Abordaje multidisciplinario del papiloma invertido nasal asociado con mucopiocele frontoetmoidal orbitario: técnica endoscópica y abierta por otorrinolaringología, neurocirugía y oftalmología / Multidisciplinary approach of nasal inverted papilloma associated with frontoethmoidal orbitary mucopiocele: endoscopic and open technique by otorhinolaryngology, neurosurgery and ophthalmology

Introducción: el papiloma invertido nasal es un tumor nasosinusal primario de comportamiento intermedio, con potencial de malignización y capacidad de recidiva en asociación con mucocele. El manejo quirúrgico de ambas patologías se ha descrito de manera independiente. Caso clínico: paciente con diagnóstico de papiloma invertido nasal Krause III y mucopiocele frontoetmoidal orbitario derecho con destrucción de techo de órbita y pared posterior del seno frontal en quien se realizó el manejo multidisciplinario mediante abordaje endoscópico y abierto sin recidiva luego de un año de seguimiento. Discusión: a la luz de la evidencia actual, el tratamiento del papiloma nasal invertido es quirúrgico recomendando abordajes endoscópicos en estadios I, II y III, y técnicas combinadas en estadio IV. En nuestro caso se realizó una resección endoscópica completa del tumor con frontoetmoidoesfenoidotomía + maxilectomía medial y fresado de inserciones óseas. Para el mucocele frontal, el abordaje debe permitir la remoción de la mucosa sinusal y la secuestrectomía ósea. Teniendo en cuenta la localización lateral y el compromiso osteolítico del techo de la órbita y la pared posterior del seno frontal, se optó por un abordaje abierto mediante un colgajo osteoplástico con cranealización de seno frontal. El manejo de las secuelas orbitarias consistió en la reconstrucción del techo de la órbita y dacriocistorrinostomía endoscópica.

Introduction: Nasal inverted papilloma is a primary nasosinusal tumor of intermediate behavior, with potential for malignancy and relapse capacity in association with mucocele. The surgical management of both pathologies has been described independently. Case report: Patient with a diagnosis of Krause III nasal inverted papilloma and right frontoethmoidal orbitary mucopiocele with destruction of the orbital roof and posterior wall of the frontal sinus is performed using a multidisciplinary approach with an endoscopic and open approach without relapse after one year of follow-up. Discussion: The treatment of inverted nasal papilloma is surgical recommending endoscopic approaches in stages I, II and III, and combined techniques in stage IV. In our case, a complete endoscopic resection of the tumor was performed with frontoethmoidosphenoidotomy + medial maxillectomy and milling of osseous insertions. For the frontal mucocele, the approach should allow the removal of the sinus mucous membrane and the bone sequestractomy. Considering the lateral location, the osteolytic involvement of the orbital roof and the posterior frontal sinus wall, we opted for an open approach using an osteoplastic flap with frontal sinus cranialisation. The management of the orbital sequelae consisted of reconstruction of the orbital roof and endoscopic dacryocystorhinostomy.

Widespread Inverted Papilloma in the Frontal Sinus Treated by Unilateral Osteoplastic Flap Surgery without Obliteration / 대한이비인후과학회지

Inverted papilloma is a rare sinonasal tumor that mainly occurs in adults during the 5th decade. Three characteristics make this tumor very different from other sinonasal tumors: a relatively strong potential for local destruction, high rate of recurrence, and a risk of carcinomatous evolution. Etiology remains little understood, but an association with human papilloma virus has been reported in up to 40% of cases, raising the suspicions of implication in the pathogenesis of inverted papilloma. Treatment of choice is surgery, by endonasal endoscopic or external approach, depending on extension and tumoral characteristics. We experienced a case of 42-year-old male with inverted papilloma which originated from the ethmoid roof and spread into the frontal sinus. He was treated successfully by unilateral osteoplastic flap surgery without obliteration, and we report on the treatment of this case, along with a review of literature.

Correlation of CEUS and microvessel density in inverted papilloma of bladder and bladder urothelial carcinoma / 中国医学影像技术

Objective To explore the correlation between time-intensity curve (TIC) parameters of CEUS and microvessel density (MVD) of inverted papilloma of bladder (IPB) and bladder urothelial carcinoma (BUC).Methods Clinical and CEUS characteristics of 30 patients with IPB and 50 patients with BUC confirmed by pathology were retrospectively analyzed.CEUS TIC parameters included rise time (RT),mean transit time (MTT),peak intensiy (PI),time from peak to one half (TPH),wash in slope (WIS),time to peak (TP),semi-descending slope (DS) were acquired by QLab software and statistical analysis was carried out.The MVD of the resectioned tissue specimens were quantified via immunohistochemistry for CD34 and the correlation with CEUS TIC parameters was investigated.Results In CEUS quantitative parameters,PI,TPH,TP and DS had statistical significance in IPB and BUC (all P＜＜0.05).MVD of BUC was obviously higher than that of IPB (P＜0.05);TPH and DS both correlated with MVD (rs =0.74,-0.81,both P＜0.05).Conclu sion CEUS characteristics has certain clinical value in identification of IPB and BUC.TIC parameters of CEUS can reflect the MVD of IPB and BUC.

Clinical analysis on the endoscopic or endoscopy-assisted treatment for the malignant transformation of sinonasal inverted papilloma / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo investigate malignant transformation of sinonasal inverted papilloma(SNIP) treated by endoscopic or endoscope assisted surgery, in order to analyze its probable prognostic factors and the optimized method.METHODSThe clinical data of 27 cases with malignant transformation of SNIP treated by endoscopic or endoscope assisted surgery from September 2001 to September 2010 were reviewed. According to preoperative imaging examination and UICC staging criteria, 3 cases were T1, 8 cases were T2, 12 cases were T3 and 4 cases were T4. 16 of them received radiotherapy after endoscopic surgery while the other 11 received surgery alone. RESULTSAll cases were confirmed as squamous cell carcinoma pathologically after surgery. The 5-year overall survival rate was 77.8% for all the patients. The 5-year survival rate was 75.0% for surgery alone group, of which 5 cases recurred locally after operation. The 5-year survival rate was 81.8% for surgery combined with radiotherapy group, of which 5 cases recurred locally and 2 cases died from intracranial metastasis.CONCLUSIONEndoscopic or endoscope assisted surgery can be used in the management of malignant transformation of SNIP to improve the quality of life, with the preponderances of desired effect and less complication. Application of radiotherapy after surgery could improve long-term survival rate of the patients.

A Case of Papillary Squamous Cell Carcinoma Which Associated with Inverted Papilloma in Sinonasal Cavity / 대한이비인후과학회지

According to the classification of World Health Organization, papillary squamous cell carcinoma is a variant of squamous cell carcinoma. This is a malignancy rarely found in the upper aerodigestive tract, especially in the sinonasal tract. We experienced a case, in which a 50-year-old man had papillary squamous cell carcinoma on his right nasal cavity, accompanied with inverted papilloma and fungiform papilloma. They were resected via endoscopic and Caldwell-Luc's approach. After the operation, the patient was treated with radiotherapy for 7 weeks, and has been disease-free for two years. We present the clinical characteristics, pathology, treatment, and prognosis of the tumor with a review of the literature.

The application of an image guidance endoscopic system for nasal inverted papilloma and sinus osteoma / 重庆医学

Objective To evaluate the clinical effect of image guided navigation system (IGNS) and traditional methods for nasal inverted papilloma and sinus osteoma .Methods 73 cases of nasal inverted papilloma and sinus osteoma patients were divided into the navigation group and the non-navigation group ,the navigation group was given image guidance endoscopic sinus surgery ,the non-navigation group was given traditional endoscopic sinus surgery .operative time ,the anesthesia time ,amount of bleeding ,compli-cations and postoperative effects of the two groups were analyzed .Results The anesthesia time of the two groups had no significant difference(P>0 .05) ,the operative time ,blood loss had significant difference(P0 .05) ,while in stage Ⅲ ,Ⅳ ,the difference of recurrence rate had significant difference(P0 .05) ,while had significant different in stage Ⅲ ,Ⅳ(P<0 .05) .In the sinus osteoma ,the com-plications of the two grouos had significant difference(P<0 .05) .Conclusion For sinus osteoma and Ⅲ ,Ⅳ level of nasal inverted papilloma ,IGNS could work well with endoscopic system ,improve operation accuracy and reduce complications .IGNS is of a useful tool for endoscopy sinus surgery and would make a great important development in future .

A evolução da cirurgia endoscópica no tratamento do papiloma invertido / Evolution of endoscopic surgery in the treatment of inverted papilloma

O papiloma invertido (PI) apresenta diversos tipos de tratamento cirúrgico. A abordagem endoscópica exclusiva tem se mostrado na última década como boa opção em relação à abordagem externa. OBJETIVO: Descrever a amostra dos pacientes com diagnóstico de papiloma invertido, mostrar a experiência do serviço no manejo do tumor e comparar os dados com os da literatura. Forma do Estudo: Estudo de coorte histórica com corte transversal. MÉTODO: Estudo retrospectivo dos prontuários de 17 pacientes operados em um serviço de Rinologia entre 2005 e 2011. Foram avaliados perfil epidemiológico, estadiamento de Krouse, via de acesso cirúrgico, malignização e recorrência pós-operatória e a correlação entre recidivas e estadiamento pré-operatório, via de acesso cirúrgico e malignização. RESULTADOS: Cinco (29,41%) dos pacientes foram classificados como estádio T2 de Krouse, nove (52,94%) como T3 e três (17,65%) como T4. Três (17,65%) pacientes apresentaram malignização e quatro (23,5%) recidiva. Onze pacientes (64,70%) foram submetidos à via endoscópica exclusiva, três (17,6%)à via combinada e três (17,6%) à via aberta. CONCLUSÃO: O acesso endoscópico exclusivo atualmente é um método não só eficaz como também seguro para o tratamento dos estádios mais avançados do PI.

Inverted papilloma (IP) has several treatment avenues. The endoscopic approach in the last decade has proven to be a good option over the traditional approach. OBJECTIVE: Describe the epidemiological profile of patients with inverted Papilloma, describe our experience on managing this tumor and compare our data with the literature. Study Design: Cross-sectional, historical cohort. METHOD: Retrospective study of medical records of 17 patients treated for histopathologicallyconfirmed inverted papilloma between 2005 and 2011. We assessed patients age, gender, tumor side, symptoms, diagnosis, comorbidities and habits, Krouse staging, surgical approach, intraoperative and postoperative, and malignant postoperative recurrence and also the correlation between recurrence with preoperative staging, the surgical approach used, and the presence of malignancy. RESULTS: Five (29.41%) patients were classified as Krouse stage T2, 9 (52.94%) as T3 and 3 (17.65%) as T4. Three (17.65%) patients had malignancy and the recurrence rate was 23.5% (4 pacients). Eleven patients (64.70%) underwent endoscopic approach, 3 (17.6%) the combined aprroach (endoscopic assisted) and 3 (17.6%) external approach. CONCLUSION: The endoscopic approach is currently becoming a method not only effective but also safe for the treatment of more advanced stages of IP.

Análise retrospectiva de 26 casos de papiloma invertido nasal / Retrospective analysis of 26 cases of inverted nasal papillomas

Papiloma invertido (PI) corresponde a 0,5 por cento-4 por cento dos tumores nasais benignos. A importância está na agressividade local, taxa de recorrência elevada e possibilidade de transformação maligna. O tratamento é controverso, encontrando melhor suporte na cirurgia endoscópica. OBJETIVO: Descrever aspectos clínico-epidemiológicos e tratamento dos casos de PI de um hospital terciário. CASUÍSTICA E MÉTODO: Estudo retrospectivo, realizado por revisão de prontuários de 26 pacientes com diagnóstico de PI nasal, avaliando localização tumoral, estadiamento clínico, tempo de seguimento, recidiva tumoral, malignidade, tipo de cirurgia realizada e complicações pós-operatórias. RESULTADO: Na casuística, havia 13 homens e 13 mulheres, com idade média de 57,8 anos. O tempo médio de seguimento foi de 29,4 meses, com 7,6 por cento de taxa de recidiva. Houve predomínio de tumores T3 e T4 e 3,8 por cento de taxa de malignidade. Todos foram submetidos a tratamento cirúrgico, predominando a cirurgia endoscópica endonasal. CONCLUSÃO: O PI é um tumor nasal originado principalmente na parede lateral nasal, mas também acomete seios paranasais. Avanços na cirurgia endoscópica vêm ganhando destaque pela menor invasividade e taxas de sucesso semelhantes às técnicas tradicionais externas, permitindo a exérese completa do tumor e proporcionando menor taxa de recidiva e tratamento completo no caso de malignidade.

Inverted papilloma (IP) comprises 0.5-4 percent of benign nasal tumors. The importance is shown by local aggressiveness, a high recurrence rate and the possibility of malignant transformation. The treatment is controversial, but endoscopic approaches tends to be the choice today. AIM: To describe clinical, epidemiological and treatment of IP cases in a tertiary hospital. METHODS: Retrospective study consisting of chart reviews of 26 patients diagnosed with IP; evaluation of tumor location, clinical staging, follow up, tumor recurrence, malignancy, type of surgery and postoperative complications. RESULTS: There were 13 men and 13 women, the mean age was 57.8 years. The mean follow up time was 29.4 months; the recurrence rate was 7.6 percent. There was a preponderance of T3 and T4 tumors and a 3.8 percent malignancy rate. All patients underwent surgical treatment, mostly endonasal endoscopic surgery. CONCLUSION: IP is an uncommon nasal tumor that originates mainly in the lateral nasal wall, but it also affects the paranasal sinuses. Advances in endoscopic surgery are gaining room due to lower invasiveness and success rates similar to traditional external techniques for completely resecting the tumor. There is a lower recurrence rate, and endoscopy a definitive treatment for malignancy cases in this study.

Clinical significance of TGF-β1 and VEGF expression in tissues of nasal inverted papilloma / 中国基层医药

ObjectiveTo investigate the clinical significance of transforming growth factor β1 (TGF-β1)and vascular endothelial growth factor (VEGF) expression in tissues of nasal inverted papilloma (NIP).MethodsThe clinical data of patients with NIP underwent surgical resection were retrospectively analyzed.The TGF-β1 and VEGF expression in NIP tissues and nasal polyps tissues were detected by immunohistochemistry method.100 patients with NIP were divided into benign lesions,atypical hyperplasia and malignant group according to result of pathological diagnosis,the nasal polyps was used as the control group.ResultsThe positive expression rate of TGF-β1 and VEGF in the NIP group were 46.0％ and 32.0％,compared with the control group the differences were significant(all P ＜ 0.05 ).In different pathological groups,the results of TGF-β1 and VEGF expression were malignant group ＞ atypical hyperplasia ＞ benign lesions.The positive expression rate of TGF-β1 and VEGF in the NIP group had significantly positive correlation(P ＜ 0.05).ConclusionThe TGF-β1 and VEGF expression were closely related to the the occurrence,development and malignant of NIP.TGF-β1 was highly expressed in the NIP tissues,and could increase the expression of VEGF and promote the formation of neovascularization of NIP.

Papiloma invertido (Papiloma Schneideriano) com envolvimento da cavidade oral: relato de caso incomum / Inverted papilloma (Schneiderian papilloma) with involvement of the oral cavity: report of an unusual case

O papiloma invertido schneideriano é uma neoplasia de origem no epitélio de revestimento que surge da mucosa respiratória revestindo a cavidade nasal e os seios paranasais. Frequentemente, surge como uma lesão unilateral no septo nasal e estende-se secundariamente para o nariz e os seios paranasais. Este trabalho relata um caso incomum desta patologia, com o envolvimento da cavidade oral em um homem branco, de 61 anos de idade, cuja avaliação clínica revelou uma massa vegetante no rebordo alveolar direito da maxila, com duração de aproximadamente 4 meses. Após avaliação radiográfica, constatouse o envolvimento do seio maxilar. A análise microscópica, hibridização in situ e análise imunoistoquímica da peça cirúrgica levaram a um diagnóstico de displasia moderada em PIS associado à infecção por HPV.

Inverted Schneiderian papilloma (ISP) is a neoplasm of epithelial lining origin which arises in the respiratory mucosa that lines the nasal cavity and paranasal sinuses. The inverted Schneiderian papilloma frequently appears as a unilateral lesion in the nasal septum and extends secondarily to the nasal and paranasal sinuses. This paper reports an unusual case of this pathology with involvement of the oral cavity in a 61-year-old white man. Clinical evaluation revealed a vegetating mass in the alveolar ridge of the right maxilla that had been present for approximately 4 months. After radiographic evaluation, involvement of the maxillary sinus was detected. Microscopic evaluation, in situ hybridization and immunohistochemical analysis of the specimen led to a diagnosis of ISP moderate dysplasia associated with HPV infection.

Endoscopic sinus surgery combined with mitomycin in nasal inverted papillom / 中国医师进修杂志

ObjectiveTo explore the effect of endoscopic sinus surgery combined with mitomycin in nasal inverted papilloma (NIP). MethodThe clinical data of 75 patients with NIP was retrospectively analyzed and divided into treatment group (endoscopic sinus surgery combined with mitomycin treatment, 38 cases) and control group (endoscopic sinus surgery treatment, 37 cases) by random digits table. Results There was no complication in treatment group, the symptoms disappeared after treatment, good recovery and surgery epithelization was found after follow-up, 1 case of grade Ⅲ recurred at 3 months after treatment and followed up for 5 years without recurrence. In control group, 37 cases of conventional dressing endoscopic treatment, recurrence within 1 year in 3 cases, 4 cases of recurrence in the second year, 5 cases of reoperation cured, 2 cases of malignant transformation. The efficacy was no statistically significant between two groups( X2 =9.86,P ＜ 0.05). ConclusionEndoscopic sinus surgery combined with mitomycin in treatment of NIP, intraoperative and postoperative adjuvant therapy given to the local mitomycin, inhibit their growth and development, can inhibit the NIP recurrence and improve the cure rate.

MRI diagnosis of sinonasal inverted papilloma / 中华放射学杂志

Objective To investigate the MRI findings of sinonasal inverted papilloma so as to promote the diagnostic accuracy.Methods All 36 cases of sinonasal inverted papilloma were verified by pathology.Their MRI findings were analyzed retrospectively.Results The lesion occurred in the lateral nasal wall in 25 cases,in the maxillary sinus in 4 cases,in the ethmoid sinus in 2 cases,in the frontal and ethmoid sinuses in 2 cases, in the ethmoid and sphenoid sinuses in 2 cases and in the frontal sinus in one case.Of the 36 cases,11 cases had recurrent lesions and 3 cases were associated with malignant change.All lesions showed well-defined margin,with lobulate configuration in 26 cases and irregular shape in 10 cases.The diameter of the lesions ranged from 22 to 82 mm (mean,38 mm).On MR T1WI,sinonasal inverted papilloma revealed isointense signal compared to adjacent muscle in 32 cases and slight hyperintense signal in 4.On T2 WI,the lesions showed heterogeneous hyperintense signal in 34 cases and inhomogeneous isointense signal in 2 cases with malignant change.Postcontrast MR imaging demonstrated marked inhomogeneous enhancement compared with nasal septum mucosa in 34 cases.Regular fence-like pattern was found on MR T2WI and enhanced T1WI in 32 cases,while irregular ones were found in three cases with malignant change.The time-intensity curve (TIC)of dynamic contrast enhancement of MRI showed rapid enhancing and slow wash-out type in 7 cases,while rapid enhancing and wash-out pattern was detected in one ease with malignant change.Conclusion Regular fence-like pattern on MR T2WI or enhanced T1WI was reliable characteristics for the diagnosis of sinonasal inverted papilloma.Irregular ones may suggest malignant change.

Atualização acerca do papiloma do urotélio / Update on urotelial papiloma

Inverted papilomas are rare urotelial neoformations, which account for 2.2% to 4.5% of urotelial neoplasms (benign or malignant). Most of them have vesical location, namely on the trigonal area, although there are cases which have been described along the whole of the urinary excretory system. In spite of the well defined histological criteria, their origin is not entirely understood. Considered as benign tumors in the past, multiple evidence points out to the possibility of recurrence and to association with urotelial carcinomas, synchronic or metachronic, thus causing problems with the patient's followup. The distinction between inverted papilomas and urotelial carcinomas also poses problems, especially when located in the high excretory system, very often leading to aggressive, unnecessary surgical procedures with loss of kidney units. The authors present a critical review of the available literature on the etiology, clinical presentation, diagnostic criteria, treatment and prognostic aspects of this condition

Os papilomas invertidos são neoformações uroteliais raras, constituindo entre 2.2% e 4.5% das neoplasias uroteliais (benignas ou malignas). Apresentam maioritariamente localização vesical, nomeadamente (principalmente) a nível da região trigonal, embora haja (aunque hay) casos descritos ao longo de todo o aparelho (aparato) excretor urinário. Apesar dos critérios histológicos estarem bem definidos, a sua génese é incompletamente compreendida. Considerados no passado tumores benignos, múltiplas evidências apontam para a possibilidade de recorrência e associação com carcinomas uroteliais, de forma síncrona ou metacrónica, impondo (imponiendo) problemas no que toca ao seguimento dos doentes (enfermos). Colocam problemas ao nível de diagnóstico diferencial com os carcinomas uroteliais, designadamente quando localizados no aparelho excretor alto, motivando muitas vezes atitudes cirúrgicas agressivas desnecessárias, condicionando perda (pérdida) de unidades renais. Os autores realizam uma revisão crítica da literatura disponível acerca da etiologia, clínica, critérios e meios de diagnóstico, tratamento e aspectos de prognóstico desta afecção

Treatment of inverted papilloma of nasal cavity and sinuses by endoscopic transnasal approach / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the outcome of endoscopic transnasal management of inverted papilloma of nasal cavity and sinuses. METHODS The clinical data of 28 cases with inverted papillomas of nasal cavity and sinuses treated via nasal endoscope were studied retrospectively. RESULTS All of the patients were followed up from 7 months to 5 years. Only 6 cases(21%) recurred. Of the 6 cases, ethmoid and sphenoid sinuses were involved in 2 cases and maxillary sinus was involved in 4 cases. CONCLUSION Endoscopic transnasal resection of inverted papilloma is a good approach for the treatment of patients with inverted papilloma of nasal cavity and sinuses.

Endoscopic management of inverting papilloma in nasal cavity and paranasal sinuses / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the therapeutic effect of intranasal endoscopic surgery on inverted papilloma of the nasal cavity and paranasal sinuses in stage Ⅰ-Ⅲ. METHODS According to the staging system developed by John H.Krouse,30 cases with inverted papilloma in the nasal cavity and paranasal sinuses in stage Ⅰ-Ⅲ were analyzed retrospectively. All patients were treated by intronasal endscopic surgery and were followed up for 24 months. RESULTS The inverted papilloma was removed completely and no serious complications occurred. One case recurred at 10 month after surgery and pathologically proved to be cancerated. Another 2 case recurred at 6 and 7 month after surgery respectively. Recurred tumors were removed again, no recurrences occurred in the following up period. The recurrence rate was 10 % and canceration rate was 3.3 %. CONCLUSION Endoscopic surgery is an effective method in management of the inverting papilloma in nasal cavity and paranasal sinuses in stage Ⅰ-Ⅲ.

Expression of SleX and CD24 in nasal inverted papilloma / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the expression of SleX and CD24 in nasal inverted papilloma and its pathologic features.METHODS HE staining were conducted to study the pathologic features in specimens of 11 cases with nasal inverted papilloma. Further,immunohistochemistry stain for SleX and CD24 were performed in total specimens.RESULTS One case(9.1%) was diagnosed as severe atypical hyperplasia but tumor cells did not invaded basal membranes.SleX staining located at cell membranes. Positive SleX staining was found in 9 specimens (81.8%) and 1 normal nasal epithelium (16.7%).CD24 staining located in cytoplasm.Positive CD24 staining was found in 8 specimens of nasal inverted papilloma (72.7%). CD24 was negative in nasal epithelial cells and only a few lymphocytes were positive.CONCLUSION Some cases of nasal inverted papilloma are diagnosed with severe atypical hyperplasia.Most of cases express CD24,so nasal inverted papilloma may be a borderline tumor.Expression of SleX and infiltration of inflammatory cells suggest that nasal inverted papilloma may be related to inflammatory reactions.

Expression and significance of PCNA and p27 in inverted papilloma of nasal cavities and paranasal sinuses / 中国耳鼻咽喉头颈外科

0.05). CONCLUSION The PCNA labeling index may reflect the proliferating condition of NIP, but does not have relationship with NIP recurrence. And the role of p27 in the development of NIP needs more investigation.

Expression of human telomerase reverse transcriptase in malignant transformation of sinonasal inverted papilloma / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the relationship of telomerase and canceration of sinonasal inverted papilloma(IP). METHODS Telomerase activity was measured by hybridization in situ in sinonasal mucosa of 10 cases of chronic in?ammation, 45 cases of sinonasal IP with dysplasia(45 cases were divided into three groups: IP with mild dysplasia, IP with moderate dysplasia and IP with severe dysplasia, 15 cases in each group), and 21 cases of cancerated sinonasal IP. RESULTSThe positive expression rates of telomerase was 0% in sinonasal mucosa with chronic inflammation, 0% in sinonasal IP with mild dysplasia, 13.3% in sinonasal IP with moderate dysplasia, 73.3% in sinonasal IP with severe dysplasia and 80.9% in cancerated sinonasal IP. CONCLUSION Telomeras plays a critical role in malignant transformation of sinonasal IP, and it is a marker of malignant transformation tendency of sinonasal IP.

Expression of Cyclooxygenase-2 and Matrix Metalloproteinases in Sinonasal Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The matrix metalloproteinases (MMPs) have been associated with tumor cell invasion and metastasis by mediating the degradation of extracellular matrix components. Cyclooxygenase-2 (COX-2) plays an important role in promotion of carcinogenesis, tumor invasiveness and angiogenesis. Recently, some investigators have reported that COX-2 could promote secretion of MMP-2 and MMP-9. Therefore, an interrelation between MMPs and the associated COX-2 may play a significant role in the invasive phenotype of malignant tumors. In the present study, the authors investigated the correlation between expressions of COX-2 and MMPs. MATERIALS AND METHOD: Immunohistochemical staining of MMP-2, -3 and -9, and COX-2 were performed on paraffin-embedded tissue sections of 51 nasal cavity and paranasal sinuses tumors (27 inverted papillomas, 5 inverted papillomas with malignant transformation, and 19 squamous cell carcinomas). Co-expression of these MMPs and COX-2 was visualized with confocal laser scanning microscope. RESULTS: MMP-2, -3 and -9 were found mainly in malignant lesions in concert with COX-2. However, the co-expressions of MMP-2 and COX-2, MMP-9 and COX-2 were detected with significance. CONCLUSION: These results suggest a potentially important role for COX-2 in the regulation of MMPs, malignant transformation, and progression of squamous cell carcinoma, and it points out the potential use of COX-2 inhibitors, in the prevention and treatment of squamous cell carcinoma of nasal cavity and paranasal sinuses.

Inverted Papilloma of the Nose and Paranasal Sinuses: An Analysis of 102 Cases / 대한이비인후과학회지

OBJECTIVES: Inverted papilloma is characterized by a high rate of recurrence, local aggressiveness and association with malignancy. We reviewed the 16-year experience of our institution in clinical presentation, history and the recurrence rate according to the tumor stage and surgical modalities. MATERIALS AND METHOD: A retrospective study was conducted on 102 patients diagnosed as inverted papilloma between January, 1986 through August, 2002. Demographic data, clinical presentations, and association with malignancy were analyzed. All patients with inverted papilloma were staged according to the Krouse's staging system. Sixty eight patients followed up at least 6 months were divided into endoscopic and conventional surgery groups. We compared the recurrence rate between the two groups according to the tumor stage. RESULT AND CONCLUSION: Patients were aged 19 to 81 years, and 73.5% were male. The most frequent presenting complaint was nasal obstruction. The most common site of involvement was the lateral nasal wall in the region of the middle meatus. The overall malignancy rate was 8.8% (9 cases), with synchronous tumors accounting for 7 cases and metachronous tumors accounting for 2 cases. When patients were first diagnosed, the most common stage was T2 (52.7%). The recurrence rates of T1, T2 and T3 were 10%, 11.1% and 4.8%, respectively, with no significant difference. Also the recurrence rates in endoscopic and conventional surgery group according to the stage had no significant difference.