Fungiform papillomas are benign mucosal neoplasms presenting as a unilateral exophytic mass involving the anterior portion of the nasal septum. In this study, we present an exceptional case of a bilateral fungiform papilloma with a synchronous verrucous carcinoma of the nasal septum.

A case study with a review of the literature concerning malignant changes in fungiform papilloma.

The general consensus in most of the literature is that malignant change in fungiform papilloma is exceptional. Our patient is probably the third reported case of verrucous carcinoma of the nasal septum, and the first report of a bilateral fungiform papilloma with a synchronous verrucous carcinoma. The tumour was subjected to complete surgical removal in the first instance. There was no recurrence at follow up seven months after surgery.

Although fungiform papillomas are generally not premalignant, occasional malignant transformation may occur. Thus, they must be managed with the utmost cautiousness.

Verrucous carcinoma occurs infrequently in the vocal folds. This tumour has an excellent prognosis with proper treatment. Management strategies include surgery, radiotherapy or both.

To evaluate the long-term results of type I and II laser cordectomy for the treatment of verrucous carcinoma of the vocal folds.

We reviewed the files of 18 patients with verrucous carcinoma of the vocal folds treated by type I or II laser cordectomy in our department from 1989 to 2006, and recorded clinical and outcome data.

None of the patients had any major post-operative complications. All had a subjectively satisfactory quality of voice, with no morbidity. Patient follow up ranged from three to 228 months (mean, 48 months). Five patients were treated with post-operative radiotherapy for persistent disease, of whom four underwent repeated surgery due to recurrence.

Type I or II laser cordectomy is a safe, feasible, secure method of treating verrucous carcinoma of the vocal folds. There were no major complications in our patient series. Most recurrent disease was manageable locally with repeated surgery.

Verrucous carcinoma is a variant of well differentiated squamous cell carcinoma characterised by an exophytic, warty growth which is slowly but locally invasive and which can cause extensive local destruction if left untreated.

We report the first known case of veruccous carcinoma of the paranasal sinuses with rapid orbital invasion. A 58-year-old man presented with right-sided nasal obstruction, a huge right intranasal lesion, intractable dacryocystitis and cutaneous involvement of the nasolacrimal sac region. The tumour was partially removed using an endoscopic transnasal approach. Post-operatively, and while waiting for the histological result, the patient developed signs of rapid invasion of the orbit, with uniocular visual acuity deficit. He underwent combined radiochemotherapy, with a moderate response.

Knowledge of the potentially aggressive nature of verrucous carcinoma may be helpful in early management of intraorbital invasion and salvaging of the eye.