Increased expression of the cell adhesion molecule, CD44 standard form (CD44s), has been associated with papillary epithelial tumors, and decreased expression has been linked to tumor invasion and metastasis. Sinonasal inverted papillomas (SIPs) are the most common papillary tumors of the sinonasal tract. This study tests whether the development of squamous cell carcinoma (SCO in situ and invasive SCC in SIP is associated with altered expression of CD44s.Seventy-six specimens of SIP from 68 patients, 2 specimens of SIP with focal SCC in situ, and 10 specimens of invasive SCC arising in SIP were studied. Automated immunohistochemistry was performed for CD44s expression on paraffin-embedded tissue sections using mouse antihuman CD44 antibody.All 76 SIPs (100%) expressed CD44 (strong membranous staining, 83%; moderate staining, 12%; weak staining, 5%). TwoThe inverted papilloma is the most frequent benign mucosal neoplasm of the sinonasal tract.1-7 Sinonasal inverted papillomas (SIPs) are derived from the Schneiderian epithelium and occur most frequently during the fourth and fifth decades of life, with a male/female incidence ratio of 2:1.1 _ 6 Most commonly, SIP manifests as a unilateral nasal obstruction and features multiple mucosal sites of origin, reflecting a diffuse polypoid change of the nasal and paranasal sinus mucosa.6 Histologic features of SIP include squamous metaplasia of surface gland ducts and, frequently, branching gland ducts; stromal edema with infiltrates of lymphocytes, eosinophils, plasma cells, and m a c r o p h a g e s ; and n u m e r o u s macrophage-rich microcysts containing fragments of degenerated nuclear material.6 Although histologically benign, SIP features a substantial rate of recurrence after initial resection, which has varied from 33% to 74% in the published literature. [1][2][3][4][5][6] Squamous cell carcinoma (SCC) has been frequently associated with SIP since the first description by Hapman and Billroth in 1883/ Squamous cell carcinoma may be identified in the original excision of SIP or develop months or years after the first SIP excision, with roughly equal frequency. In published studies, the incidence of SCC associated with SIP has varied substantially. Woodson and c o w o r k e r s 8 reported an incidence of less than 2% of SCCs arising in SIP; Phillips and coworkers 9 reported a 7% incidence in 112 patients; and Bielamowicz et al 10 more recently reported a 17% cancer incidence in SIP.Cell adhesion molecules have been studied in a variety of papillary and nonpapillary epithelial neoplasms. CD44 is a polymorphic integral glycosylated cartilage link protein associated with cell matrix adhesion, lymphocyte activation and recirculation, and cell 309