ll say it again...you are truly a godsend and a wonderful and compassionate doctor! Words cannot express how grateful I am to you for explaining and clarifying my doubts and worries over this issue. Many, many thanks to you Dr. XXXXXXX ..you are the best!! Sending you a virtual hug from the other side of the globe!!
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Follow up: Dr. Naveen Kumar 0 minute later
Dr. XXXXXXX ..I’ve said it before, and I’ll say it again...you are truly a godsend and a wonderful and compassionate doctor! Words cannot express how grateful I am to you for explaining and clarifying my doubts and worries over this issue. Many, many thanks to you Dr. XXXXXXX ..you are the best!! Sending you a virtual hug from the other side of the globe!!
doctor
Answered by Dr. Naveen Kumar 1 hour later
Brief Answer:
Wish you good XXXXXXX

Detailed Answer:
Hi

May the prayers and blessings of good health make you strong and healthy. God bless you.

warm regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Naveen Kumar 0 minute later
Brief Answer:
Wish you good XXXXXXX

Detailed Answer:
Hi

May the prayers and blessings of good health make you strong and healthy. God bless you.

warm regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by : Dr. Prasad
doctor
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