Concomitant inverted papilloma and fungus ball in unilateral maxillary sinus

Concomitant inverted papilloma and fungus ball in unilateral maxillary sinus. Problem: The concomitant appearance of an inverted papilloma and a fungus ball in unilateral maxillary sinus is rare. These disease entities may be difficult to distinguish before surgery. Methodology: A male patient presented with the characteristic symptoms of chronic rhinosinusitis. A preoperative sinus computed tomography scan revealed unilateral sinus opacification, hyperdense calcified spots, and bony erosion of the medial maxillary sinus wall. Results: During the operation, a cheesy, clay-like fungus ball was removed. In addition, a papillary appearance of the sinus mucosa led to the suspicion of inverted papilloma behind the fungus ball and nasal polyps. The histopathology showed an inverted papilloma concomitant with a fungal ball and some inflammatory polyps. Conclusion: In addition to preoperative imaging, one should be aware of the potential etiology; careful intraoperative reevaluation is imperative for clinicians to avoid misdiagnosis and to provide adequate management of the underlying disease.