Application experience of prelacrimal recess combined with septotomy in resection of recurrent inverted papilloma / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the effectiveness of nasal endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum in resecting recurrent nasal inverted papilloma. Methods:Patients with recurrent nasal inverted papilloma who underwent reoperation in our hospital during the past 2 years were included . The nasal septum may hinder full access to and effective treatment of the lesions at the anterior and medial wall of the maxillary sinus by endoscope, aspirator and surgical instrument in the narrow aperture of the prelacrimal recess, although these lesions could be observed by 70° nasal endoscope. Results:The nasal septum is temporarily opened on the basis of the prelacrimal recess approach, and the nasal endoscope and instrument was introduced through trans-septal window, so as to provide a better view of the operative field and the angular range of the instrument's movement. Conclusion:The recurrent nasal inverted papilloma could be successfully managed by re-endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum, and no recurrence was observed during the 2-year follow-up. This surgical approach is recommended for the inverted papilla which originates from the anterior medial wall of the maxillary sinus, as the tumor can be removed completely using this surgical approach.

Prognostic significance of p16, VEGF, and p53 expression patterns, Krouse stage, and smoking status in sinonasal inverted papillomas

Aim: The aim of our study is to analyze the staining models for VEGF, p16, and p53, as well as to understand the biology of inverted papilloma caused by smoking. Materials and Methods: Thirty-one cases, diagnosed with sinonasal inverted papilloma between 2015 and 2019, were included. Demographic data such as age and gender, admission symptoms of the patients, and anatomical location, stage, surgical technique, and recurrence information were obtained from clinical follow-up files. Immunohistochemical staining for p16, VEGF, and p53 were performed on patient materials. Results: In our study, the female to male ratio was 9.33 with an average age of 53.137 ± 13.96 years. Of the patients, 17 were nonsmokers and 14 were smokers. No significant relationship was found between smoking status and relapse and dysplasia. In contrast, a significant relationship between the Krouse stage and dysplasia (P = 0.005) was observed. A similar significant relationship was observed between p16 immunohistochemical expression and dysplasia (P = 0.030). On the other hand, VEGF and p53 immunohistochemical expressions were not significantly related with dysplasia and recurrence. Conclusions: Inverted papillomas are benign tumors that clinically give symptoms similar to nasal polyps. However, recurrence and malignant transformation potential exist and the factors causing this risk are not clearly identified. In our study, no malignant transformation was observed in patients who were admitted to our hospital.

Does evaluation of tumor volume or/both origination site better guide to optimal surgery for inverted papilloma? / A avaliação do volume do tumor e/ou dos seus locais de origem fornece a melhor orientação para a técnica cirúrgica ideal do papiloma invertido?

Abstract Introduction Sinonasal inverted papilloma is noted for its high rate of recurrence. Staging systems aid to reduce recurrence and avoid excessive surgeries by guiding the selection of the optimal surgical approach. Objective To evaluate the effectiveness of different endoscopic approaches in inverted papilloma by assessing tumor origin site and tumor volume. Methods Krouse classification system that is based on tumor volume was used for staging; furthermore, tumor origin sites were grouped as lateral nasal wall, medial wall and other walls of maxillary sinus. The main treatment method for all patients was endoscopic sinus surgery. Endoscopic extended middle meatal antrostomy, endoscopic Caldwell-Luc and endoscopic medial maxillectomy were the additional surgery types performed in different combinations. Results Fifty-five patients (42 male) with a mean 54.9 ± 14.4 years of age were included. 37 patients were diagnosed with advanced stage inverted papilloma (67.2 %). Recurrence was observed in 12 patients (21.8 %). In early stage lateral nasal wall origination, no recurrence was observed in the simple tumor resection group (0/10). In early stage medial wall origination, no recurrence was observed in the extended middle meatal antrostomy group (0/8). In advanced stage medial wall origination, the recurrence rates of extended middle meatal antrostomy, extended middle meatal antrostomy + endoscopic Caldwell- Luc and endoscopic medial maxillectomy were 100.0 %, 53.8 % and 13.6 %, respectively (p = 0.002). In advanced stage other walls of maxillary sinus origination, recurrence rates of extended middle meatal antrostomy + endoscopic Caldwell-Luc and endoscopic medial maxillectomy were 20 % and 16.6 %, respectively (p = 0.887). Conclusion Tumor origin site, tumor stage and surgery types show an impact on recurrence. Despite the fact that tumor origin site singly could lead to appropriate selection of the surgery type in most cases, tumor stage carries substantial importance in selection of surgery type for sinonasal-inverted papilloma. An operation plan regarding both tumor volume and tumor origin site may aid surgeons in selecting optimal endoscopic surgical method to avoid recurrence or excessive surgeries.

Resumo Introdução O papiloma invertido nasossinusal é conhecido por sua alta taxa de recorrência. Os sistemas de estadiamento ajudam a reduzir a recorrência e evitar cirurgias excessivas e orientam a seleção da abordagem cirúrgica ideal. Objetivo Avaliar a eficácia de diferentes abordagens endoscópicas no papiloma invertido, de acordo com o local de origem e o volume do tumor. Método Para o estadiamento, usou-se o sistema de classificação de Krouse, baseado no volume do tumor; além disso, os tumores foram agrupados de acordo com seus locais de origem: parede nasal lateral, parede medial e outras paredes do seio maxilar. O principal método de tratamento para todos os pacientes foi a cirurgia endoscópica nasossinusal. Foram feitos, em diferentes combinações, os seguintes tipos de cirurgia: antrostomia estendida do meato médio, Caldwell-Luc endoscópica e maxilectomia medial endoscópica. Resultados Foram incluídos 55 pacientes (42 homens) com média de 54,9 ± 14,4 anos. Trinta e sete pacientes foram diagnosticados com papiloma invertido avançado (67,2%). Foi observada recorrência em 12 pacientes (21,8%). No estágio inicial com origem na parede nasal lateral, não foi observada recorrência no grupo de ressecção simples de tumor (0/10). No estágio inicial com origem na parede medial, não foi observada recorrência no grupo de antrostomia estendida do meato médio (0/8). Com tumor em estágio avançado com origem na parede medial, as taxas de recorrência na antrostomia estendida do meato médio, antrostomia estendida do meato médio + Caldwell-Luc endoscópica e maxilectomia medial endoscópica foram de 100,0%, 53,8% e 13,6%, respectivamente (p = 0,002). No tumor em estágio avançado em outras paredes do seio maxilar, as taxas de recorrência na antrostomia estendida do meato médio + Caldwell-Luc endoscópica e maxilectomia medial endoscópica foram de 20% e 16,6%, respectivamente (p = 0,887). Conclusão O local de origem do tumor, o estágio do tumor e os tipos de cirurgia mostram impacto na recorrência. Apesar da consideração de que na maioria dos casos o local de origem do tumor pode, de forma isolada, orientar a seleção apropriada do tipo de cirurgia, o estágio do tumor tem importância substancial na seleção do tipo de cirurgia para papiloma invertido nasossinusal. Um planejamento cirúrgico considerando tanto o volume quanto o local de origem do tumor pode ajudar os cirurgiões a selecionar o tipo ideal de cirurgia endoscópica para evitar recorrências ou remoções excessivas.

Surgical outcomes of sinonasal inverted papilloma: a 17 year review / Resultados cirúrgicos do papiloma invertido nasossinusal: uma revisão de 17 anos

Abstract Introduction: Inverted papillomas represent one of the most common benign neoplasic lesions located in the sinonasal tract. Owing to the local erosive behavior, tendency to recur and the potential for malignant transformation, surgical management of inverted papillomas is often challenging. Objective: This study aimed to analyze the surgical outcomes of patients with inverted papillomas, according to the Krouse staging and the different surgical approaches. Methods: Retrospective study of patients diagnosed with sinonasal inverted papillomas who underwent surgical treatment between 2000 and 2016 at a tertiary referral hospital. Cases with follow-up less than 12 months were excluded. The rate and the time of recurrence were the main outcomes. Values of p < 0.05 were considered statistically significant. Results: Thirty-six cases with mean age of 60 years, predominantly male (72%), were included. The follow-up period ranged from 1 to 16 years, with an average of 4.5 years. Krouse T1 Stage corresponded to 11.1%; T2 occurred in 50% of cases; while T3 and T4 Stages accounted for 30.6% and 8.3% of patients, respectively. Most cases were approached by an endoscopic technique alone (83.3%), with a recurrence rate of 13.3%. Patients treated via a combined or open approach revealed a recurrence of 16.7%. No differences in the recurrence rate were reported when comparing endoscopic surgery with the open or combined techniques. Krouse Stage T3 had a significant association with inverted papillomas recurrence (p = 0.023). All inverted papilloma relapses occurred up to 2 years post-operatively. One case of malignant transformation was recorded (2.7%). Conclusion: Endoscopic surgery did not increase the recurrence rates and can be a safe and efficient alternative to open or combined techniques. The recurrence of inverted papillomas seem to be related to the persistence of the disease and tend to occur early after primary surgery. Krouse T3 Stages may be associated with a higher recurrence of inverted papillomas.

Resumo Introdução: Os papilomas invertidos são uma das lesões neoplásicas benignas mais comuns no trato nasossinusal. Devido ao seu comportamento localmente agressivo, tendência para recidivar e potencial de malignização, o tratamento cirúrgico dos papilomas invertidos constitui frequentemente um desafio. Objetivo: Analisar os resultados cirúrgicos dos papilomas invertidos segundo o estadiamento de Krouse, bem como avaliar as diferentes abordagens cirúrgicas. Método: Estudo retrospectivo de pacientes com diagnóstico de papiloma invertido nasossinusal submetidos a tratamento cirúrgico entre 2000 e 2016 em hospital terciário. Casos com acompanhamento inferior a 12 meses foram excluídos. A taxa e o tempo de recidiva foram os principais resultados analisados desfechos avaliados. Valores p < 0,05 foram considerados estatisticamente significativos. Resultados: Foram incluídos 36 casos, com média de idade de 60 anos, predominantemente do sexo masculino (72%). O período de acompanhamento variou de 1 a 16 anos, em uma média de 4,5 anos. Relativamente ao estadiamento, 11,1% dos pacientes foram classificados como estadio Krouse T1, 50% como T2, 30,6% como T3 e 8,3% como T4. A maioria dos casos foi tratada exclusivamente por cirurgia endoscópica (83,3%), com taxa de recidiva de 13,3%. Pacientes tratados com uma técnica combinada ou aberta apresentaram recidiva de 16,7%. Não foram observadas diferenças quanto à taxa de recidiva entre os casos abordados por via endoscópica e os casos tratados com técnica aberta ou combinada. Verificou-se uma associação significativa entre o estadio T3 de Krouse e recidiva de papilomas invertidos (p = 0,023). Todas as recidivas de papilomas invertidos foram observadas até dois anos após a cirurgia. Um caso de transformação maligna foi registrado (2,7%). Conclusão: A cirurgia endoscópica não aumentou as taxas de recidiva e pode ser uma alternativa segura e eficiente às técnicas abertas ou combinadas. Os casos de recidiva do papiloma invertido parecem estar relacionados com a persistência da doença e tendem a ocorrer precocemente após a cirurgia primária. Os estadios T3 de Krouse podem estar associados a uma maior recidiva.

Glandular-type inverted papilloma of urinary bladder – Report of a unique case with immunohistochemistry

Inverted papilloma of urothelium is a rare benign tumour accounting for 1–2% of all the urothelial lesions. Morphologically, these are of two main subtypes – trabecular and glandular, of which the former subtype is most frequently encountered compared to the latter. The glandular subtype closely mimics cystitis glandularis and urothelial carcinoma with inverted growth pattern. We discuss a case of a 27-year-old male presenting with hematuria. On cystoscopy, he was found to have a bladder mass which was diagnosed as glandular-type of inverted papilloma on histopathology. The image illustrates the histopathology for easy identification and early diagnosis of this rare entity.

Clinical value of Siemens 64 row CT and 1.5T MRI in the single or combined diagnosis of SNIP / 中国基层医药

Objective@#To compare the clinical value of Siemens 64 row CT and 1.5 T MRI in the diagnosis of sinonasal inverted papilloma (SNIP).@*Methods@#From June 2008 to June 2017, 200 patients with inverted papilloma of the nasal cavity and paranasal sinuses admitted to Lyuliang People's Hospital were selected.All patients were confirmed by surgery and pathology, and preoperative MRI and CT examination were adopted.Pathological diagnosis was taken as the gold standard for clinical diagnosis, and the coincidence rate of MRI and CT examination with pathological diagnosis was analyzed.@*Results@#The detection rate of disease stage and origin site of pathological examination was significantly higher than those of CT examination (13.00%, 35.00%, 45.00%, 7.00%, 100.00% vs.10.00%, 21.00%, 53.00%, 16.00%, 85.00%, χ2=8.273, 15.273, all P<0.05). There was no statistically significant difference in the malignant detection rate between disease detection and CT (100.00% vs.75.00%; χ2=1.923, P>0.05). There was no statistically significant difference in the detection rate of stage and origin site between the two examination methods (13.00%, 35.00%, 45.00%, 7.00%, 100.00% vs.11.00%, 37.00%, 44.00%, 8.00%, 97.00%; χ2=0.384, 2.073, all P>0.05). The malignant detection rate of pathological examination was 100%, which was significantly higher than that of MRI (100.00% vs.25.00%; χ2=9.923, P<0.05). The malignant rate of MRI examination was 25.00%, which was significantly lower than that of CT examination(χ2=4.233, P<0.05). The detection rates of stage and origin site in MRI examination were significantly higher than those in CT examination (11.00%, 37.00%, 44.00%, 8.00%, 97.00% vs.10.00%, 21.00%, 53.00%, 16.00%, 85.00%; χ2=7.384, 8.073, all P<0.05).@*Conclusion@#There are advantages and disadvantages in the early diagnosis and treatment of inverted papilloma of nasal cavity and paranasal sinuses by CT and MRI, respectively.Therefore, it is suggested that CT and 1.5T MRI should be used together.The extent of the disease and the boundary between the disease and the surrounding soft tissue are more comprehensive, which is helpful to accurately evaluate the clinical stage and origin of the tumor before operation.

Clinical value of Siemens 64 row CT and 1.5T MRI in the single or combined diagnosis of SNIP / 中国基层医药

Objective To compare the clinical value of Siemens 64 row CT and 1.5 T MRI in the diagnosis of sinonasal inverted papilloma (SNIP).Methods From June 2008 to June 2017,200 patients with inverted papilloma of the nasal cavity and paranasal sinuses admitted to Lyuliang People ˊs Hospital were selected.All patients were confirmed by surgery and pathology ,and preoperative MRI and CT examination were adopted.Pathological diagnosis was taken as the gold standard for clinical diagnosis ,and the coincidence rate of MRI and CT examination with patho－logical diagnosis was analyzed.Results The detection rate of disease stage and origin site of pathological examination was significantly higher than those of CT examination (13.00%,35.00%,45.00%,7.00%,100.00%vs.10.00%, 21.00%,53.00%,16.00%,85.00%,χ2 ＝8.273,15.273,all P ＜0.05).There was no statistically significant difference in the malignant detection rate between disease detection and CT (100.00%vs.75.00%;χ2 ＝1.923,P＞0.05).There was no statistically significant difference in the detection rate of stage and origin site between the two examination methods (13.00%,35.00%,45.00%,7.00%,100.00% vs.11.00%,37.00%,44.00%,8.00%, 97.00%;χ2 ＝0.384,2.073,all P＞0.05).The malignant detection rate of pathological examination was 100%, which was significantly higher than that of MRI (100.00%vs.25.00%;χ2 ＝9.923,P＜0.05).The malignant rate of MRI examination was 25.00%,which was significantly lower than that of CT examination (χ2 ＝4.233,P＜0.05). The detection rates of stage and origin site in MRI examination were significantly higher than those in CT examination (11.00%,37.00%,44.00%,8.00%,97.00% vs.10.00%,21.00%,53.00%,16.00%,85.00%;χ2 ＝7.384, 8.073,all P＜0.05).Conclusion There are advantages and disadvantages in the early diagnosis and treatment of inverted papilloma of nasal cavity and paranasal sinuses by CT and MRI ,respectively.Therefore,it is suggested that CT and 1.5T MRI should be used together.The extent of the disease and the boundary between the disease and the surrounding soft tissue are more comprehensive ,which is helpful to accurately evaluate the clinical stage and origin of the tumor before operation.

Comparison Between Endoscopic Prelacrimal Medial Maxillectomy and Caldwell-Luc Approach for Benign Maxillary Sinus Tumors

OBJECTIVES: Endoscopic prelacrimal medial maxillectomy (EPMM) was previously reported to treat maxillary inverted papilloma. This study aimed to compare prelacrimal recess approach with the conventional Caldwell-Luc approach (CLA) to remove benign maxillary sinus tumors and to evaluate the usefulness of this approach based on our experience. METHODS: Ten patients who underwent EPMM at our hospital from January 2013 to December 2017 were reviewed. We also reviewed 30 patients who underwent benign maxillary sinus tumor resection via CLA during the same period. From medical records, postoperative pathological results, complications due to surgery, and recurrence rate were evaluated. RESULTS: There were eight inverted papilloma, one ameloblastoma, and one ossifying fibroma in the EPMM group. In the CLA group, all 30 cases were inverted papilloma. There were no cases of failure at gross total removal during surgery, and no recurrences were observed during follow-up in either groups. Mean follow-up period was 13.0 months in CLA group and 10.8 months in EPMM group. Regarding postoperative complications, 11 patients of the CLA group (37%) and three patients of the EPMM group (30%) had numbness around the cheek and upper lip area after surgery (P=0.715). In the CLA group, there were eight patients who had numbness lasting more than 3 months after surgery, and two patients had numbness for more than 1 year. However, facial numbness disappeared within 3 months in all patients in the EPMM group, in which epiphora was not observed. CONCLUSION: EPMM is the effective surgical approach for resecting benign maxillary sinus tumor compared with CLA. Although facial numbness was reported in EPMM, the duration of numbness was shorter than CLA.

A Case of Concurrent Non-Intestinal Type Adenocarcinoma and Inverted Papilloma in a Maxillary Sinus / 대한이비인후과학회지

Inverted papilloma is a benign epithelial tumor that arises from the sinonasal epithelium and occurs in 0.5–4% of all sinonasal tumors. Although benign, it is associated with malignant transformation in 2–27% of the cases, with the most commonly accompanying malignant tumor being squamous cell carcinoma. The malignant transformation of inverted papilloma into adenocarcinoma is extremely rare, with two cases reported worldwide to date. Here, along with a literature review, we report a recent case of a 53-year-old man with non-intestinal type adenocarcinoma associated with a sinonasal inverted papilloma. This case shows the possibility of a malignant transformation of inverted papilloma into non-intestinal type adenocarcinoma, which may be associated with human papilloma virus and thus requires further investigation.

Prelacrimal Recess Approach for Maxillary Sinus Inverted Papilloma: Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various surgical approaches have been employed for the complete resection of inverted papilloma (IP) of the nose and paranasal sinus. Sacrificing the inferior turbinate (IT) and nasolacrimal duct (NLD) is often unavoidable due to the anatomy of maxillary sinus. However, the prelacrimal recess approach (PLRA) provides a wider entrance to the maxillary sinus without the ablation of NLD and IT. We present seven cases of IP successfully treated by the PLRA. SUBJECTS AND METHOD: We collected data from seven different cases involving patients who underwent resection of IP by means of the PLRA from 2016 to 2017. If the lesion could not be removed first via middle meatal antrostomy (MMA), then PLRA was attempted. The surgical specimens were all confirmed to be IP. RESULTS: Preoperative imaging studies demonstrated that the lesions of IP were located mainly in the maxillary sinus. All of the seven patients had unilateral lesions and all tumors were completely resected via PLRA. The follow-up ranged from 3 to 24 months, during which no recurrence or complications were observed in any of the seven patients. CONCLUSION: PLRA provides an adequate operation field without unfavorable scars. It allows the preservation of sinus structure and function. PLRA is feasible and can be used for the diffuse maxillary sinus IP.

Prevalence Of Inverted Papilloma In A Teritiary Hospital

Inverted papilloma is a benign tumour of nasal cavity arising from lateral wall of nose, septum or anywhere in nasal cavity and sinuses. Pathogenesis is unknown even though many causes are explained like viral infection by HPV, HSV, chronic rhinosinusitis. These have capacity of malignant transformation 10 to 15%.Epstein–Barr virus (EBV), smoking, occupational, environmental and industrial exposures, cell cycle related proteins, angiogenic factors and chronic inflammation.Aims : To findout prevalence of inverted papilloma among nasal massesTo evaluate the sex incidence among these casesTo know symptomatology compared to other nasal massesMethods –ASRAM Medical College, Eluru, Dept of ENT.This is a prospective study over 2 years period ( 2015 Sept to 2017 August)Sample size – total no of 50 cases with nasal mass was studiedMethodology – All the patients having nasal masses were taken for the study. All the malignant masses were excluded from the study. Thorough clinical examination and investigations were done and data were analyzed.Results • The incidence of nasal mass to be higher in Males (58%). Especially males majority seen in inverted papilloma (5cases) and 1 female.nd• Most common nasal mass is nasal polyp,followed by 2most common is inverted papilloma.

Cirugía endoscópica nasal en el tratamiento de papiloma invertido: a propósito de 18 casos / Endoscopic sinus surgery in the management of inverted papilloma: an analysis of 18 cases

RESUMEN Introducción El papiloma invertido nasosinusal es un tumor benigno con tendencia a la recidiva, y con riesgo de malignización. El tratamiento habitual es la extirpación quirúrgica. Objetivo Describir y analizar las características clínicas, epidemiológicas, y resultados del tratamiento quirúrgico por vía endoscópica. Material y método Estudio retrospectivo, descriptivo, incluyendo pacientes con papiloma invertido nasosinusal sometidos a extirpación quirúrgica endoscópica entre los años 2012 y 2016. Se analizaron variables epidemiológicas, clínicas, complicaciones quirúrgicas, recurrencias y transformación maligna. El grado de extensión se evaluó con tomografia computarizada según la clasificación de Krouse. Resultados La serie está constituida por 18 pacientes, con una edad promedio de 57,4 años. La clínica se caracterizó por obstrucción nasal unilateral 72,2% (13/18 pacientes), rinorrea 33,3% (6/18 pacientes), hiposmia 27,8% (5/18 pacientes) y epistaxis 27,8% (5/18 pacientes). Según la clasificación de Krouse, las lesiones iniciales se describen como estadio T1 en 7/18, T2 en 5/18, T3 en 5/18 y T4 en 1/18 pacientes. En el período de seguimiento, se observa recurrencia en 4 pacientes en un período promedio de seguimiento de 5,6 meses, y un caso de transformación maligna. No hubo complicaciones quirúrgicas, excepto un caso de epífora por obstrucción de la vía nasolagrimal. Conclusiones El abordaje endoscópico fue efectivo para el tratamiento de papilomas invertidos nasosinusales.

ABSTRACT Introduction Sinonasal inverted papillomas are benign tumors with a tendency to recur and a potential for malignant transformation. Surgical resection is the treatment of choice. Aim To describe and analyze the clinical characteristics, epidemiology, and surgical results from an endoscopic endonasal approach. Material and method Retrospective and descriptive study of all patients who underwent endoscopic sinus surgery for the treatment of a sinonasal inverted papilloma between the years 2012 and 2016. Variables analyzed include demographics, signs and symptoms, surgical complications, recurrence rate and malignant transformation. Tumor extension was evaluated with the Krouse staging system on computed tomography imaging. Results This series includes 18 patients, with a mean age of 57.4 years. Clinically, patients presented with unilateral nasal obstruction 72.2% (13/18 patients), followed by rhinorrhea 33.3% (6/18 patients), hyposmia 27.8% (5/18 patients) and epistaxis 27.8% (5/18 patients). Based on the Krouse staging system, 7/18 were T1, 5/18 were T2, 5/18 were T3 and 1/18 was T4 on initial evaluation. On follow-up, 4 patients presented with a recurrence at a mean period of 5.6 months, and one patient exhibited malignant transformation. No surgical complications were observed except for one case of epyphora as a consequence of nasolacrimal obstruction. Conclusions The endoscopic approach was effective for the treatment of sinonasal inverted papillomas.

The analysis of expression of p16 protein in group of 53 patients treated for sinonasal inverted papilloma / Análise da expressão da proteína p16 em um grupo de 53 pacientes tratados para papiloma invertido nasossinusal

Abstract Introduction: Sinonasal inverted papilloma constitute relevant therapeutic problem due to destructive character of growth, tendency to recur and the possibility of malignant transformation. Therefore, many attempts to identify risk factors for inverted papilloma occurrence have been undertaken, as well as research to find markers that would allow for the earlier detection of tumors and the application of adequate therapy. A widely known risk factor of inverted papilloma is HPV infection. One of the markers of HPV infection and the ongoing effect of this change (although arousing some controversy) is the expression of the p16 protein. Objective: The aim of the study was to analyze the correlation between the expression of p16 as a surrogate of HPV infection in analyzed histopathological material and epidemiological variables, recurrences or malignant transformation. Methods: The retrospective study includes a group of 53 patients (18 women and 35 men) undergoing treatment for sinonasal inverted papilloma in the period of 2002-2012. The intensity of the p16 protein in histopathological material was scored as: 0 - no expression, 1 - diffuse expression (borderline) and 2 - positive expression; or 0 - no expression/diffuse expression (borderline); 1 - positive expression. The Ethics Committee agreement was obtained (1089/12; 245/13). Results and conclusion: There was no statistically significant relationship between the expression of p16 and the age of patients, cigarette smoking, tumor location, tumor staging according to the Krouse and Cannady classification, the presence of dysplasia or the occurrence of relapse.

Resumo Introdução: Papiloma invertido nasossinusal constitui um problema terapêutico relevante devido ao caráter destrutivo do crescimento, a tendência à recorrência e a possibilidade de transformação maligna. Assim, muitas tentativas têm sido realizadas para identificar fatores de risco para ocorrência de papiloma invertido, bem como pesquisas para encontrar marcadores que permitam a detecção precoce de tumores e a utilização de terapia adequada. Um fator de risco amplamente conhecido de papiloma invertido é a infecção pelo HPV. Um dos marcadores da infecção por HPV e do efeito contínuo dessa alteração (embora suscite alguma controvérsia) é a expressão da proteína p16. Objetivo: Analisar a correlação entre a expressão de p16 como um substituto da infecção pelo HPV no material histopatológico analisado e as variáveis epidemiológicas, recorrências ou transformação maligna. Método: O estudo retrospectivo inclui um grupo de 53 pacientes (18 mulheres e 35 homens) submetidos a tratamento para papiloma invertido nasossinusal de 2002 a 2012. A intensidade da expressão da proteína p16 no material histopatológico foi pontuada como: 0 - sem expressão, 1 - expressão difusa (limite) e 2 - expressão positiva; ou 0 - sem expressão/expressão difusa (limite); 1 - expressão positiva. O Comitê de Ética aprovou o estudo (1.089/12; 245/13). Resultados e conclusão: Não houve relação estatisticamente significante entre a expressão de p16 e a idade dos pacientes, o tabagismo, a localização tumoral e o estadiamento tumoral de acordo com a classificação de Krouse e Cannady, presença de displasia ou ocorrência de recidiva.

Abordaje endoscópico transeptal de tumores benignos de cavidades paranasales / Transseptal endoscopic approach of benign tumors of paranasal sinuses

RESUMEN La cirugía endoscópica nasosinusal es un procedimiento frecuente en la práctica otorrinolaringológica, y en la última década se han introducido nuevas técnicas para ayudar a la resección de tumores en regiones tradicionalmente consideradas de difícil acceso. Una de estas técnicas es el abordaje transeptal, que permite el abordaje de la pared anterior y lateral del seno maxilar, así como el trabajo a cuatro manos para el abordaje de estos tumores. El objetivo de esta revisión es describir el abordaje endoscópico transeptal, como técnica complementaria en la cirugía endoscópica de tumores nasales benignos, específicamente de papiloma invertido y angiofibroma nasofaríngeo juvenil.

ABSTRACT Endoscopic sinus surgery is a frequent procedure in Otorhinolaryngology practice, in the last decade new techniques have been introduced to help the resection of tumors in regions traditionally considered of difficult access. One of these techniques is the trans-septal approach, which allows the approach of the anterior and lateral wall of the maxillary sinus, as well as four-handed work for approach of these tumors. The aim of this review is to describe the transeptal endoscopic approach as a complementary technique in the endoscopic surgery of benign nasal tumors, specifically inverted papilloma and juvenile nasopharyngeal angiofibroma.

Comparative analysis of nasal NK/T-cell lymphoma with nasal polyps and inverted papilloma by CT / 实用放射学杂志

Objective To analyze CT findings of nasal NK/T-cell lymphoma.Methods The CT findings of 11 nasal NK/T-cell lymphomas, 134 nasal polyps and 24 nasal inverted papillomas were analyzed retrospectively.Fisher exact test was used to compare the differences of the three nasal lesions.Results Compared with the nasal polyps, nasal NK/T-cell lymphoma had a higher occurrence in the unilateral nasal cavity, more presented as nodular mass or mold growth,and more easily to invade nasal vestibule,nasal ala,nasal mucosal,nasopharyngeal wall and causebone destruction.Compared with the inverted papilloma,nasal NK/T-cell lymphoma had a higher incidence of tumor invasion to nasal vestibule, nasal ala, nasopharyngeal cavity, nasal mucosal.Conclusion Nasal NK/T-cell lymphoma is a homogenous tumor and often occurres in the unilateral nasal cavity, which creeps along the lateral wall of the nasal cavity, and causes the damage of nasal mucosal and surrounding soft tissue and slight destruction of bone in the early satge.

Efficacy evaluation of the resection of nasal inverted papilloma under nasal endoscope / 中国医学装备

Objective:To evaluate the efficacy of the resection of nasal inverted papilloma (NIP) under endoscope.Methods: A total of 100 patients with NIP from April 2008 to December 2013 in our hospital were randomly divided into endoscopic surgery group (endoscopic group) and conventional surgery group (conventional group), each with 50 cases. All patients were followed up for 2 years, whose recurrence, complications and satisfaction were observed. Results: The patients were followed up for 2 years, and the recurrence rate between the two groups was not statistically significant (x2=0.96,P>0.05). The traditional group had a higher incidence of complications than the endoscopic group, and the difference was statistically significant (x2=4.16,P<0.05). Endoscopic patients’ satisfaction was higher, and the difference was statistically significant (x2=5.02,P<0.05).Conclusion: The resection of (NIP) under endoscope can reduce the incidence of complication, improve patient satisfaction, and will not increase the recurrence rate, which is an effective means of treatment to the NIP.

Significance of HIF-1α, MVD and EGFR expression in detection of nasal inverted papilloma and clinical effect of taxol / 中国免疫学杂志

Objective:To explore the significance of the expression of HIF-1α,MVD and EGFR on diagnostic of nasal inverted papilloma and the clinical effect of taxol .Methods:The expression of HIF-1α,MVD and EGFR were detected by immunohistochemistry in nasal inverted papilloma .Results:The expression of HIF-1α,MVD and EGFR were enhanced with the degree of atypical hyperplasia in epithelium.The research also showed that the expression of HIF-1α,MVD and EGFR were increased dramatically in severe atypical hyperplasia with a significant statistical differences ( P0.05).Conclusion:HIF-1α,MVD and EGFR are involved in the pathogenesis and deteriorate of nasal inverted papilloma and can be taken as biomarkers for the diagnosis of the dete -rioration of nasal inverted papilloma .

Sphenoid Sinus Inverted Papilloma: A Case Report and Literature Review

Introduction: Inverted papilloma is a rare benign tumor of the nasal fossa, which usually originates from its lateral wall. Only 5% of cases demonstrate exclusive sinus involvement. Primary sphenoid sinus involvement is even rarer. Although considered a benign lesion, the tumor has a potentially invasive nature and has also been found to have an associated malignancy rate of 7 to 15%. Objectives: To report a case of inverted nasal papilloma originating in a rare location: the sphenoid sinus. Resumed: Report a 56-year-old woman, presented to our outpatient clinic complaining of frontal headache, occasional otalgia and recent forgetfulness. She was initially evaluated by a neurologist and then submitted to a head magnetic resonance imaging. A lesion was found to be filling both sphenoid sinuses. Sinus computed tomography showed an opacified sphenoid sinus with apparent bony integrity. The patient underwent sphenoidotomy through a transnasal endoscopic approach. A bleeding papillomatous lesion was identified. A biopsy was performed and histopathologic study suggested inverted papilloma. The lesion was then completely resected. The patient has been followed for 60 days after surgery; no signs of recurrence were found upon flexible nasofibroscope examination. Conclusion: Inverted Papilloma exclusively involving the sphenoid sinus is a rare entity. Non specific symptomatology and Clinical presentation make this kind of tumor a diagnostic and therapeutic challenge. The Endoscopic Sphenoidotomy has been the treatment of choice. Close follow-up is required in order to detect possible recurrences and malignant transformation...

Inverted papilloma of the hard palate masquerading as a carcinoma.

Inverted papilloma (IP) is a rare, benign tumor of the nose and paranasal sinus. However, it is locally aggressive, the recurrence rate is high and malignant transformation is possible. Until now, IP of the hard palate has rarely been reported in the literature. Here, we reported a case with IP of the hard palate, which clinically presented as a carcinomatous growth. The management of IP is complete surgical excision with a close follow-up to detect early recurrence and/or malignant transformation

Angioleiomyoma of the Nasal Cavity

Introduction Vascular leiomyoma of the nasal cavity is an extremely rare tumor that represents less than 1% of all vascular leiomyomas. It is more prevalent in women between the fourth and sixth decades, reaching primarily the inferior nasal turbinates. Objectives Reporting and assisting the systematization of more accurate diagnostic methods in clinical and complementary investigation of vascular leiomyoma in the nasal cavity. Resumed Report We present the case of a 49-year-old woman diagnosed with vascular leiomyoma in the nasal cavity, which manifested mainly with nasal obstruction. During investigation, computer tomography was not diagnostic, the cytologic study was not conclusive, and according to the biopsy, it was a squamous papilloma. Conclusion We suggest that the technical difficulty in obtaining an adequate amount of material for preoperative biopsy, associated with the topography of the lesion in the vestibular nasal region, may have contributed to changing the postoperative diagnosis. Thus, pathologic study of the surgical fragment is the more accurate method for diagnosis...