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Viitasalo S, Ilmarinen T, Aaltonen LM, Hagström J, Hytönen M, Hammarén-Malmi S, Pietarinen P, Järvenpää P, Kinnari T, Geneid A, Lilja M. Sinonasal inverted papilloma - malignant transformation and non-sinonasal malignancies. Laryngoscope 2023; 133:506-511. [PMID: 35383941 DOI: 10.1002/lary.30128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To assess malignant transformation rate, non-sinonasal malignancies, and factors contributing to recurrence in patients treated for sinonasal inverted papilloma (SNIP). STUDY DESIGN Retrospective study. METHODS We retrospectively reviewed medical records of all patients treated for SNIP (n = 296) between the years 1984-2014 at Helsinki University Hospital. Data from the Finnish Cancer Registry confirmed the number of those patients with sinonasal and non-sinonasal malignancies. RESULTS Only 2 of 296 (0.7%) patients primarily diagnosed with benign SNIP developed sinonasal cancer in a mean follow-up of 5.8 years. The most common non-sinonasal cancer sites were similar to those reported for the whole Finnish population. None of the patients presented with an HPV-associated non-sinonasal malignancy. The recurrence rate among patients who underwent attachment-oriented surgery was significantly lower compared to those operated on with other approaches (40.2% vs. 56.6%, p = 0.006). Dysplasia in SNIP was associated with a higher recurrence rate (p < 0.001). CONCLUSIONS Malignant transformation of SNIP was rare. Patients with SNIP were not prone to HPV-associated non-sinonasal malignancies. Endoscopic resection and attachment-oriented surgery have become predominant approaches in the treatment of SNIP; meanwhile, the total number of SNIP recurrences has decreased. LEVEL OF EVIDENCE 3 Laryngoscope, 133:506-511, 2023.
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Affiliation(s)
- Sanna Viitasalo
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taru Ilmarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagström
- Department of Pathology, Helsinki University Hospital, Helsinki, Finland.,Department of Oral Pathology and Radiology, University of Turku, Turku, Finland
| | - Maija Hytönen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sari Hammarén-Malmi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petra Pietarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pia Järvenpää
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Kinnari
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ahmed Geneid
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markus Lilja
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Birkenbeuel JL, Pang JC, Lee A, Nguyen ES, Risbud A, Goshtasbi K, Abiri A, Lehrich BM, Tong CCL, Adappa ND, Palmer JN, Kuan EC. Long-term outcomes in sinonasal squamous cell carcinoma arising from inverted papilloma: Systematic review. Head Neck 2022; 44:1014-1029. [PMID: 35141984 DOI: 10.1002/hed.26995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/03/2021] [Accepted: 01/24/2022] [Indexed: 12/30/2022] Open
Abstract
Long-term survival and recurrence patterns of squamous cell carcinoma arising from inverted papilloma (IP-SCC) have not been thoroughly investigated. Four electronic databases were searched and primary studies describing overall survival (OS), recurrence, and mean time to recurrence of patients with IP-SCC were included for review. Our search yielded 662 studies. The 28 studies selected for inclusion identified 663 patients with IP-SCC. In 596 patients with reported T classification, 439 (73.7%) were T3/T4 on presentation. Of the 650 participants with recurrence data (local, regional, and distant), 155 (23.8%) experienced a recurrence, with an aggregate mean time-to-recurrence of 24.3 months. In 565 patients with 5-year OS rates, the aggregate 5-year OS was 62%. Based on the literature to date, IP-SCC is associated with a 5-year OS rate of 62%. 23.8% of patients experienced recurrence at a mean time of 24.3 months, suggesting the need for long-term surveillance.
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Affiliation(s)
- Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Jonathan C Pang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Ariel Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Emily S Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Adwight Risbud
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Brandon M Lehrich
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Charles C L Tong
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James N Palmer
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
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Wang J, Ford J, Esmaeli B, Langer P, Esmaili N, Griepentrog GJ, Couch SM, Nguyen J, Gold KG, Duerksen K, Burkat CN, Hartstein ME, Gandhi P, Sobel RK, Moon JY, Barmettler A. Inverted Papilloma of the Orbit and Nasolacrimal System. Ophthalmic Plast Reconstr Surg 2021; 37:161-167. [PMID: 32501879 DOI: 10.1097/iop.0000000000001719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Periocular inverted papilloma (IP) is a rare, locally aggressive tumor with a propensity for recurrence and malignant transformation. Historically treated via wide excision, this study examines the characteristics and management of periocular IP, comparing those confined to the nasolacrimal system with those invading the orbit. METHODS An Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant retrospective, comparative case series was conducted in patients with IP of the orbit or nasolacrimal system across 15 clinical sites. RESULTS Of 25 patients, 22 met inclusion criteria with 9 limited to the nasolacrimal system and 13 invading the orbit. Mean age was 60.4 years, 55% were women, all were unilateral. Mean follow-up was 48 months. Rates of smoking, dust and/or aerosol exposure, human papillomavirus (HPV) status, and inflammatory polyps were elevated compared to rates in the general population (45%, 18%, 18%, and 14%, respectively). Bony erosion on computed tomography scans was statistically significantly associated with orbit-invading IP (p = 0.002). Treatment involved all confined IP undergoing surgery alone while 39% of orbit-invading IP also received radiation therapy and/or chemotherapy (p = 0.054). Orbit-invading IP was more likely to be excised with wide margins than IP confined to the nasolacrimal system (85% vs. 22%, p = 0.007). Overall rates of malignancy, recurrence, and patient mortality from IP were found to be 27%, 23%, and 9%, respectively. CONCLUSIONS IP invading the orbit typically requires aggressive therapy, while IP confined to the nasolacrimal system may be treated more conservatively. Using risk factors, characteristics, and outcomes, a treatment algorithm was created to guide management.
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Affiliation(s)
- Jessie Wang
- Montefiore Medical Center, Department of Ophthalmology & Visual Sciences, Albert Einstein College of Medicine, Bronx, New York
| | | | | | - Paul Langer
- New Jersey Medical School, Newark, New Jersey
| | - Neda Esmaili
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Steven M Couch
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - John Nguyen
- West Virginia University, Morgantown, West Virginia
| | | | | | - Cat N Burkat
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Morris E Hartstein
- Shamir Medical Center, Sackler School of Medicine, Be'er Ya'akov, Israel
| | | | - Rachel K Sobel
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jee-Young Moon
- Montefiore Medical Center, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Anne Barmettler
- Montefiore Medical Center, Department of Ophthalmology & Visual Sciences, Albert Einstein College of Medicine, Bronx, New York
- William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, U.S.A
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Long C, Jabarin B, Harvey A, Ham J, Javer A, Janjua A, Thamboo A. Clinical evidence based review and systematic scientific review in the identification of malignant transformation of inverted papilloma. J Otolaryngol Head Neck Surg 2020; 49:25. [PMID: 32354352 PMCID: PMC7193386 DOI: 10.1186/s40463-020-00420-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background Inverted papilloma (IP) is an unusual type of benign tumor that has high recurrence rates and the potential to transform into squamous cell carcinomas (SCC). The mechanism of the transformation process from IP to IP-SCC is uncertain and there is no consensus regarding the best practice for IP-SCC detection. The goal of this study is to identify the best clinical methods to detect for IP-SCC. Methods An evidence-based review was performed using Medline and Ovid to obtain all articles up to October 10th, 2019 pertaining to identification of IP malignant transformation. All manuscripts discussing clinical methods or biomarkers were included. Results Based on clinical research studies, convoluted cerebriform pattern and apparent diffusion coefficient values on Magnetic Resonance Imaging (MRI) can help differentiate benign IP from SCC and increased SUVmax on PET/CT is associated with higher probability of malignancy although not as specific. No consensus about the best biomarker for IP-SCC has been reached among researchers and continues to be exploratory. Conclusion Endoscopy with biopsy is the gold standard practice to identify IP-SCC; however, MRI is the preferred imaging modality to recognize malignant transformation in cases where biopsy is difficult. Multiple biomarkers have shown positive results, but no single indicator with clinical significance for monitoring malignant transformation process has been found.
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Affiliation(s)
- Cai Long
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Basel Jabarin
- St Paul's Sinus Centre, University of British Columbia, Vancouver, BC, Canada
| | - Alexandra Harvey
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jennifer Ham
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Amin Javer
- St Paul's Sinus Centre, University of British Columbia, Vancouver, BC, Canada
| | - Arif Janjua
- St Paul's Sinus Centre, University of British Columbia, Vancouver, BC, Canada
| | - Andrew Thamboo
- St Paul's Sinus Centre, University of British Columbia, Vancouver, BC, Canada.
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Goudakos JK, Blioskas S, Nikolaou A, Vlachtsis K, Karkos P, Markou KD. Endoscopic Resection of Sinonasal Inverted Papilloma: Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2018; 32:167-174. [PMID: 29649889 DOI: 10.1177/1945892418765004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Pure endoscopic surgery (functional endoscopic sinus surgery) has been increasingly replacing external approaches in the management of sinonasal inverted papillomas. Objective To analyze and compare the effectiveness of pure endoscopic procedure with external or combined procedures to paranasal inverted papillomas, including the experience from two institutions in North Greece, over a 20-year period. Methods Systematic literature searches of MEDLINE (1952-2016), EMBASE (1974-2016), and the Cochrane Central Register of Controlled Trials. Review of all English-language studies comparing endoscopic and open techniques. Odds ratios (ORs), risk ratio, 95% confidence intervals (CIs), and tests for heterogeneity were reported. Recurrence rates according to initial tumor stage. Results In total, 2451 patients had been enrolled in the 23 studies, published between 1992 and 2014. All the included articles are graded as level IV evidence. Among the 1526 patients of the endoscopic group, 212 (13.8%) had recurrence, with the mean time of recurrence to range from 14 to 46.6 months. In the external approach group, 111 (18.7%) of the 592 patients had recurrence, with the time of recurrence to range from 7 to 92 months. The recurrence rate in the combined approach group was 12.9%. The occurrence rate of recurrence attributable to the surgical choice was significantly different between endoscopic and external group (OR: 0.61; 95% CI: 0.40-0.92; P = 0.02; 14.9% vs. 18.8% in endoscopic and external group, respectively). Conclusions The present systematic review and meta-analysis indicates that endoscopic approach seems a favorable treatment option of sinonasal inverted papillomas and confirms the global recommendation that is the gold standard in the treatment of such nose lesions, revealing a lower recurrence rate compared to external approaches.
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Affiliation(s)
- John K Goudakos
- 1 ENT Department, St Mary's Hospital, Imperial College, London, UK
- 2 2nd Department of Otorhinolaryngology-Head and Neck Surgery, Papageorgiou University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sarantis Blioskas
- 2 2nd Department of Otorhinolaryngology-Head and Neck Surgery, Papageorgiou University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angelos Nikolaou
- 3 Department of Otorhinolaryngology-Head and Neck Surgery, Papanikolaou General Hospital, Thessaloniki, Greece
| | - Konstantinos Vlachtsis
- 3 Department of Otorhinolaryngology-Head and Neck Surgery, Papanikolaou General Hospital, Thessaloniki, Greece
| | - Peter Karkos
- 4 1st Department of Otorhinolaryngology-Head and Neck Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos D Markou
- 2 2nd Department of Otorhinolaryngology-Head and Neck Surgery, Papageorgiou University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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The clinical behavior of sinonasal inverted papilloma with cellular dysplasia: case series and review of the literature. Eur Arch Otorhinolaryngol 2017; 274:3375-3382. [PMID: 28597339 DOI: 10.1007/s00405-017-4629-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/31/2017] [Indexed: 12/18/2022]
Abstract
The prognosis and recurrence rate of inverted papilloma (IP) with concomitant cellular dysplasia are not well-delineated. Demographic, clinical and imaging data of all patients who were surgically treated for sinonasal inverted papilloma (SNIP) in our center between 1996 and 2013 were reviewed. Data regarding the coexistence of dysplastic changes or malignancy within the resected tissues were also retrieved. After the exclusion of malignant cases and patients who were lost for follow-up, 92 patients were included in the study. Five patients had coexisting cellular dysplasia (4.7%), four of them had severe dysplasia and one had mild-to-moderate dysplasia. All four cases with severe dysplasia recurred, three were primarily treated endoscopically and one by external approach. Only the case with mild to moderate dysplasia which had been treated by subcranial approach did not recur. Patients with dysplasia had significantly higher recurrence rate than patients without dysplasia (80 vs. 14%, p = 0.019). This significant relation between histology and recurrence remained even after adjustment to tumor extent. The adjusted odd ratio of dysplasia (dysplasia vs. no dysplasia) is 9.7, p = 0.043. SNIP with dysplasia should be treated aggressively and followed closely. The histopathologic investigation of SNIP specimens should always note the presence of dysplasia and its severity. Further investigation on the clinical behavior of SNIP with dysplasia is needed. Multicenter studies are warranted due to the rarity of dysplastic SNIP.
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Sun Q, An L, Zheng J, Zhu D. Advances in recurrence and malignant transformation of sinonasal inverted papillomas. Oncol Lett 2017; 13:4585-4592. [PMID: 28599459 DOI: 10.3892/ol.2017.6089] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 01/26/2017] [Indexed: 01/06/2023] Open
Abstract
Sinonasal inverted papilloma (SIP) is a benign tumor of the nasal cavity and sinus. SIP is characterized by aggressive malignant transformation and a high rate of recurrence. Inadequate removal of the tumor during surgery is one of the most significant contributors to SIP recurrence. A growing body of evidence suggests that molecular alteration in SIP, including human papilloma virus infections, single nucleotide polymorphisms of key genes, deregulation of signaling pathways and immunological changes, may lead to SIP occurrence and malignant transformation. However, the extent to which these molecular mechanisms contribute to SIP pathology and transformation remains unclear due to limited research. Further studies are warranted to elucidate the primary dependent factors that contribute to SIP etiology. The present article reviewed risk factors of progression and recurrence of SIP, including outdoor and industrial occupational exposure, smoking, septal deviation, SIP location, recurrent cases, stage of SIP-associated squamous cell carcinoma and choice of surgical method.
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Affiliation(s)
- Qingjia Sun
- Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Lifeng An
- Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Jun Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Dongdong Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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