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Exophytic sinonasal papilloma consists of finger-like growths of squamous epithelium lining delicate fibrovascular cores (a). The lining epithelium of exophytic sinonasal papilloma resembles that of inverted sinonasal papilloma (i.e., squamous with intraepithelial neutrophils) but also demonstrates koilocytic changes superficially. These cells are typically positive for low-risk HPV types by in situ hybridization (inset) (b)
