Inverted papilloma of middle ear and temporal bone.
A fifty year old male presenting with right painless non fetid otorrhoea of several months onset and severe ipsilateral mixed hearing loss, with no other symptoms. His history included an operation for a right inverted nasosinusal papilloma 2 years earlier. Otoscopy showed a granuloma occluding the external auditory canal. A CT scan was requested (Fig. 1A and B) that revealed occupation of the mastoid, with destruction of the cell walls, the tegmen tympani and the ossicular chain. MRI was recommended (Fig. 1C, T2 weighted axial image and D, coronal FLAIR image) and reported a mass with poorly defined margins with areas of necrosis on the posterior superior slope with intracranial expansion to the temporal fossa and integrity of the dura mater. A subtotal petrosectomy was performed, obtaining various samples that were cystic, granulous and brown in appearance. The histological study (Fig. 2) showed a proliferation of epithelial squamous cells with no atypias, monomorphic, arranged in papillary formation with expansive growth towards the stroma, with a diagnosis of inverted