Nasal polyps and epithelial papillomas of the sinonasal tract often manifest similar clinical signs and symptoms. The similarity ends, however, when one considers their disparate biologic behavior. Polyps are associated with atopy, infection, and some metabolic, systemic disorders, whereas papillomas are enigmatic in pathogenesis and do not have an association with possible precursor disorders. While recurrences of nasal polyps may be an annoyance for the patient, such recurrences lack the local aggressiveness of the papilloma. Malignancies are rare in nasal polyps, whereas the frequency of malignancies in papillomas is both statistically and biologically significant. In this report, selected aspects of nasal polyps are considered and serve to contrast with the clinicopathologic evaluation of epithelial papillomas.