CT and MR Findings of the Inverted Papilloma

PURPOSE: The purpose of this study is to describe the CT and MR findings of inverted papilloma and to determine the specific differential finding between inverted papilloma with and without coexisting malignancy. MATERIALS AND METHODS: Twenty-two histopathologically proven inverted papillomas were included in this study; in six patients there was coexisting malignancy. Twenty-two CT images and eight MR images were retrospectively reviewed. RESULTS: On CT images, the inverted papillomas were seen as unilateral sinonasal masses with bone remodeling (n=15) rather than bone destruction (n=1) and showed iso- or slightly high attenvation. Three of the six malignant cases showed aggressive bone destruction and widespread extension into the orbit, intracranial and buccal spaces, and pterygopalatine fossa. On MR images, the inverted papillomas (n=3) were iso- (n=2) or slightly high (n=1) in signal intensity in relation to muscle on T1 weighted images, and high (n=3) on T2 weigihted images. Gadolinium enhanced images showed heterogenous moderate enhancement. In the cases of coexisting malignancy (n=5), the masses were iso- (n=5) on T1 weighted images, high (n=5) on T2 weighted images and also showed heterogenous moderate enhancement. CONCLUSION: Inverted papilloma should be considered in the differential diagnosis of a bulky unilateral nasal mass extending into the adjacent paranasal sinuses, especially in an elderly patient with chronic nasal obstruction. Although there were no specific differential findings in signal intensiy and enhancement pattern on CT and MR images between benign and malignant inverted papilloma, aggressive bone destruction and widespread extension beyond the sinonasal cavity are findings which are highly suggestive of coexisting malignancy.

Fixed Vocal Cord in Laryngeal Cancers: Mechanisms and Spiral CT Findings

PURPOSE: To analyze the causes of vocal cord fixation in laryngeal cancer and to demonstrate its spiral CT findings. MATERIALS AND METHODS: We retrospectively applied the five pathologic mechanisms of vocal cord fixationto spiral CT findings and evaluated mechanisms of fixed vocal cord in 16 patients with laryngeal cancer of T3 or more on staging. CT findings of another six patients (T2) showing one or more suspicious mechanisms of vocal cord fixation in conventional CT were compared with those of the 16 patients (T3 or more). RESULTS: In 16 patients with laryngeal cancer of T3 or more, the most common finding of vocal cord fixation was the complete replacement of the true vocal cord (including the thyroarytenoid and vocalis muscle) by the tumor and tumor invasion of the paralaryngeal space (n = 16). Other findings were tumor invasion and fixation of the cricoarytenoid joint (n = 9), interference with cord mobility by the bulky mass (n = 6), tumor invasion of the thyroid cartilage, with vocalcord fixation (n = 4) and subglottic tumor spread (n = 3). In another six patients (T2) with suspicious vocal cordfixation, conventional CT showed partial vocal cord invasion and intact or minimal invasion of the paralaryngeal space (n = 3), a bulky mass without vocal cord invasion (n = 1) and subglottic extension but movable vocal cord (n= 2). CONCLUSION: Although the cause of vocal cord fixation from laryngeal cancer may be due to one of five patterns of cancer spread, or to a combination of these, the most common spiral CT finding is complete replacement of true vocal cord by the cancer and tumor invasion of the paralaryngeal space. Accurate evaluation of vocal cord fixation and the extent of the tumor could be evaluated with spiral CT using the breathing technique.