Given histological features of inverted papilloma and comparatively low detection rates of HPV in inverted papilloma without dysplasia (2.7%), as well as the summary of the world literature, HPV is not related to the initial pathogenesis of inverted papilloma or inverted papilloma's tendency to persist or recur. It is postulated that since inverted papilloma is more an inflammatory polyp, it is susceptible to secondary HPV infection because of its metaplasia. Tobacco and other causes of respiratory epithelium remodeling are more plausible explanations for the initial tissue transformation to inverted papilloma.

A 63-year-old white man had a history of recurrent pneumonia, pancytopenia, and splenomegaly when the diagnosis of hairy cell leukemia was made on bone marrow biopsy examination. Splenectomy confirmed that diagnosis and his pancytopenia moderately improved. Three years following the diagnosis, the patient developed an upper abdominal mass involving the stomach wall that was found to be an anaplastic "large cell" neoplasm. Palliative radiotherapy was started, but the patient died 2 months later. Cytochemical studies of the anaplastic gastric neoplasm revealed cytoplasmic tartrate resistant acid phosphatase activity. Electron microscopy showed no epithelial differentiation. These observations suggest that the gastric neoplasm represented an evolution of hairy cell leukemia into a more aggressive tumor analogous to the transformation that occurs in other B-cell neoplasms.

A man in his 20s presented to a tertiary rhinology center in southwestern Florida with a 3-month history of progressive left nasal obstruction and intermittent epistaxis. Two years previously, the man had similar presenting symptoms at an outside facility and was treated with surgery to excise a sinonasal mass. He did not have any visual changes, pain, or purulent nasal discharge. He reported no olfactory impairment. He was originally from Bangladesh but had moved to the United States 6 years earlier. In-office flexible fiberoptic nasal endoscopy revealed a soft, friable polypoid mass with a strawberry-like appearance originating from the lateral nasal wall and filling the left nasal cavity (Figure, A). Computed tomography of the sinuses revealed a left nasal cavity mass without bony destruction or paranasal sinus involvement (Figure, B). The patient underwent endoscopic sinus surgery on the left side, where complete surgical excision of the mass was performed along with electrocautery of attachment sites. The mass was found to have multiple attachments surrounding the maxillary sinus ostium and mucosa overlying the lacrimal bone. Pathologic evaluation revealed squamoid-type mucosa with large, thick-walled sporangia with numerous endospores. Also present was an exuberant mixed inflammatory infiltrate consisting of polymorphonuclear leukocytes, plasma cells, and lymphocytes (Figure, B and C).