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Sheth RK, Choudhary DA, Vishnurag A, Thomas I, Pandey R, Arvind I. Unusual Locations of Inverted Papilloma. Indian J Otolaryngol Head Neck Surg 2024; 76:2057-2061. [PMID: 38566729 PMCID: PMC10982235 DOI: 10.1007/s12070-023-04398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/22/2023] [Indexed: 04/04/2024] Open
Abstract
Inverted papilloma is a tumor found involving the nasal cavity and paranasal sinuses. They are not cancerous but can be locally aggressive. They are most commonly seen involving the lateral wall of nose and maxillary sinus. When the tumor involves the frontal sinus and sphenoid sinus or the post ethmoid cells it presents a surgical challenge. Inverted papilloma almost always occur unilateraly and affect mainly the maxillary sinus. Inverted papilloma arising from the sphenoid and frontal sinuses are rare. Here we present two cases; one involving a 60 year man, with inverted papilloma originating from the frontal sinus and another case where it originated from the sphenoid sinus anterior wall and posterior ethmoidalcell (Onodi cell) and was resected endoscopically.
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Affiliation(s)
- Ritu K. Sheth
- Department of ENT, Seth V C Gandhi and M A Vora Muncipal General Hospital, Rajawadi, Mumbai India
| | - Deepika A. Choudhary
- Department of ENT, Seth V C Gandhi and M A Vora Muncipal General Hospital, Rajawadi, Mumbai India
| | - Athira Vishnurag
- Department of ENT, Seth V C Gandhi and M A Vora Muncipal General Hospital, Rajawadi, Mumbai India
| | - Irine Thomas
- Department of ENT, Seth V C Gandhi and M A Vora Muncipal General Hospital, Rajawadi, Mumbai India
| | - Roop Pandey
- Department of ENT, Seth V C Gandhi and M A Vora Muncipal General Hospital, Rajawadi, Mumbai India
| | - Isha Arvind
- Department of ENT, Seth V C Gandhi and M A Vora Muncipal General Hospital, Rajawadi, Mumbai India
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Rozendorn N, Yakirevitch A, Glikson E, Landsberg R, Ritter A, Mozzanica F, Schneider S, Soudry E. The implications of concomitant mucosal inflammation on clinical manifestations and outcomes of sinonasal inverted papilloma. Eur Arch Otorhinolaryngol 2023; 280:4963-4968. [PMID: 37452833 DOI: 10.1007/s00405-023-08088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE This study examines the impact of concomitant mucosal inflammation on clinical manifestations and long-term outcomes of Inverted Papilloma (IP). METHODS This retrospective cohort study was conducted in five tertiary medical centers. The included patients underwent an attachment-oriented surgical resection for IP with a minimum follow-up of 3 years. RESULTS Of 185 patients with IP, 65 patients (35.1%) had synchronous mucosal inflammation with polypoid changes. The mean age was 56.7 years, and 69% were males. Most tumors originated from the maxillary sinus. Age, gender, Krouse stage, and tumor attachment site did not differ between the mucosal inflammation and IP-only groups. IP recurrence rate was twofold in the patients with mucosal inflammation (15.4% vs. 7.5%, p = 0.092). However, the difference was not significant, with a similar median time to recurrence between the two groups [15.5 (3-36) months vs. 16(6-96) months, p = 0.712]. In revision cases, IP recurred only in patients with mucosal inflammation (19% vs. 0%, p = 0.07). This group had a significantly worse 5-years recurrence-free survival than revision cases without mucosal inflammation (80.6% vs. 100%, p = 0.04). CONCLUSIONS IP in the setting of mucosal inflammation might be associated with a higher recurrence rate, predominantly after revision surgery. Otolaryngologists should consider this during these patients' diagnosis, surgical planning, and follow-up.
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Affiliation(s)
- Noa Rozendorn
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.
| | - Arkadi Yakirevitch
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Glikson
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roee Landsberg
- ARM Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Amit Ritter
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Francesco Mozzanica
- Department of Otorhinolaryngology, Ospedale San Giuseppe IRCCS Multimedica, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Shay Schneider
- ARM Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Ethan Soudry
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
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Park MJ, Cho W, Kim JH, Chung YS, Jang YJ, Yu MS. Preoperative Prediction of Sinonasal Inverted Papilloma-associated Squamous Cell Carcinoma (IP-SCC). Laryngoscope 2023; 133:2502-2510. [PMID: 36683553 DOI: 10.1002/lary.30583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/28/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Sinonasal inverted papillomas (IP) can undergo transformation into IP-squamous cell carcinomas (IP-SCC). More aggressive treatment plan should be established when IP-SCC is suspected. Nevertheless, inaccuracy of the preoperative punch biopsy results to detect IP-SCC from IP raises the need for an additional strategy. The present study aimed to investigate significant clinicoradiological remarks associated with IP-SCC than IP. MATERIAL AND METHODS Postoperative surgical specimens obtained from patients with confirmed IP or IP-SCC at a single tertiary medical center from 1997 to 2018 were retrospectively evaluated. Patients' demographic and clinical characteristics, preoperative in-office punch biopsy results, and preoperative computed tomography (CT) or magnetic resonance images were reviewed. Univariate and multivariate analyses were performed to assess the odds ratio (OR) associated with IP-SCC. The area under the curve (AUC) in the receiver Operating Characteristic (ROC) curve was calculated in the prediction model to discriminate IP-SCC from IP. RESULTS The study included 44 IP-SCC and 301 patients with IP. The diagnostic sensitivity of in-office punch biopsy to detect IP-SCC was 70.7%. Multivariate analysis showed that factors significantly associated with IP-SCC included tobacco smoking >10PY (adjusted-OR [aOR]: 4.1), epistaxis (aOR: 3.4), facial pain (aOR: 4.2), bony destruction (aOR: 37.6), bony remodeling (aOR: 36.3), and invasion of adjacent structures (aOR: 31.6) (all p < 0.05). Combining all significantly related clinicoradiological features, the ability to discriminate IP-SCC from IP reached an AUC of 0.974. CONCLUSION IP patients with a history of tobacco smoking, facial pain, epistaxis, and bony destruction, remodeling, or invasion of an adjacent structure on preoperative images may be at higher risk for IP-SCC. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2502-2510, 2023.
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Affiliation(s)
- Marn Joon Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University Medical Center, Inha University School of Medicine, Incheon, South Korea
| | - Wonki Cho
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Heui Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoo-Sam Chung
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong Ju Jang
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myeong Sang Yu
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Cavada MN, Roshan DJ, Lodhia CA, Sacks R. The inverted papilloma arising from the cribriform plate of the ethmoid bone. ANZ J Surg 2023; 93:707-709. [PMID: 35801951 DOI: 10.1111/ans.17900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Marina Neves Cavada
- Department of Otolaryngology - Head and Neck Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David James Roshan
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Chetan Ashok Lodhia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Otolaryngology-Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Raymond Sacks
- Department of Otolaryngology - Head and Neck Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Otolaryngology, Concord General Hospital, Sydney, New South Wales, Australia
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Sterling BC, Mehrad M, Ely K, Lewis JS. CD163 Immunohistochemical "Circle Sign" Staining Pattern Differentiates Sinonasal Papillomas From Morphologically Similar Non-neoplastic Lesions. Am J Surg Pathol 2022; 46:1507-1513. [PMID: 35993580 PMCID: PMC9588669 DOI: 10.1097/pas.0000000000001953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sinonasal papillomas are a diverse group of benign epithelial neoplasms of the sinonasal tract. Inverted papilloma, in particular, must be distinguished from other lesions with no malignant potential. The aim of this study was to distinguish sinonasal papillomas from morphologically similar lesions using CD163 immunostaining. Cases from a 19-year period were identified. These included 49 inverted, 10 exophytic, and 12 oncocytic papillomas, 21 chronic sinusitides with squamous metaplasia, 27 inflammatory polyps, 5 verrucae vulgares, 5 respiratory epithelial adenomatoid hamartomas, and 6 DEK::AFF2 carcinomas of the sinonasal tract. A subset of biopsy cases (8 inverted papillomas, 5 inflammatory polyps) was separately analyzed. CD163 immunohistochemistry (IHC) was performed. A unique "circle" staining pattern was identified in the surface epithelium. After locating a hotspot, circles were quantified in 10 consecutive high-power fields. Circles were present in 66/71 (93%) cases of sinonasal papilloma, with a mean of 35 circles/10 HPF (range: 0 to 160/10 HPF) and a median of 19 circles/10 HPF. Circles were present in 20/58 (34%) non-neoplastic cases, with a mean of 2 circles/10 HPF (range: 0 to 27/10 HPF) and a median of 0. Considering all resection and biopsy cases, performance for distinguishing papillomas from non-neoplastic lesions was best at a cutoff of 10 circles/10 HPF (2-tailed P <0.0001) with sensitivity, specificity, positive predictive value, and negative predictive value of 66.2%, 93.1%, 92.1%, and 69.2%, respectively. The results were similar in the biopsy subset. One other neoplastic entity, the DEK::AFF2 carcinomas, also showed prominent CD163 circle staining. In summary, sinonasal papillomas demonstrate extensive CD163 "circle" staining in the epithelium compared with the non-neoplastic lesions studied. As such, the "circle sign" on CD163 IHC may be helpful in distinguishing between diagnoses, particularly on small biopsies or equivocal specimens.
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Affiliation(s)
- Brent C. Sterling
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Mitra Mehrad
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kim Ely
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - James S. Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
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Hou XY, Peng CR, Zhang GN, Wang DF. A Rare Case of Cervical Squamous Cell Carcinoma Concurrent with Sinonasal Inverted Papilloma: A Case Report. Int J Womens Health 2022; 14:1657-1666. [DOI: 10.2147/ijwh.s380385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/17/2022] [Indexed: 11/30/2022] Open
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Shukla A, Kumar B. A Study of Otorhinolaryngological Diseases with Ophthalmic Complications: At a Tertiary Care Center. Indian J Otolaryngol Head Neck Surg 2022; 74:1820-1825. [PMID: 36452530 PMCID: PMC9702250 DOI: 10.1007/s12070-020-01849-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022] Open
Abstract
The eyeball and the orbit are neighbours of the ENT region. This close proximity, makes the involvement of the orbit and there of ophthalmological manifestations fairly common in the practise of Otorhinolaryngology. This was a prospective study. All the patients presenting with ophthalmological manifestations due to various ear, nose, throat and head-neck pathologies were constituted in this study. This study was carried out on 50 patients of all age groups with ophthalmological complications along with ENT diseases who came to the department of ENT and head-neck surgery and department of Ophthalmology of N.S.C.B. Government Medical College, Jabalpur from August 2018 to August 2019. The diseases of ENT with orbital extension must be considered whenever a patient presents with signs and symptoms of orbital disease such as proptosis, orbital mass, restriction of eye movements, neurological dysfunction of eye, chemosis, vision disturbances or epiphora. A firmer knowledge of orbital anatomy with respect to sinonasal region is required for any surgeon dealing with this important area, for a safer and more secure management in this complex region. Surgery remains the main stay of treatment for sinonasal diseases with orbital complications. Rapid diagnosis and treatment are of utmost importance in preserving vision and life in these patients.
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Affiliation(s)
- Anirudh Shukla
- Department of ENT and Head–Neck Surgery, N.S.C.B. Medical College, Jabalpur, MP India
| | - Brijesh Kumar
- Department of ENT and Head–Neck Surgery, N.S.C.B. Medical College, Jabalpur, MP India
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Comparison of MRI and CT in the Evaluation of Unilateral Maxillary Sinus Opacification. Radiol Res Pract 2021; 2021:5313196. [PMID: 34306753 PMCID: PMC8285193 DOI: 10.1155/2021/5313196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives To evaluate the diagnostic performance of MRI compared with CT in differentiating neoplastic from infectious/inflammatory causes of complete unilateral maxillary sinus opacification (UMSO). Although MRI is increasingly used, no studies validate its utility compared to CT or nasal endoscopy in this context. Methods A retrospective analysis of 49 patients presenting with complete UMSO to a tertiary referral centre was performed, investigated with both CT and MRI. Two head and neck radiologists independently reviewed each imaging modality and recorded both a final diagnosis and Likert-scale diagnostic certainty score. A consensus radiological diagnosis was determined, stratified into potentially neoplastic or infectious/inflammatory aetiology, and compared with nasal endoscopy and final diagnosis. Diagnostic performance and interoperator agreement for predicting neoplasia were calculated. Results Both CT and MRI demonstrated high sensitivity and negative predictive value for neoplasm, although MRI was more specific (79%; 95% CI: 60–92%) than CT (14%; 95% CI: 4–32%), with a higher positive predictive value. MRI was more accurate (88%; 95% CI: 75–95%) than CT (49%; 95% CI: 34–64%) in diagnosing neoplasia. MRI had significantly higher diagnostic certainty Likert scores than CT (p < 0.0001 for both observers). Interobserver agreement was fair for CT (kappa coefficient = 0.327) and excellent for MRI (kappa coefficient = 0.918). Conclusions MRI is more specific than CT in characterising UMSO, with greater diagnostic certainty and reproducibility. The additive diagnostic value of MRI complements CT, potentially reducing diagnostic delays in some cases and the need for diagnostic endoscopic sinus surgery in others. We recommend MRI incorporation into the diagnostic pathway for patients with UMSO.
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Biondi V, Passantino A, Pugliese M, Monti S, Sfacteria A, Di Pietro S. Conjunctival Inverted Papilloma Progressing to Carcinoma. First Report in Horse. Vet Sci 2021; 8:vetsci8060108. [PMID: 34200940 PMCID: PMC8230449 DOI: 10.3390/vetsci8060108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Abstract
A five-year-old, entire female Arabian horse with a 6-month history of a non-painful nodule on the conjunctiva of the right eye was evaluated. Ophthalmological examination showed a firm, smooth and fleshy conjunctival mass that raised the suspicion of a conjunctival neoplasm. Histological evaluations showed that the mass was composed of an endophytic growth consisting of numerous long papillary projections of hyperplastic stratified squamous epithelium supported by thin fibrovascular stalks. Typical features of squamous cell carcinoma with disorganized cell growth and infiltration of surrounding tissues were detectable within the mass. Inverted papilloma progressing to carcinoma was diagnosed. Follow-up examination showed that no local recurrence was present during the 12-month follow-up period. To the authors’ knowledge, this is the first report describing the inverted papilloma in the horse and, due to its progression to squamous cell carcinoma, warns about the inclusion of the inverted papilloma in the differential diagnosis of conjunctival neoplasm and driven treatments.
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Saab-Chalhoub MW, Guo X, Shi Q, Chernock RD, Lewis JS. Low Grade Papillary Sinonasal (Schneiderian) Carcinoma: A Series of Five Cases of a Unique Malignant Neoplasm with Comparison to Inverted Papilloma and Conventional Nonkeratinizing Squamous Cell Carcinoma. Head Neck Pathol 2021; 15:1221-1234. [PMID: 34041710 PMCID: PMC8633211 DOI: 10.1007/s12105-021-01335-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
There have been a few case reports and one small series of low grade papillary sinonasal (Schneiderian) carcinomas (LGPSC) which mimic papillomas but have overtly invasive growth and which occasionally metastasize. We describe the morphologic, clinical, immunohistochemical, and molecular features of five patients with LGPSC compared with eight cases each of inverted papilloma (IP) and conventional nonkeratinizing squamous cell carcinoma (SCC) with papillary growth. All LGPSC were nested with predominantly pushing invasion, no stromal reaction, and frequent surface papillary growth. All consisted of one cell type only, with polygonal cells with round nuclei, no (or limited) cytologic atypia, low mitotic activity, and prominent neutrophilic infiltrate. One patient had slightly more infiltrative bone invasion, another lymphovascular, perineural, and skeletal muscle invasion, and a third nodal metastasis after 17 years. By comparison, IPs had bland cytology, neutrophilic microabscesses, mixed immature squamous, goblet cell, and respiratory epithelium, and extremely low mitotic activity. Nonkeratinizing SCCs had basaloid-appearing cells with nuclear pleomorphism, brisk mitotic activity, and apoptosis. All LGPSC were p63 positive. Mitotic activity and Ki67 indices were significantly higher for LGPSCs than IPs and significantly lower than NKSCCs, while p53 immunohistochemistry in LGPSC was identical to nonkeratinizing SCC and higher than for IP. Sequencing showed all five tumors to harbor a MUC6 mutation, one tumor to harbor CDKN2A and PIK3R1 mutations, and one tumor to harbor a NOTCH1 mutation. All LGPSC lacked EGFR and KRAS mutations and lacked copy number variations of any main cancer genes. At a median follow up of 12 months, two LGPSC recurred locally, and one patient died after massive local recurrences and nodal metastases. LGPSC is a distinct, de novo sinonasal carcinoma that can be differentiated from papillomas by morphology and selected immunohistochemistry.
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Affiliation(s)
- Mario W. Saab-Chalhoub
- grid.412807.80000 0004 1936 9916Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Xingyi Guo
- grid.412807.80000 0004 1936 9916Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - Qiuying Shi
- grid.189967.80000 0001 0941 6502Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Rebecca D. Chernock
- grid.4367.60000 0001 2355 7002Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO USA
| | - James S. Lewis
- grid.412807.80000 0004 1936 9916Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN USA ,grid.412807.80000 0004 1936 9916Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN USA ,grid.412807.80000 0004 1936 9916Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 3020D Vanderbilt University Hospital, Nashville, TN 37232-7415 USA
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Eo TS, Kim EK, Kim JH, Shin HA. Inverted Papilloma of the Epiglottis: A Rare Case. EAR, NOSE & THROAT JOURNAL 2020; 101:114-116. [PMID: 32744900 DOI: 10.1177/0145561320945567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tae Seong Eo
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eun Kyung Kim
- Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ji Hoon Kim
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyang Ae Shin
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Ho AKH, Brinkman D, Khan MH. Inverted papilloma of the sphenoid sinus – A case report. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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13
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Koç N, Boyacıoğlu H, Avcu N, Parlak Ş, Taşkın Türkmenoğlu T. Invasive squamous cell carcinoma arising in an inverted papilloma involving oral cavity. Oral Radiol 2020; 36:209-214. [PMID: 31989404 DOI: 10.1007/s11282-020-00423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
Inverted papilloma (IP) is a benign tumour characterized by the growth of epithelial cells downward into the underlying supportive tissue. The tumour derives from the lining mucosa of the nasal cavity and paranasal sinuses. IP typically arises as a unilateral lesion from the lateral wall of the nasal cavity and extends secondarily to the paranasal sinuses. The aggressive behaviour of IP causing local invasion, its tendency for local recurrence, and its propensity to be associated with carcinoma constitute serious complications. This paper describes a very rare case of IP associated with squamous cell carcinoma, extending into paranasal sinuses, causing destruction of the bony wall of maxillary sinus and involvement of the oral cavity.
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Affiliation(s)
- Nagihan Koç
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hacettepe University, Sıhhiye, 06230, Ankara, Turkey.
| | - Hatice Boyacıoğlu
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hacettepe University, Sıhhiye, 06230, Ankara, Turkey
| | - Nihal Avcu
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hacettepe University, Sıhhiye, 06230, Ankara, Turkey
| | - Şafak Parlak
- Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Tuğba Taşkın Türkmenoğlu
- Department of Pathology, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
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Resection of inverted papilloma in nasal cavity with transseptal access and crossing multiple incisions minimizes bleeding and reveals the tumor pedicle. Auris Nasus Larynx 2019; 47:410-414. [PMID: 31732283 DOI: 10.1016/j.anl.2019.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/30/2019] [Accepted: 10/17/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Sinonasal inverted papilloma can be resected endoscopically, but has a risk of recurrence. This risk can be minimized by identifying the pedicle of the tumor and ensuring complete resection. Intraoperative bleeding, particularly from the tumor, decreases endoscopic visualization and contributes to failure to identify the tumor pedicle, and piecemeal resection with dissection of the non-tumoral mucosa makes it impossible to distinguish the tumor pedicle. Previously reported transseptal access with crossing multiple incisions (TACMI) increases mobility of an inverted papilloma within the otherwise restricted nasal cavity. This technique often allows en bloc resection complete with the pedicle and control of bleeding. METHODS We retrospectively reviewed our patients who underwent endoscopic resection of inverted papilloma with or without TACMI and compared the operating times, estimated blood loss, and en bloc resection and recurrence rates between the two groups. RESULTS Thirty-five patients underwent endoscopic resection of inverted papilloma (Krouse stage 2-4) with (n = 23) or without (n = 12) TACMI. The operating time was longer in the TACMI group (218±68 min) than in the non-TACMI group (129±33 min). Estimated blood loss was less in the TACMI group (72±103 mL vs. 120±136.5 mL) but this finding was not significant. En bloc resection was achieved in 19 patients (83%) in the TACMI group but not in any patient in the non-TACMI group. There were no recurrences in the TACMI group. Multivariate analysis showed significant relationships between estimated amount of blood loss and operating time according to Krouse stage and whether or not TACMI was performed. CONCLUSIONS Endoscopic resection of inverted papilloma with TACMI may achieve better treatment results with less blood loss.
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Maina IW, Tong CCL, Baranov E, Patel NN, Triantafillou V, Kuan EC, Kohanski MA, Papagiannopoulos P, Yan CH, Workman AD, Lambert JL, Cohen NA, Kennedy DW, Adappa ND, Feldman MD, Palmer JN. Clinical Implications of Carcinoma In Situ in Sinonasal Inverted Papilloma. Otolaryngol Head Neck Surg 2019; 161:1036-1042. [DOI: 10.1177/0194599819883298] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective Sinonasal inverted papilloma (IP) is a typically benign sinonasal tumor with a tendency to recur and the potential for malignant transformation. Varying degrees of dysplasia may be present, of which carcinoma in situ (CIS) is most advanced. We hereby describe the biological and clinical behavior of IP with CIS (IPwCIS). Study Design Retrospective cohort. Setting Tertiary academic referral center. Subjects and Methods Patients who underwent surgical resection for IP between 2002 and 2017. Pertinent clinical data were obtained, and all IPwCIS cases were histologically confirmed. Results In total, 37 of 215 cases (17.2%) were identified with IPwCIS. Mean age was 57 years and 86.5% of patients were male. Median follow-up was 82 months, and the recurrence rate was 27%. The maxillary sinus was the most common primary site (37.8%) and 14 tumors (37.8%) demonstrated multifocal attachment, which was associated with recurrence (odds ratio [OR], 9.7; 95% confidence interval [CI], 1.4-112.8; P = .028). IPwCIS was also associated with multiple recurrences (OR, 2.71; 95% CI, 1.246-5.814; P = .021). Most patients were treated with surgery alone (89.1%) and 4 patients received adjuvant radiotherapy (8.1%). Only 1 patient (2.7%) demonstrated malignant transformation after definitive surgery. Conclusions IPwCIS represents the most severe degree of dysplasia prior to malignant transformation and is associated with higher recurrence rate and multifocal involvement but low rate of conversion to invasive carcinoma. The need for adjuvant therapy remains controversial, and further research into the etiology of the disease is warranted.
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Affiliation(s)
- Ivy W. Maina
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Charles C. L. Tong
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Esther Baranov
- Department of Pathology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Neil N. Patel
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Vasiliki Triantafillou
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Edward C. Kuan
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Department of Otorhinolaryngology–Head & Neck Surgery, UCI School of Medicine, Irvine, California, USA
| | - Michael A. Kohanski
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Carol H. Yan
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Alan D. Workman
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Justina L. Lambert
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Noam A. Cohen
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - David W. Kennedy
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Nithin D. Adappa
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Michael D. Feldman
- Department of Pathology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - James N. Palmer
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Meng Y, Fang G, Wang X, Song X, Wang K, Lou H, She W, Qin L, Lv M, Zhang T, Yuan T, Tao Y, Meng X, Zhang L, Wang C. Origin site-based staging system of sinonasal inverted papilloma for application to endoscopic sinus surgery. Head Neck 2018; 41:440-447. [PMID: 30554455 PMCID: PMC6590184 DOI: 10.1002/hed.25435] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/20/2018] [Accepted: 09/12/2018] [Indexed: 12/30/2022] Open
Abstract
Background We aimed to assess the recurrence risk of sinonasal inverted papillomas (SNIPs), based on a staging system developed according to the originating site of SNIP. Methods A total of 200 patients with SNIP were enrolled, and a staging system was developed based on the originating sites and corresponding recurrence rates of tumor in the patients. In the verification phase, 675 patients with SNIPs were enrolled as above, and the originating sites of the SNIPs were confirmed by an endoscopic sinus surgery. Cluster analysis was performed to determine the stage for each SNIP. Results Overall, 608 patients completed the study. SNIP recurrence rates for stages 1‐4 were 0 (n = 43), 4.0% (n = 420), 13.4% (n = 134), 36.4% (n = 11), respectively (total = 6.4%). Conclusions The origin site‐based classification of SNIP may aid surgeons in selecting appropriate endoscopic surgical approaches to minimize the risk of recurrence.
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Affiliation(s)
- Yifan Meng
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Gaoli Fang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiangdong Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Song
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Kuiji Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Hongfei Lou
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Wenyu She
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Long Qin
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Baotou Capital Medical University, Inner Mongolia, China
| | - Mei Lv
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Dalian Medical University, Liaoning, China
| | - Tao Zhang
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of JiNan University, Guangdong, China
| | - Tiejun Yuan
- Department of Otolaryngology, Head and Neck Surgery, Weifang People's Hospital, Shandong, China
| | - Yanli Tao
- Department of Otolaryngology, Head and Neck Surgery, Weifang People's Hospital, Shandong, China
| | - Xun Meng
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of JiNan University, Guangdong, China
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing Institute of Otolaryngology, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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17
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Teng Y, Li Y, Lin Z, Gao Y, Cao X, Lou X, Lin F, Li Y. Analysis of miRNA expression profiling identifies miR-214-3p as a novel biomarker in sinonasal inverted papilloma. Epigenomics 2018; 10:1541-1553. [PMID: 29952653 DOI: 10.2217/epi-2018-0071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim: To analyze the expression profile, diagnostic and clinicopathological significances of miRNAs in sinonasal inverted papilloma (SNIP). Materials & methods: The expression profile of miRNAs was analyzed using a miRNA microarray approach. The potential functions and clinical significances of specific miRNAs were further analyzed by bioinformatics and statistical methods. Results: The microarray assay identified 37 significantly upregulated and 21 downregulated miRNAs in SNIP. Of nine miRNAs randomly selected, the expression levels of seven miRNAs were confirmed by quantitative real-time PCR. The potential target genes of several candidate miRNAs were enriched in some biological processes and cellular signaling pathways related to tumorigenesis. Receiever operating characteristic curve analysis for miR-214-3p indicated an area under the curve of 0.932. Notably, its expression level was significantly decreased in SNIP tissues and associated with SNIP staging and recurrence. Conclusion: MiR-214-3p can possibly serve as a valuable biomarker and a therapeutic target for SNIP.
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Affiliation(s)
- Yaoshu Teng
- Department of Otorhinolaryngology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310006 Hangzhou, PR China
- Department of Otorhinolaryngology, The Fourth Clinical Medical College, Zhejiang Chinese Medical University, 310006 Hangzhou, PR China
| | - Yuandong Li
- Department of Otorhinolaryngology, The Fourth Clinical Medical College, Zhejiang Chinese Medical University, 310006 Hangzhou, PR China
| | - Zhihong Lin
- Department of Otorhinolaryngology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310008 Hangzhou, PR China
| | - Yueqiu Gao
- Department of Otorhinolaryngology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310006 Hangzhou, PR China
- Department of Otorhinolaryngology, The Fourth Clinical Medical College, Zhejiang Chinese Medical University, 310006 Hangzhou, PR China
| | - Xiaolin Cao
- Department of Otorhinolaryngology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310006 Hangzhou, PR China
- Department of Otorhinolaryngology, The Fourth Clinical Medical College, Zhejiang Chinese Medical University, 310006 Hangzhou, PR China
| | - Xiangyu Lou
- Department of Otorhinolaryngology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310006 Hangzhou, PR China
- Department of Otorhinolaryngology, The Fourth Clinical Medical College, Zhejiang Chinese Medical University, 310006 Hangzhou, PR China
| | - Fengchun Lin
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 310008 Hangzhou, PR China
| | - Yong Li
- Department of Otorhinolaryngology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 310006 Hangzhou, PR China
- Department of Otorhinolaryngology, The Fourth Clinical Medical College, Zhejiang Chinese Medical University, 310006 Hangzhou, PR China
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18
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Lee JH. An inverted papilloma arising from the middle turbinate and extending to the maxillary sinus ostium. EAR, NOSE & THROAT JOURNAL 2018; 97:E39-E40. [PMID: 30036423 DOI: 10.1177/014556131809700604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jae Hoon Lee
- Department of Otolaryngology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Chonbuk, Korea
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19
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Mohajeri S, Lai C, Purgina B, Almutairi D, Baghai T, Dimitroulakos J, Kilty S. Human papillomavirus: An unlikely etiologic factor in sinonasal inverted papilloma. Laryngoscope 2018; 128:2443-2447. [DOI: 10.1002/lary.27207] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/08/2018] [Accepted: 03/07/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Sepideh Mohajeri
- Faculty of Medicine, University of Ottawa; Ottawa Ontario Canada
| | - Chi Lai
- Department of Pathology; University of Ottawa; Ottawa Ontario Canada
| | - Bibianna Purgina
- Department of Pathology; University of Ottawa; Ottawa Ontario Canada
| | | | - Tabassom Baghai
- Department of Biochemistry, Microbiology and Immunology; University of Ottawa; Ottawa Ontario Canada
- Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | - Jim Dimitroulakos
- Department of Biochemistry, Microbiology and Immunology; University of Ottawa; Ottawa Ontario Canada
- Ottawa Hospital Research Institute; Ottawa Ontario Canada
| | - Shaun Kilty
- Ottawa Hospital Research Institute; Ottawa Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery; University of Ottawa; Ottawa Ontario Canada
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20
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Abstract
Background The aim of this study was to evaluate the efficacy and safety of endoscopically resecting paranasal sinus inverted papillomas at a tertiary medical center. Methods Over a 9-year period, 51 patients with a diagnosis of inverted papilloma underwent endoscopic resection at the University of Miami/Jackson Memorial Medical Center. The study group consisted of 14 women and 37 men with a mean age of 59 years (range, 20–88 years) enrolled in a clinical data base. All of the patients were followed endoscopically at regular intervals on an outpatient basis. Results Endoscopic evidence of extensive papillomas involving the anterior and posterior ethmoid sinuses and at least one (usually the maxillary) dependent sinus was found in 60% of the cases. Extensive radiological disease (varying degrees of mucoperiosteal thickening or opacification of all five cavities) was evident in 50% of the cases. All but two had unilateral disease. An association with chronic inflammatory polyps (clinically and pathologically) was observed in 25 of 51 patients (49%). Follow-up ranged from 6 to 99 months (mean, 30 months). There have been seven recurrences (14%). Four of these have been managed in the office under topical anesthesia. Three recurrences were managed surgically in the operating room. All of the patients have been free of disease. Complications included an intraoperative CSF leak (three patients); temporary infraorbital hypesthesia (three patients); periorbital ecchymosis, hematoma, or cheek edema (four patients); and orbital symptoms (two patients). Carcinoma was found in four patients (8%) who received postoperative radiotherapy and remain free of disease. Conclusion The endoscopic approach continues to provide at least equivalent short-term results as compared with external techniques for the removal of paranasal sinus inverted papilloma. The final cavity should allow for adequate postoperative surveillance and potential resection of recurrences in the office setting, without the need for a return to the operating room in most patients. The association of inverted papilloma with chronic inflammatory polyps and tobacco use warrants additional study.
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21
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Unlu HH, Songu M, Ovali GY, Nese N. Inverted Papilloma with New Bone Formation: Report of Three Cases. ACTA ACUST UNITED AC 2018; 21:607-10. [DOI: 10.2500/ajr.2007.21.3077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background An inverted papilloma (IP) is a benign sinonasal tumor of ectodermal origin, which is locally aggressive and destructive, tends to recur if incompletely removed, and has significant malignant potential. On CT scan, the appearance of an IP is variable and nonspecific but most commonly it appears to have soft tissue density. The association of IPs and new bone formation is extremely rare; to the best of our knowledge, only one case has been reported in the literature to date. Methods We report three cases with existence of bony mass surrounded by polypoid soft tissue diagnosed as IP histopathologically. Results The nature, shape, and location of the bony mass were not in concordance with trapped bone, with tumoral calcifications, or with osteoma. Conclusion We propose that with regard to the three cases presented here, new bone formation may be associated with IP pathologically. We also believe that additional investigations are required to characterize the pathophysiological mechanisms involved in neoplasm-induced osteogenesis.
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Affiliation(s)
- H. Halis Unlu
- Department of Otorhinolaryngology/Head and Neck Surgery, Celal Bayar University Hospital, Manisa, Turkey, Celal Bayar University Hospital, Manisa, Turkey
| | - Murat Songu
- Department of Otorhinolaryngology/Head and Neck Surgery, Celal Bayar University Hospital, Manisa, Turkey, Celal Bayar University Hospital, Manisa, Turkey
| | | | - Nalan Nese
- Department of Pathology, Celal Bayar University Hospital, Manisa, Turkey
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22
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Abstract
Background Given the malignant potential and propensity for recurrence of inverted papilloma (IP) of the sinonasal cavity, complete excision is warranted. For disease extending to multiple sites, open surgical oncological procedures are associated with high morbidity and do not assure complete control of the tumor. The endoscopic approach provides excellent visualization, permits removal of diseased mucosa while preserving vital anatomic structures, and allows for excellent postoperative surveillance. Recurrences are identified early and endoscopic resection is repeated as necessary until there is no evidence of disease. Methods Data were prospectively collected and subsequently reviewed on 18 consecutive patients who underwent endoscopic management of extensive IP (present at more than one anatomic site) between 1999 and 2003. Results Fourteen men and four women with a mean age of 54 years (range, 36–74 years) were followed for an average of 29 months (range, 6–46 months) after initial endoscopic resection. Seventy-eight percent (14 patients) complained of nasal airway obstruction for more than 6 months and 22% (4 patients) were incidentally noted to have a nasal mass on endoscopy or computed tomography. Eleven patients had undergone therapeutic procedures on initial evaluation. The most common sites affected were maxillary sinus, lamina papyracea, and ethmoid sinus. Patients required an average of 1.6 endoscopic surgeries (range, 1–3 surgeries) to achieve local control; 10 patients (56%) required only one. All patients were symptomatically improved and complications were limited to one cerebrospinal fluid leak, which was repaired intraoperatively. Conclusion Extensive IP can be controlled using minimally invasive endoscopic procedures as long as close follow-up is maintained. Operative risk and postoperative morbidity are significantly less than observed with open procedures.
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Affiliation(s)
- Mark J. Jameson
- Department of Otolaryngology–Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Stilianos E. Kountakis
- Department of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia
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23
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Fakhri S, Citardi MJ, Wolfe S, Batra PS, Prayson RA, Lanza DC. Challenges in the Management of Sphenoid Inverted Papilloma. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900216] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Inverted papilloma (IP) arising in the sphenoid sinus is extremely rare. Management of sphenoid sinus IP is especially challenging because of the paucity of sinonasal symptoms on presentation and the inherent surgical risks associated with the anatomic location of the sphenoid sinus. Methods We performed a retrospective review of medical records of all patients with IP arising within the sphenoid sinus. Results A total of five patients were identified. All patients were managed with endoscopic resection. The most common presenting symptom was headache (three patients). The mean follow-up period was 37.6 months (range, 10–79 months). Two patients with erosive skull base lesions adjacent to the internal carotid artery were managed with a staged endoscopic resection. Only one patient developed a recurrence after 38 months and underwent revision endoscopic resection. Conclusions Endoscopic management of sphenoid IP allows maximal resection with minimal morbidity and facilitates endoscopic postoperative surveillance. Complete preoperative radiological assessment of tumor extent is essential. Preoperative medical therapy can help normalize inflamed mucosa and minimize intraoperative bleeding. For large erosive IP, surgical risks may be minimized by considering a staged resection and using computer-aided surgery.
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Affiliation(s)
- Samer Fakhri
- Rhinology and Sinonasal Surgery University of Texas Medical School, Houston, Texas
| | | | - Stephen Wolfe
- Department of Otolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Richard A. Prayson
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Donald C. Lanza
- St. Anthony's Carillon Outpatient Center, St. Petersburg, Florida
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24
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Kamel R, Khaled A, Kandil T. Inverted Papilloma: New Classification and Guidelines for Endoscopic Surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240501900407] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Surgery is the gold standard in the management of inverted papilloma (IP); however, the approach and extent of the surgical procedure are still controversial. Moreover, there is still no universal staging system of IP to plan surgery and/or evaluate results. We performed a retrospective study. Methods A new classification depending on the origin of the lesion was used to plan surgery in 70 cases of IP. Conservative transnasal endoscopic excision was performed in lesions arising from the nasal septum and lateral nasal wall (type I IP, 42 cases) and radical transnasal endoscopic medial maxillectomy was performed in lesions arising from the maxillary sinus (type II IP, 28 cases). Results Excluding cases with a follow-up of <2 years, follow-up for periods ranging between 2 and 13.3 years with a median of 78 months showed recurrence in a single case of type I (3.2%) and 2 cases of type II (9.5%). Conclusion The new classification system, based on the origin of IP, is a simple tool for grading IP. It can be used to define cases suitable for conservative excision or radical medial maxillectomy. Both could be performed transnasally and endoscopically.
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Affiliation(s)
| | | | - Tarek Kandil
- Student's Hospital, Cairo University, Cairo, Egypt
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25
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Llorente JL, Deleyiannis F, Rodrigo JP, Nuñez F, Ablanedo P, Melón S, Suárez C. Minimally Invasive Treatment of the Nasal Inverted Papilloma. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240301700604] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The purpose of this work is to evaluate our results in the treatment of the nasal inverted papillomas with an endoscopic approach using a retrospective case series. Methods Between 1993 and 2000 we treated 27 patients with nasal inverted papillomas. All patients underwent endoscopic nasal surgery under general anesthesia. None of the inverted papillomas extended outside of the paranasal sinuses. All tissue samples underwent polymerase chain reaction and hybridization in situ to detect genetic sequences of the human papilloma virus and Epstein Barr virus. Results The study population consisted of 16 men and 11 women with a median age of 52 years (range, 22–77 years). Ten patients (37%) had undergone a previous nasal surgery. The median follow-up was 5 years (range, 2–8 years). None of the patients presented with bilateral nasal involvement or a synchronous carcinoma. Seven patients underwent an additional surgical approach (two endoscopic approaches via a Caldwel-Luc approach, four sublabial approaches via a Caldwel-Luc approach, and one external ethmoidectomy). There were no surgical complications. Two patients (7%) had recurrent papilloma 4 and 6 years after surgery and again underwent endoscopic resection. The amplification both by polymerase chain reaction and hybridization in situ for human papilloma virus and Epstein Barr virus were negative in the specimens from all patients. Conclusions According to the literature and our own experience, we believe that the initial surgical management of primary and recurrent inverted papillomas limited to the nasal cavity and paranasal sinuses should be endoscopic sinus surgery.
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Affiliation(s)
| | | | | | - Faustino Nuñez
- Departments of the Ear, Nose, and Throat Asturias, Spain
| | - Pilar Ablanedo
- Departments of Pathology, Hospital Central Universitario de Asturias, Oviedo, Asturias, Spain
| | - Santiago Melón
- Departments of Microbiology, Hospital Central Universitario de Asturias, Oviedo, Asturias, Spain
| | - Carlos Suárez
- Departments of the Ear, Nose, and Throat Asturias, Spain
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26
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Liang N, Huang Z, Liu H, Xian J, Huang Q, Zhou B. Bone involvement: Histopathological evidence for endoscopic management of sinonasal inverted papilloma. Laryngoscope 2017; 127:2703-2708. [DOI: 10.1002/lary.26659] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/03/2017] [Accepted: 03/31/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Na Liang
- Department of Otolaryngology-Head and Neck Surgery; Capital Medical University; Beijing People's Republic of China
| | - Zhenxiao Huang
- Department of Otolaryngology-Head and Neck Surgery; Capital Medical University; Beijing People's Republic of China
| | - Honggang Liu
- Department of Pathology; Capital Medical University; Beijing People's Republic of China
| | - Junfang Xian
- Department of Radiology; Capital Medical University; Beijing People's Republic of China
| | - Qian Huang
- Department of Otolaryngology-Head and Neck Surgery; Capital Medical University; Beijing People's Republic of China
| | - Bing Zhou
- Department of Otolaryngology-Head and Neck Surgery; Capital Medical University; Beijing People's Republic of China
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27
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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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Re M, Gioacchini FM, Bajraktari A, Tomasetti M, Kaleci S, Rubini C, Bertini A, Magliulo G, Pasquini E. Malignant transformation of sinonasal inverted papilloma and related genetic alterations: a systematic review. Eur Arch Otorhinolaryngol 2017; 274:2991-3000. [PMID: 28432463 DOI: 10.1007/s00405-017-4571-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/17/2017] [Indexed: 12/31/2022]
Abstract
Schneiderian papillomas are uncommon tumors which may develop within the nasal cavity and comprise three well-defined histological types: sinonasal inverted papilloma (SNIP), exophytic papilloma, and oncocytic papilloma. It is well known the rate of Schneiderian papilloma may also present a malignant degeneration and SNIP represents the most important subgroup in consideration of its frequency and malignant propensity. Although HPV infection is always considered the first event favoring the development of SNIP, however, it is not established as an eventual connection between viral actions and malignant transformation. In fact, different molecular mechanisms are suspected to play a crucial role in this process and, currently, many authors agree that only by improving our knowledge about these mechanisms it will be possible to achieve new and effective targeted therapies. So the aim of this study was firstly to systematically review the literature focusing on different biomarkers that could be implicated in the stages of SNIP malignant degeneration. Secondly, a systematic review with meta-analysis was performed to better define the incidence of sinonasal malignancies originating from Schneiderian papilloma (SNIP, exophytic papilloma, and oncocytic papilloma). Twenty-nine studies comprising a total of 3177 patients were statistically analyzed. Results showed a 9% (95% CI = 7-11) overall rate of malignant transformation from Schneiderian papilloma. In conclusion, this analysis confirmed that the potential malignancy of Schneiderian papilloma should not be underestimated. On the other hand, our review showed the paucity of studies investigating the molecular alterations which may be related with the malignant transformation of SNIP.
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Affiliation(s)
- M Re
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ospedali Riuniti of Ancona, Via Conca 71, 60020, Ancona, Italy
| | - F M Gioacchini
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ospedali Riuniti of Ancona, Via Conca 71, 60020, Ancona, Italy.
| | - A Bajraktari
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ospedali Riuniti of Ancona, Via Conca 71, 60020, Ancona, Italy
| | - M Tomasetti
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - S Kaleci
- Department of Diagnostic Medicine, Clinical and Public Health, University Hospital of Modena, Modena, Italy
| | - C Rubini
- Pathologic Anatomy and Histopathology Division, Department of Biomedical Sciences and Public Health, Polytechnic University of the Marches, Ancona, Italy
| | - A Bertini
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ospedali Riuniti of Ancona, Via Conca 71, 60020, Ancona, Italy
| | - G Magliulo
- Department of Otorhinolaryngology, Audiology and Phoniatrics "G. Ferreri"University La Sapienza, Rome, Italy
| | - E Pasquini
- ENT Metropolitan Unit, Bellaria Hospital, AUSL Bologna, Bologna, Italy
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Albathi M, Ramanathan M, Lane AP, Boahene KDO. Combined endonasal and eyelid approach for management of extensive frontal sinus inverting papilloma. Laryngoscope 2017; 128:3-9. [PMID: 28407252 DOI: 10.1002/lary.26552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/09/2017] [Accepted: 01/31/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Sinonasal inverting papilloma (IP) is a benign but locally aggressive mucosal neoplasm with a high recurrence rate. Extension into the frontal sinus presents surgical challenges for endonasal resection. This study presents an orbitofrontal approach for managing extensive IP. STUDY DESIGN Case series. METHODS Four patients seen between 2012 and 2016 with biopsy-proven IP with lateral frontal sinus extension underwent a combined endonasal and transpalpebral approach for tumor resection. Patient demographic data, preoperative characteristics, imaging, and follow-up data were compiled through retrospective chart review. Patients were selected for this approach when the tumor extended to the posterior frontal sinus wall, lateral frontal sinus recess, and orbit. Tumors were first approached endonasally until the frontal recess was reached. A Draf IIB or Draf III procedure was then performed to gain better exposure. Orbitofrontal exposure was achieved through an upper eyelid incision. Miniorbitofrontal craniotomy window was designed based on tumor location. Resection of the frontal and orbital extension was enhanced by endoscopic-assisted dissection through the orbitofrontal window. RESULTS The transpalpebral approach provided access to all walls of the ipsilateral frontal sinus, the intersinus septum, and the medial aspect of the contralateral sinus. Complete tumor resection was achieved in all patients. There were no orbital complications, no visible eyelid asymmetry or scarring, and all patients had preserved forehead sensation. There were no recurrences on follow-up. CONCLUSION Combining a transpalpebral orbitofrontal craniotomy with the endonasal approach allows complete resection of invasive IP with extension into the frontal sinus. This is achieved with great cosmetic results. LEVEL OF EVIDENCE 4. Laryngoscope, 128:3-9, 2018.
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Affiliation(s)
- Monirah Albathi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Andrew P Lane
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Kofi D O Boahene
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Abstract
The interesting history of papillomavirus (PV) research has been reviewed before. The history of human papillomavirus (HPV) in head and neck region starts in 1901 when the contagious transmission of warty lesions into the mouth via oral sex was described, although the confirmation of their viral etiology had to wait until 1907. Ullman was the first to associate the human wart virus with laryngeal warts. Parsons and Kidd described the natural history of oral PV infections in rabbits already in 1942, but these findings were corroborated in humans only recently. Koilocytotic atypia described by Koss and Durfee in 1956 was recognized as a sign of HPV infection in cervical precancer lesions only in 1976-1977 (Meisels and Fortin; Purola and Savia). This prompted systematic surveys of head and neck lesions for the detection of koilocytosis since the late 1970s, and the authors of this communication were the first to propose the HPV involvement in a subgroup of head and neck cancers. Brandsma and Abramson demonstrated HPV16 DNA in tonsillar SCCs in 1989. Since the early 2000s, HPV research of head and neck squamous cell carcinomas (HNSCC) has made impressive progress, confirming that the specific anatomic site plays a key role in determining the susceptibility to HPV infection. The most likely cancer sites associated with HPV are the base of the tongue and palatine tonsils, followed by oral cavity, larynx, and sinonasal mucosa. There is substantial geographic variation in HPV association with HNSCC. Patients with HPV-associated HNSCC are younger, and survival is better than in the absence of HPV.
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Affiliation(s)
- Stina Syrjänen
- Department of Oral Pathology, Faculty of Medicine, Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland. .,Department of Pathology, Turku University Hospital, University of Turku, Turku, Finland.
| | - Jaana Rautava
- Department of Oral Pathology, Faculty of Medicine, Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, 20520, Turku, Finland.,Department of Pathology, Turku University Hospital, University of Turku, Turku, Finland
| | - Kari Syrjänen
- Department of Clinical Research, Biohit Oyj, Helsinki, Finland
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31
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Roh HJ, Mun SJ, Cho KS, Hong SL. Smoking, not human papilloma virus infection, is a risk factor for recurrence of sinonasal inverted papilloma. Am J Rhinol Allergy 2016; 30:79-82. [PMID: 26980388 DOI: 10.2500/ajra.2016.30.4272] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The recurrence rate of sinonasal inverted papillomas (SNIP) is 15-20%. However, few studies have investigated patient-dependent factors related to recurrence of SNIPs. OBJECTIVE To analyze risk factors, including human papilloma virus (HPV) infection and smoking, as well as other factors, for recurrence of SNIPs. METHODS Fifty-four patients who were diagnosed with SNIP and underwent surgery were enrolled: 39 men and 15 women, with the mean age of 54.0 years. Their mean follow-up was 40.6 months. Demographics and information about the history of smoking, previous surgery, tumor extent, follow-up, and recurrence were reviewed retrospectively. Those patients whose tumors were associated with malignant transformation were excluded in this study. HPV detection and genotyping in the tumor specimens were performed with the HPV DNA chip, a polymerase chain reaction-based DNA microarray system. RESULTS Seven patients (13.0%) had recurrence, with a mean time to recurrence of 39.8 months. Recurrence rates in T1, T2, T3, and T4 of the Krouse staging system were 0% (0/4), 8.3% (2/24), 17.4% (4/23), and 33.3% (1/3), respectively (p > 0.5). Eight patients (14.8%) were positive for HPV DNA. All of these patients belonged to the group without recurrence (p > 0.5). However, recurrence rates according to HPV DNA positivity were not statistically different (0% versus 15.2%). Three (42.9%) in the group with recurrence and four (8.5%) in the group without recurrence were smokers (p < 0.5). CONCLUSION Smoking was associated with recurrence of SNIP. However, HPV infection is not a recurrence of SNIP risk factor.
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Affiliation(s)
- Hwan-Jung Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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32
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Smith JE, Ducic Y. Inverting Papilloma of the Base of Tongue with Malignant Transformation. Otolaryngol Head Neck Surg 2016; 130:142-4. [PMID: 14726923 DOI: 10.1016/s0194-5998(03)01450-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jesse E Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, USA
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Iida E, Anzai Y. Imaging of Paranasal Sinuses and Anterior Skull Base and Relevant Anatomic Variations. Radiol Clin North Am 2016; 55:31-52. [PMID: 27890187 DOI: 10.1016/j.rcl.2016.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This article reviews the normal anatomy and variants of the anterior skull base and sinonasal cavities that are relevant to endoscopic sinus and skull base surgery. Radiologists should be aware of sinonasal anatomy that can be impediments to surgical access and increase risk of vascular or cranial nerve injury during surgery. Imaging features of the paranasal sinuses and anterior skull base pathologies are also discussed.
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Affiliation(s)
- Estushi Iida
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Yoshimi Anzai
- Department of Radiology, University of Utah Health Sciences Center, 30 North, 1900 East #1A071, Salt Lake City, UT 84132-2140, USA.
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Ossifying inverted papilloma and ossifying polyp of the sinonasal tract: comparison of CT and MRI features. Clin Radiol 2016; 72:84-90. [PMID: 27773333 DOI: 10.1016/j.crad.2016.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/13/2016] [Accepted: 09/28/2016] [Indexed: 11/24/2022]
Abstract
AIM To investigate the key imaging points in distinguishing ossifying inverted papilloma (IP) from polyps. MATERIALS AND METHODS The native computed tomography (CT), conventional and enhanced MRI manifestations of 20 ossifying IPs and eight polyps, which were confirmed histopathologically, were retrospectively evaluated by two doctors majoring in head and neck imaging. RESULTS A significant difference was detected between the two entities for the involved sites (p<0.05). Although two lesions had similar CT findings, the MRI features differed significantly (p<0.05). Twenty ossifying IPs demonstrated heterogeneously isointense with moderate gadolinium enhancement, and a convoluted "cerebriform" configuration. Seven ossifying polyps revealed low T1 and high T2 signal, with marginal enhancement, and one showed isointense with moderate enhancement. The ossification appeared as oval or striped bone-like high attenuation, which consisted of peripheral hyperattenuating cortical bone and central fat-like attenuation of the medullary cavity. The corresponding MRI findings of the ossifying regions were peripherally low signal and centrally high signal on both T1- and T2-weighted images. The occurrence of two key MRI features of cystic appearance and the "cerebriform" sign were significantly different between two entities (p<0.05). CONCLUSIONS CT can better detect intralesional ossification, but MRI is the optimal imaging technique for discriminating between two disease entities.
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Elliot A, Marklund L, Håkansson N, Song H, Ye W, Stjärne P, Hammarstedt-Nordenvall L. Incidence of IP and risk of malignant transformation in the Swedish population 1960-2010. Eur Arch Otorhinolaryngol 2016; 274:1445-1448. [PMID: 27757542 PMCID: PMC5309288 DOI: 10.1007/s00405-016-4321-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/23/2016] [Indexed: 10/25/2022]
Abstract
The true incidence of inverted papilloma (IP) is not yet known. From hospital-based studies, its incidence has been estimated to approximately 0.5/100,000 person years. Earlier hospital case studies have shown that IP can undergo a malignant transformation in 1-53 %. The frequency of its malignant transformation on a population basis is unknown. To our knowledge, no standardised incidence ratio (SIR) has been reported for malignancies among IPs. This study aims to investigate these incidences on a population basis. Using the data from the Swedish Cancer Registry (SCR), we have identified patients with IP and patients with Squamous Cell Carcinoma (SCC) diagnosed between 1960 and 2010 in Sweden. Incidence of IP and incidence of SCC among patients with IP and SIR were analyzed. Eight hundred and fourteen patients with IP were identified. The incidence of IPs reported to the SCR increased from 1960 to 2010. In this cohort, SCC was overrepresented, as compared with the general population. The incidence of IP in the Swedish population seems to have increased.
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Affiliation(s)
- Alexandra Elliot
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Linda Marklund
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Niclas Håkansson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Huan Song
- Institute of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Weimin Ye
- Institute of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pär Stjärne
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Lalle Hammarstedt-Nordenvall
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
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36
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Kim JS, Kwon SH. Recurrence of sinonasal inverted papilloma following surgical approach: A meta-analysis. Laryngoscope 2016; 127:52-58. [PMID: 27531693 DOI: 10.1002/lary.26222] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/17/2016] [Accepted: 07/05/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS Inverted papilloma (IP) is a rare benign tumor, which is found in the sinonasal area. It is characterized by recurrence, local destruction, and malignant change. Of these, recurrence is a challenging problem to many otolaryngologists. In this study, we evaluated recurrence based on the type of surgical approach using a meta-analysis. STUDY DESIGN MEDLINE, Embase, and Cochrane database. METHODS Relevant studies were identified by searching the following databases: MEDLINE, Embase, and Cochrane through February 2016. Random-effects models were used to estimate risk ratio (RR) and 95% confidence interval (CI). The Newcastle-Ottawa scale was used to assess the quality of cohort studies. RESULTS Our search yielded 14 retrospective cohort studies involving a total of 696 endoscopic approaches and 444 nonendoscopic approaches. The pooled RR for IP recurrence (endoscopic vs. external approach) was 0.56 [95% CI: 0.36-0.85, I2 =48.3%]. A subgroup analysis was also performed. CONCLUSIONS Surgical management of IP via an endoscopic approach reduces the risk of recurrence compared to an external approach. Although further data are needed, early- stage IP requires endoscopic or endoscopic-assisted surgery to reduce the risk of tumor recurrence. LEVEL OF EVIDENCE NA Laryngoscope, 127:52-58, 2017.
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Affiliation(s)
- Jong Seung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
| | - Sam Hyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea
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37
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Khandekar S, Dive A, Mishra R, Upadhyaya N. Sinonasal inverted papilloma: A case report and mini review of histopathological features. J Oral Maxillofac Pathol 2016; 19:405. [PMID: 26980974 PMCID: PMC4774299 DOI: 10.4103/0973-029x.174644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Inverted papilloma is a benign epithelial growth in the underlying stroma of the nasal cavity and paranasal sinuses. The pathogenesis of this lesion remains unclear although allergy, chronic sinusitis and viral infections have been suggested as possible causes. The tumor is well known for its invasiveness, tendency to recur and association with malignancy. Recurrence rates of inverted papilloma are unacceptably high, which actually represents residual disease in most cases. In this study, we have presented a case report and reviewed the histological features of sinonasal inverted papilloma.
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Affiliation(s)
- Shubhangi Khandekar
- Department of Oral and Maxillofacial Pathology, V.S.P.M.D.C.R.C, Nagpur, Maharashtra, India
| | - Alka Dive
- Department of Oral and Maxillofacial Pathology, V.S.P.M.D.C.R.C, Nagpur, Maharashtra, India
| | - Rakesh Mishra
- Department of Otorhinolaryngology, Hind Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Upadhyaya
- Department of Oral and Maxillofacial Pathology, C.D.C.H, Lucknow, Uttar Pradesh, India
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38
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Jung YG, Lee HW, Kim MG, Dhong HJ, Cho KS, Roh HJ. Role of Wnt signaling pathway in progression of sinonasal inverted papilloma to squamous cell carcinoma. Am J Rhinol Allergy 2016; 29:e81-6. [PMID: 25975243 DOI: 10.2500/ajra.2015.29.4193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Sinonasal inverted papilloma (IP) is one of the most common benign tumors of the sinonasal area and malignant transformation has frequently been reported. However, the exact mechanism of the transition from benign lesion to malignancy is not known. The Wnt signaling pathway involves a network of multiple signaling glycoproteins that are known to play an important role in embryogenesis and carcinogenesis. OBJECTIVE The purpose of this study was to evaluate the role of the Wnt pathway and signaling proteins in malignant transformation of IP to dysplasia and squamous cell carcinoma. METHODS Expression of the Wnt signaling pathway proteins, including Wnt-1, beta-catenin, cyclin D1, and Dishevelled-1 (Dvl-1), were detected by immunohistochemistry by using 3-mm tissue core microarrays that consisted of 115 cores of IP tissue. Each of the IP cores was graded as I (prominent squamous metaplasia), II (inverted pattern), III (dysplasia), or IV (squamous cell carcinoma). The expression pattern of each protein and the correlation between the expression of each target protein and IP grade were evaluated. RESULTS Membranous staining of beta-catenin showed a significant positive correlation with IP grade (ρ = 0.247, p < 0.001), as did staining of cyclin D1 (ρ = 0.365, p < 0.001), which showed a nuclear pattern and staining of Dvl-1 (ρ = 0.380, p < 0.001), which showed a membranous, cytoplasmic, and nuclear pattern. For Dvl-1, a nuclear expression pattern was more frequently observed in grade III and IV IP (p = 0.036). In the case of Wnt-1, cytoplasmic expression was observed; however, it did not show a significant correlation with IP grade (ρ = 0.141, p = 0.130). CONCLUSIONS Wnt signaling proteins, including beta-catenin, cyclin D1, and Dvl-1, may play crucial roles in the malignant transformation of IP.
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Affiliation(s)
- Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon-Si, Republic of Korea
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Abstract
Low-grade epithelial proliferations of the sinonasal tract include Schneiderian papillomas, respiratory epithelial adenomatoid hamartoma, seromucinous hamartoma and low-grade non-intestinal adenocarcinoma. There is considerable overlap in their clinical presentation, endoscopic appearance, and imaging features. Although well-described diagnostic criteria exist, a definitive diagnosis may be difficult to reach on a small biopsy. Schneiderian papillomas are divided into fungiform, inverted, and oncocytic types, each with characteristic clinical and morphological features. The latter two may progress to malignancy. The majority are still considered to be HPV-related. Two lesions are designated as hamartomas, but their pathogenesis remains uncertain, with inflammatory and neoplastic origins proposed. Respiratory epithelial adenomatoid hamartoma is increasingly being recognized for its association with chronic rhinosinusitis and olfactory cleft site of origin. Seromucinous hamartoma has gained attention in recent years and overlaps with both respiratory epithelial adenomatoid hamartoma and low-grade non-intestinal adenocarcinoma. Controversy surrounds their distinction, particularly from low-grade adenocarcinoma. The latter generally is cured by complete excision, with a 26 % risk of recurrence but rare metastases and deaths from disease.
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Affiliation(s)
- Martin J Bullock
- Departments of Pathology and Surgery, Dalhousie University, Halifax, NS, Canada.
- Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre (QEII HSC), 716-5788 University Avenue, Halifax, NS, B3H 1V8, Canada.
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40
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Hong SL, Mun SJ, Cho KS, Roh HJ. Inverted Papilloma of the Maxillary Sinus: Surgical Approach and Long-term Results. Am J Rhinol Allergy 2015; 29:441-4. [DOI: 10.2500/ajra.2015.29.4219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Inverted papillomas (IP) commonly develop in the maxillary sinus (MS). However, the MS is a complex structure, and all areas in the MS are not easily approachable. Objective This study reviewed our surgical outcome of patients with IPs that originated from the MS in long-term follow-up and suggests appropriate approaches according to the tumor origin. Methods Thirty-one patients who were diagnosed with IP that originated from the MS, underwent surgery by a single operator between 1999 and 2011, and had postoperative follow-up of >3 years were enrolled. Results In all the cases, the endoscopic endonasal approach (EEA) was attempted at first and then canine fossa puncture (CP), canine fossa opening via the Caldwell-Luc approach (CO), and Caldwell-Luc operation (CLO) were added in consecutive order as the occasion demands. Six patients (19.4%) were treated only with EEA, and they had IPs from the superior, posterior, or medial wall. Five (16.1%) were treated with EEA plus CP, which was added for removal of IPs that originated from the lateral wall. Sixteen (51.6%) were treated with EEA plus CO, which was for removal of tumors from the medial, anterior, or inferior wall. Four patients (12.5%) whose IP attached to the whole MS mucosa underwent CLO. Three (9.7%) experienced recurrences, and the mean period to recurrence was 20.7 months. Conclusion The overall recurrence rate was 9.7%. IPs that originated from the lateral wall of the MS can be removed by using CP. When IPs originate from the anterior, inferior, or medial wall of the MS, CO may be needed for the thorough removal of them.
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Affiliation(s)
- Sung-Lyong Hong
- Department of Otorhinolaryngology, Head and Neck Surgery
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sue Jean Mun
- Department of Otorhinolaryngology, Head and Neck Surgery
| | - Kyu-Sup Cho
- Department of Otorhinolaryngology, Head and Neck Surgery
| | - Hwan-Jung Roh
- Department of Otorhinolaryngology, Head and Neck Surgery
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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41
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Dubal PM, Bhojwani A, Patel TD, Zuckerman O, Baredes S, Liu JK, Eloy JA. Squamous cell carcinoma of the maxillary sinus: A population-based analysis. Laryngoscope 2015; 126:399-404. [PMID: 26393540 DOI: 10.1002/lary.25601] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 07/16/2015] [Accepted: 07/30/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS Squamous cell carcinoma (SCC) accounts for > 90% of head and neck cancers and 60% to 75% of malignancies of the paranasal sinuses. The most commonly affected paranasal sinus is the maxillary. Epidemiologic, incidence, and survival trends have been studied for maxillary sinus SCC (MSSCC), but far less is known about its metastatic potential. STUDY DESIGN Retrospective database analysis. METHODS The Surveillance, Epidemiology, and End Results database was used to extract frequency, incidence, and survival data for MSSCC between 2004 and 2012. The resultant cases were stratified according to patient demographics and collaborative stage information, including extent of disease, lymph node involvement, TNM staging, and regional and distant metastasis. RESULTS A total of 854 cases of MSSCC were identified. The mean age at diagnosis was 66.6 years, with 87.4% presenting at > 50 years. Most patients (65.1%) were male. Whites accounted for 74.6% of cases. A majority (64.3%) of cases presented with stage IV disease. Overall 5-year disease-specific survival was 23.4%. Neck involvement was seen in 7.6% of T1 tumors, 22.2% of T2 tumors, 18.5% of T3 tumors, and 12.2% of T4 tumors. Distant metastasis was not seen in T1-T3 tumors, but was present in 6.8% of T4 tumors. CONCLUSIONS MSSCC is a rare entity with poor overall prognosis. The majority of patients included in this study were white males aged ≥50 years, with most tumors presenting at advanced stages. Nodal involvement and distant metastasis are poor prognostic indicators. T1-T3 tumors did not metastasize to distant sites. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Pariket M Dubal
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Amit Bhojwani
- Department of Otolaryngology and Facial Plastic Surgery, Rowan University School of Osteopathic Medicine, Stratford
| | - Tapan D Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Omry Zuckerman
- Rowan University School of Osteopathic Medicine, Stratford
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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42
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Adriaensen GFJPM, Lim KH, Georgalas C, Reinartz SM, Fokkens WJ. Challenges in the Management of Inverted Papilloma: A Review of 72 Revision Cases. Laryngoscope 2015; 126:322-8. [PMID: 26344930 DOI: 10.1002/lary.25522] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 06/24/2015] [Accepted: 06/26/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS We report on the treatment outcome of endoscopically managed sinonasal inverted papilloma, focusing on revision cases. Our aim was to identify the properties of revision cases that affect treatment outcome by comparing them to primary cases in a single center. We propose using 5-fluorouracil (5-FU) in the postoperative management of inverted papilloma. STUDY DESIGN A retrospective single-center case series. This study met the criteria for approval by the local medical ethics committee. METHODS We performed a retrospective chart review identifying patients operated on between January 2003 and September 2013. Data were collected about patient demographics, symptoms, tumor attachment site, imaging, intraoperative and pathological findings, surgical approaches, postoperative treatment, follow-up, and recurrence. RESULTS One hundred and twenty-one (72 revision and 49 primary) cases were retrieved with a minimum follow-up of 1 year. Revision cases have significantly higher Krouse staging (P = 0.003), different distribution of tumor attachment sites, and higher recurrence rates. The recurrence rate was 4.1% for primary cases (mean follow-up 35.5 months) and 18.1% for revision cases (mean follow-up 45 months). Eight of the recurrent cases recurred within the first year. 5-fluorouracil was applied postoperatively in 18 (5 primary and 13 revision) cases, which included one (5.6%) recurrence and one minor complication (transient periorbital swelling). CONCLUSION The most important factors in preventing the recurrence of inverted papilloma are the determination of the location of the attachment and the completeness of resection in the primary endoscopic surgery. Revision cases have a higher recurrence rate, and the attachment sites are surgically more challenging. The use of 5-FU might have a place in the postoperative treatment of surgically challenging inverted papilloma. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - Keng-Hua Lim
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
| | - Christos Georgalas
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Susanne M Reinartz
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
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Low-grade papillary schneiderian carcinoma, a unique and deceptively bland malignant neoplasm: report of a case. Am J Surg Pathol 2015; 39:714-21. [PMID: 25634744 DOI: 10.1097/pas.0000000000000390] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The sinonasal tract harbors several different types of papillomas, some of which can progress to carcinoma. The most frequent among these are inverted and oncocytic Schneiderian papillomas. The rates of progression are somewhat controversial but are approximately 5% to 10% and are almost invariably described in the literature as in situ or invasive squamous cell carcinoma. Other carcinoma types, such as mucoepidermoid and sinonasal undifferentiated carcinoma, have also been described. Almost all of the described patterns of malignancy involve frank carcinoma with overtly dysplastic nuclear features, lack of cell maturation, and increased mitotic activity. Some squamous cell carcinomas, particularly nonkeratinizing, can grow in a papillary pattern, appearing to only line the surface epithelium, but they are cytologically overtly malignant throughout. In this case report, however, we describe a novel, human papillomavirus-negative, papillary carcinoma, which presented as a left nasal and maxillary sinus exophytic and inverted-appearing, papillomatous mass with very bland cytomorphology. The initial features were not typical for any defined Schneiderian papilloma but were also not clearly diagnostic of papillary carcinoma. The tumor recurred >10 times over 18 years despite extensive surgical resection including orbital exenteration. The tumor retained a bland appearance throughout the patient's entire clinical course, but did develop a pushing pattern of stromal invasion, increased mitotic activity, vesicular nuclei with prominent nucleoli, lymph node metastases, and eventually overwhelming local recurrence and nodal metastases, resulting in death. This tumor seems best characterized as a low-grade papillary Schneiderian carcinoma and appears to represent a novel type of sinonasal carcinoma.
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Lou H, Fang J, Li P, Zhou W, Wang Y, Fan E, Li Y, Wang H, Liu Z, Xiao L, Wang C, Zhang L. Frequency, suppressive capacity, recruitment and induction mechanisms of regulatory T cells in sinonasal squamous cell carcinoma and nasal inverted papilloma. PLoS One 2015; 10:e0126463. [PMID: 26020249 PMCID: PMC4447263 DOI: 10.1371/journal.pone.0126463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/03/2015] [Indexed: 02/04/2023] Open
Abstract
Background Sinonasal squamous cell carcinoma (SSCC) and nasal inverted papilloma (NIP) represent the predominant type of malignant and benign tumors in sinonasal tract, respectively. CD4+CD25+Foxp3+ natural regulatory T (Treg) cells might play critical role(s) in the suppression of anti-tumor immune response and thus shed light on tumor progression from benign to malignant. Objective This study aimed to evaluate the frequency and suppressive capacity of Treg cells in SSCC compared to NIP and further to explore the underlying mechanisms. Patients and Methods Frequencies of Treg, Th1 and Th2 cells were evaluated by flow cytometry in tissue homogenate and peripheral blood from 31 SSCC patients, 32 NIP patients and 35 normal controls. Treg cells were tested for regulatory function by co-culture with effector T cells. CCR4 and its ligands, CCL22 and CCL17, were analyzed by flow cytometry and Luminex, respectively. The chemoattractant properties of CCR4/CCL22 and CCR4/CCL17 for Treg cells were assessed using the Boyden chamber technique, to elucidate the potential mechanisms of Treg recruitment in tumor microenvironment. Treg cells induction via TGF-β was assessed with transwells after local CD4+Foxp3+ T cells were assessed by immunohistochemistry and TGF-β concentration was measured by Luminex. Results Tumor-infiltrating Treg cells increased significantly from normal to NIP to SSCC (P ≤ 0.001 for normal vs. NIP and P = 0.004 for NIP vs. SSCC). Significantly elevated frequency and enhanced suppression capacity of circulating Treg cells in SSCC were detected compared to NIP and healthy controls, concomitant with Th1 decrease and Th2 increase. Apparently increased CCL22 attracted CCR4-expressing Treg cells to tumor microenvironment in SSCC, compared to NIP. SSCC produced significantly more TGF-β than NIP and thus possessed greater potential for Treg cell induction. Conclusion Frequency and suppressive capacity of Treg cells enhanced with progression of malignancy from NIP to SSCC. Circulating Treg cells were recruited to tumor tissue via CCR4/CCL22 signalling, whereas tumor-synthesised TGF-β contributed to induction of peripheral Treg cells.
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Affiliation(s)
- Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing, PR China
| | - Jugao Fang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China
| | - Pingdong Li
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China
| | - Weiguo Zhou
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China
| | - Yang Wang
- Beijing Key Laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing, PR China
| | - Erzhong Fan
- Beijing Key Laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing, PR China
| | - Ying Li
- Beijing Key Laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing, PR China
| | - Hong Wang
- Beijing Key Laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing, PR China
| | - Zhongyan Liu
- Beijing Key Laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing, PR China
| | - Lei Xiao
- Sections of Pulmonary & Cardiology, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China
- * E-mail: (CW); (LZ)
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory of nasal diseases, Beijing Institute of Otolaryngology, Beijing, PR China
- * E-mail: (CW); (LZ)
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Dean NR, Illing EA, Woodworth BA. Endoscopic resection of anterolateral maxillary sinus inverted papillomas. Laryngoscope 2014; 125:807-12. [PMID: 25418039 DOI: 10.1002/lary.25033] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Endoscopic medial maxillectomy (EMM) has become the surgical procedure of choice for resection of maxillary sinus inverted papillomas (IPs). Traditionally, IPs pedicled on the anterior and/or lateral walls of the maxillary sinus have required an adjuvant Caldwell-Luc approach due to decreased visualization with transnasal endoscopy in these locations. The objective of the current study is to evaluate outcomes following endoscopic resection of anterolateral maxillary sinus IPs. STUDY DESIGN Prospective case series. SUBJECTS AND METHODS Over 6 years, a total of 35 patients underwent EMM for maxillary sinus IPs located on the anterolateral maxillary wall. Demographics, operative technique, pathology, complications, recurrence, and postoperative follow-up were evaluated. RESULTS The majority of patients were male (71%) with a mean age of 56 years (range 27-83). Most patients (71%) were referred for recurrence after previous attempts at surgical resection. Adequate visualization was obtained following EMM in the majority of patients with use of a 70-degree endoscope and angled instrumentation. The addition of transseptal surgical access was critical to the removal of IPs in 16 patients. No Caldwell-Luc approaches were required. Pathologic dysplasia was identified in nine patients, and three had carcinoma. There were no recurrences with a mean disease-free interval of 29 months (10-72 months). CONCLUSION In the present study, EMM provided excellent surgical access to anterolateral maxillary sinus IPs. The transseptal approach allowed enhanced visualization to this challenging location, previously considered accessible only with external procedures.
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Affiliation(s)
- Nichole R Dean
- Departments of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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Kadapa NPB, Reddy LS, Reddy V, Kumuda P, Reddy MVV, Rao LMSCS. Nasal endoscope: an armamentarium in the management of sinonasal inverted papilloma. Indian J Otolaryngol Head Neck Surg 2014; 66:200-4. [PMID: 24822163 DOI: 10.1007/s12070-014-0716-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/15/2014] [Indexed: 11/24/2022] Open
Abstract
Sinonasal inverted papillomas (SIP) are unique group of locally aggressive benign neoplastic lesions arising from mucosa of sinonasal tract with potential for recurrences and known association with squamous cell carcinoma in 5-15 % of cases. This study was conducted was to assess the efficacy and usefulness of the nasal endoscope in treating SIP. We reviewed 28 biopsy proven cases of SIPs that were treated at our hospital between June 2009 and September 2013. Average patient age was 46 years. Fourteen were treated by transnasal endoscopic excision of tumor with noted recurrence of 21.43 %. Thirteen were treated by endoscopic assisted open surgery which had 23 % recurrence. Three patients had malignant inverted papillomas, of whom two (7 %) were found to have synchronous squamous cell carcinoma and one (3.6 %) had metachronous squamous cell carcinoma. No evidence of recurrence was found in rest during our follow up. The endoscopic approach is the preferred method for the treatment of the majority of inverted papillomas. Powered instrumentation is extremely useful to achieve good results. Although significant number of cases was done by external approach by lateral rhinotomy, the endoscopic assistance is required to ensure complete removal of the tumour to reduce the recurrence rates. Close follow up of the patient for a longer period of time is necessary for the early detection of recurrence and to allow for surgical salvage.
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Affiliation(s)
- Nagendra P B Kadapa
- Dept. of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital, Hyderabad, India
| | - L Sudarshan Reddy
- Osmania Medical College, Govt. ENT Hospital, Koti, Hyderabad, 500095 India
| | - Venkataram Reddy
- Dept. of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital, Hyderabad, India
| | - P Kumuda
- Dept. of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital, Hyderabad, India
| | - M Vishnu Vardhan Reddy
- Dept. of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital, Hyderabad, India
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Lin GC, Akkina S, Chinn S, Prince ME, McHugh JB, Carey T, Zacharek MA. Sinonasal inverted papilloma: prognostic factors with emphasis on resection margins. J Neurol Surg B Skull Base 2014; 75:140-6. [PMID: 24719801 DOI: 10.1055/s-0033-1363169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 10/23/2013] [Indexed: 10/25/2022] Open
Abstract
Objective We review our institution's experience with the treatment of inverted papilloma (IP) with emphasis on the implications of surgical margins for disease control. Design Retrospective chart review of patients with IP treated at the University of Michigan from 1996 to 2011. Setting Tertiary care center. Participants Patients undergoing surgical resection with curative intent for IP. Main Outcome Measures Overall survival, disease-specific survival, and locoregional control were used as main outcome measures. Results We studied 129 patients including 19 with carcinoma arising from IP. Disease-free rates at 2, 3, and 5 years were 79.7%, 77.9%, and 61%, respectively. Overall, 10 of 18 recurrences were detected > 2 years from follow-up, with recurrences detected up to 8 years from surgery. For benign disease, obtaining tissue margins outside of the primary specimen for margin control did not affect disease control rates. Conclusion IP is a disease that requires significant follow-up periods beyond 2 years. For IP without carcinogenesis, acquiring margins outside of the tumor specimen did not appear to affect disease control rates in this study. No clear predictors of malignancy were seen in this study, which highlights the need for further research to predict this phenomenon.
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Affiliation(s)
- Giant C Lin
- Department of Otolaryngology, University of Michigan Health Systems, Ann Arbor, Michigan, United States
| | - Sarah Akkina
- Department of Otolaryngology, University of Michigan Health Systems, Ann Arbor, Michigan, United States
| | - Steven Chinn
- Department of Otolaryngology, University of Michigan Health Systems, Ann Arbor, Michigan, United States
| | - Mark E Prince
- Department of Otolaryngology, University of Michigan Health Systems, Ann Arbor, Michigan, United States
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan Health Systems, Ann Arbor, Michigan, United States
| | - Thomas Carey
- Department of Otolaryngology, University of Michigan Health Systems, Ann Arbor, Michigan, United States
| | - Mark A Zacharek
- Department of Otolaryngology, University of Michigan Health Systems, Ann Arbor, Michigan, United States
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Byun JY, Lee SH, Shin JM, Baek BJ, Lee JY. Overexpression of angiomotin in sinonasal inverted papilloma. Int Forum Allergy Rhinol 2014; 4:512-6. [PMID: 24532565 DOI: 10.1002/alr.21293] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/11/2013] [Accepted: 12/12/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although inverted papilloma (IP) is one of the most common sinonasal tumors, its etiology and factors associated with tumor progression have not been fully determined. Generally, tumorigenesis or tumor growth requires angiogenesis to feed tumor cells. Angiomotin is a recently discovered protein that regulates migration and tubule formation in endothelial cells. It has been reported that angiomotin affects angiostatin (circulating inhibitor of angiogenesis), resulting in promotion of angiogenesis. Thus, we evaluated the expression and distribution of angiomotin in sinonasal IP, compared to normal control tissue. METHODS The study included 10 subjects with sinonasal IP and 5 normal controls. Ethmoid sinus mucosa obtained during reduction of blowout fractures was used as a normal control. Reverse transcriptase-polymerase chain reaction (RT-PCR), real-time PCR, immunohistochemistry, and Western blot analysis were used to assess the expression, intensity, and distribution of angiomotin in tissues. RESULTS Positive bands for angiomotin were seen in all specimens by RT-PCR. The expression level of angiomotin was significantly upregulated in IP tissues versus normal sinus mucosa by real-time PCR. Immunohistochemistry revealed positive reactions on endothelial cells of capillaries and small vessels within the tumor and normal tissues, but the positivity was significantly stronger in IP. Western blot analysis showed that expression levels of angiomotin were increased in IP compared to normal sinus mucosa. CONCLUSION Angiomotin, a novel protein in angiogenesis, was overexpressed in IP. Although it is not an etiological or initiating factor in tumor development, it seems to be associated with progression and growth of IP via promoting angiogenesis.
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Affiliation(s)
- Jang Yul Byun
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
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Nudell J, Chiosea S, Thompson LDR. Carcinoma ex-Schneiderian papilloma (malignant transformation): a clinicopathologic and immunophenotypic study of 20 cases combined with a comprehensive review of the literature. Head Neck Pathol 2014; 8:269-86. [PMID: 24519376 PMCID: PMC4126921 DOI: 10.1007/s12105-014-0527-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 02/03/2014] [Indexed: 11/30/2022]
Abstract
Schneiderian papilloma (SP) are uncommon tumors with malignant transformation even less common. The histologic criteria to define malignant transformation are not well developed nor is the immunohistochemical profile reported in a large series of carcinomas. 20 cases of malignant transformation of SP included 7 females and 13 males, aged 38-86 years (mean 60.7 years). Patients presented most frequently with a mass (n = 11) and obstructive symptoms (n = 7), present for 38.7 months (mean). Most patients had no previous history of SP (n = 13); metachronous carcinoma was identified in 7 patients an average of 34.4 months after the first diagnosis of SP, with 1-4 recurrences of SP. With a mean size of 4.1 cm, the majority of tumors involved a combination of more than one anatomic site (n = 10), followed by the maxillary sinus only (n = 5) or nasal cavity only (n = 3). Histologically, 17 were inverted and 3 exophytic type SP. There were 17 squamous cell carcinomas, 2 mucoepidermoid carcinomas and 1 sinonasal undifferentiated carcinoma, comprising from 10 to 95 % of the tumor volume. Malignant histologic features included atypical mitoses, necrosis, bone invasion, lymphovascular invasion, decreased transmigrating neutrophils, paradoxical maturation, dyskeratosis and/or perineural invasion (n = 3). Patients tended to present with advanced stage (n = 14, Stage III and IV). Immunohistochemical studies showed positive reactions in the malignancies for CK5/6 (86 %), p63 (86 %), CK7 (luminal, 50 %), p53 (83 %), and p16 (25 %). In situ hybridization detected human papillomavirus in 26 %. Surgery was often accompanied by radiation therapy (n = 13), with a mean of 2.4 years of follow-up. Five patients developed a recurrence between 0.8 and 3.3 years. Carcinomas ex-SP are less common and are associated with better outcome than previously reported. Patients tend to present with a synchronous carcinoma, developing in an inverted type SP, with squamous cell carcinoma the most common malignancy. Development of metachronous carcinomas ex-SP was always preceded by SP recurrence in this series.
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Affiliation(s)
- Jeremy Nudell
- Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
| | - Simion Chiosea
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA USA
| | - Lester D. R. Thompson
- Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
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Gaio E, Marioni G, Blandamura S, Staffieri A. Inverted papilloma involving the temporal bone and its association with squamous cell carcinoma: critical analysis of the literature. Expert Rev Anticancer Ther 2014; 5:391-7. [PMID: 15877533 DOI: 10.1586/14737140.5.2.391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inverted papilloma is a rare, benign neoplasm, which usually originates from the lateral nasal wall and can be locally aggressive, extending into surrounding structures. Unusually, this disease involves temporal bone. There have been only 18 reported cases in the literature. The available data regarding inverted papilloma of the temporal bone are reviewed, and its etiopathogenesis, recurrence rate and association with squamous cell carcinoma are discussed.
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Affiliation(s)
- Elena Gaio
- Department of Otolaryngology, Head and Neck Surgery, University of Padova, Padova, Italy
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