ABSTRACT
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.
Subject(s)
Humans , Papilloma, Inverted/pathology , Endoscopy , Maxillary Sinus/pathology , Lacrimal Apparatus/surgery , Treatment Outcome , Retrospective StudiesABSTRACT
Introducción: El papiloma invertido es un tumor benigno inusual del tracto nasosinusal, caracterizado por el riesgo de recurrencia y transformación maligna. Objetivo: Nuestro objetivo es describir la serie de casos diagnosticados con papiloma invertido del tracto nasosinusal entre 2002 y 2010. Material y método: Se trata de un análisis retrospectivo de los casos nuevos de papiloma invertido del tracto nasosinusal atendidos en nuestro Hospital entre los años 2002 y 2010. Resultados: Se presentaron 25 casos nuevos de papiloma invertido. Los síntomas tenían en promedio 2 años de evolución, siendo la obstrucción nasal y rinorrea los más frecuentes. La etapificación preoperatoria fue realizada mediante tomografía computarizada en 15 pacientes. El abordaje endoscópico fue el preferido. Cincuenta y seis por ciento de los pacientes correspondía a la etapa 2 de la clasificación de Krause. El promedio de seguimiento fue 29 meses. Durante ese periodo, 4 casos presentaron recurrencia, correspondiendo al 16% de nuestra serie. La mitad de ellos presentó displasia o atipia al momento de la recurrencia. Ocurrió 1 caso de transformación maligna, el cual se presentó como un carcinoma indiferenciado. Conclusión: Las características generales son similares a los reportes internacionales. En nuestro medio los pacientes son diagnosticados en etapas avanzadas de la enfermedad, no obstante, el abordaje endoscópico es el método quirúrgico preferido.
Introduction: Inverted papilloma is an unusual benign tumor of the sinonasal tract, characterized by an important risk of recurrence and malignant transformation. Aim: Our objective is to describe the case series diagnosed with inverted papilloma of the sinonasal tract between the years 2002 and 2010. Material and method: A retrospective analysis of new cases of inverted papilloma of the sinonasal tract treated at our Hospital between the years 2002 and 2010. Results: 25 cases of newly diagnosed inverted papilloma presented in our institution. The symptoms had on average 2 years of evolution, being nasal obstruction and rhinorrhea the most frequent. Preoperative staging by computed tomography (CT) was performed in 15 patients. The endoscopic aproach was preferred as surgical approach. 56% of the patients corresponded to stage 2 of Krause classification. Median folow up was 29 months. During that period, 4 patients had recurrence, corresponding to 16% in our series. Half of these patients had dysplasia or atypia at the time of recurrence. 1 case of malignant transformation ocurred, which presented as an undifferentiated carcinoma. Conclusions: General characteristics were similar to those reported in international reports. In our setting, patients are diagnosed in advanced stages of disease, nevertheless, endoscopic approach is the preferred surgery method.
Subject(s)
Humans , Male , Female , Middle Aged , Paranasal Sinus Neoplasms/surgery , Papilloma, Inverted/surgery , Recurrence , Paranasal Sinus Neoplasms/pathology , Tomography, X-Ray Computed , Nasal Obstruction/etiology , Retrospective Studies , Follow-Up Studies , Papilloma, Inverted/pathology , Endoscopy/methods , Neoplasm StagingABSTRACT
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.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Papilloma, Inverted/surgery , Paranasal Sinus Neoplasms/surgery , Cohort Studies , Cross-Sectional Studies , Endoscopy/methods , Neoplasm Staging , Papilloma, Inverted/pathology , Paranasal Sinus Neoplasms/pathology , Retrospective Studies , Treatment OutcomeSubject(s)
Humans , Male , Middle Aged , Ear Neoplasms/pathology , Ear, Middle/pathology , Mastoid/pathology , Papilloma, Inverted/pathology , Skull Neoplasms/pathology , Ear Neoplasms/surgery , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Papilloma, Inverted/surgery , Skull Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
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.
Subject(s)
Humans , Male , Middle Aged , Mouth Neoplasms/pathology , Papilloma, Inverted/pathology , Papillomavirus Infections/complications , Paranasal Sinus Neoplasms/pathology , Immunohistochemistry , In Situ Hybridization , Mouth Neoplasms/diagnosis , Mouth Neoplasms/virology , Neoplasm Invasiveness , Papilloma, Inverted/diagnosis , Papilloma, Inverted/virology , Papillomavirus Infections/diagnosis , Paranasal Sinus Neoplasms/diagnosis , Paranasal Sinus Neoplasms/virologyABSTRACT
Aims: Inverted papilloma (IP) is an uncommon benign neoplasm of the urinary tract. Its multiplicity, recurrence, and association with transitional cell carcinoma (TCC) leads to conflicting clinical conclusions regarding its biological behavior, and hence, the need for rigorous follow-up protocols. In this study, we review all cases of urinary bladder IP in our institution and determine the need for strict follow-up. Materials and Methods :0 We included consecutive patients from August 2004 to August 2008 with IP of the urinary bladder in this study who did not have prior or concurrent urothelial carcinoma. A single pathologist performed the histologic review. The patients had undergone strict a follow-up schedule every 6 months. Results: In our study of the 24 patients, the mean age at presentation was 53.5 (range 22-81) years. The mean follow-up period was 25.8 months (range 6-58 months). Of the 24 patients, 21 were men and 3 were women. No patient had a synchronous or previous bladder tumor. The most common presenting symptoms were macroscopic hematuria and dysuria. All were solitary tumors except one, most commonly found at the bladder neck and trigone. The average follow-up period was 2.5 years without any evidence of recurrence. Conclusions: We conclude that when diagnosed by strictly defined criteria, IP as benign urothelial neoplasm was with extremely low incidence of recurrence and good prognosis. It does not seem to be a risk factor for TCC, especially if located in the bladder. Therefore, a good transurethral resection is adequate therapy and follow-up protocol as rigorous as those for TCC may not be necessary.
Subject(s)
Adult , Age of Onset , Aged , Aged, 80 and over , Female , Humans , India , Male , Middle Aged , Papilloma, Inverted/pathology , Retrospective Studies , Urinary Bladder Neoplasms/pathology , Young AdultABSTRACT
Introducción: El papiloma invertido es un tumor benigno que afecta fosas nasales y senos paranasales; histológicamente se clasifica en oncocítico, invertido y fungiforme. Los signos y síntomas son obstrucción nasal unilateral, rinorrea, cefalea, epistaxis, anosmia. El diagnóstico de certeza es por anatomía patológica; se utilizan además métodos de diagnóstico por imagen para determinar la extensión tumoral. Existe cierto porcentaje de asociación de esta patología al carcinoma escamoso. El tratamiento es quirúrgico. Objetivo: Evaluar las características clínicas y quirúrgicas de papilomas invertidos operados en la Cátedra de ORL del Hospital de Clínicas de la Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Paraguay (UNA). Material y método: En este trabajo de carácter observacional y descriptivo se estudiaron los casos de papiloma invertido operados en el Hospital de Clínicas entre los años 1994 a 2008, mediante revisión de fichas de casos consecutivos, analizando las cirugías realizadas. Resultados: Treinta casos de los cuales la mayoría fue de estadio II y III de Krause, con una recidiva global del 30 por ciento con una malignización del 17 por ciento. Discusión: En esta serie de pacientes se vio tumores con poca extensión pero con una transformación maligna presente, elevándolos al estadio IV de Krause. Conclusión: Se sugiere intentar la mayor radicalidad posible siempre con el total consentimiento y conocimiento del paciente.
Introduction: Inverted papilloma is a benign tumor that affects nasal cavity and Para nasal sinuses; histologically classified as oncecitas, inverted papillomas and fundiform or exophytic. Signs and symptoms include unilateral nasal obstruction, rhino rhea, headache, epitasis, and anosmia. The certainty diagnosis is given by pathology and in diagnosis are used imaging methods to determine the extent of the tumor. There is a certain percentage of association of this pathology with squamous carcinoma. The treatment is surgical. Aim: To evaluate the clinical and surgical characteristics of inverted papillomas that were operated in the Department of ENTin the Hospital School of Medical Sciences, UNA. Material and method: In this observational and descriptive work were studied cases of inverted papilloma operated at the Hospital from 1994 to 2008, by reviewing records of consecutive cases and analyzing the surgeries performed. Results: 30 cases in which the majority were Stage II and III of Krause, with an overall of 30 percent, relapse with a malignancy of 17 percent. Discussion: In this series of patients we observed tumors with low extension but with malignant transformation which elevated them to stage IVKrause. Conclusión: We suggest trying the most radical possible surgery provided with the fuII consent and knowledge of the patient.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Nose Neoplasms/surgery , Nose Neoplasms/pathology , Papilloma, Inverted/surgery , Papilloma, Inverted/pathology , Age and Sex Distribution , Neoplasm Staging , Cross-Sectional Studies , Nose Neoplasms/epidemiology , Papilloma, Inverted/epidemiology , Otorhinolaryngologic Surgical Procedures/methods , Neoplasm Recurrence, Local/epidemiology , Signs and SymptomsABSTRACT
O papiloma invertido é um tumor benigno nasal que geralmente se origina na parede lateral da fossa nasal, mais especificamente da região do meato médio. Apresenta grande potencial invasivo local, com alta taxa de recorrência e potencial para transformação maligna. O acometimento do recesso esfenoetmoidal é raro e, quando ocorre, é decorrente de doença primária do seio esfenoidal. Não há relato de papiloma invertido isolado em recesso esfenoetmoidal na literatura. Relatamos um caso de papiloma invertido originado em recesso esfenoetmoidal, sem comprometimento do seio esfenoidal.
Inverted papilloma is a nasal benign tumor that usually arises from the lateral nasal wall, especially from the middle meatus. It has high local invasive likelihood, high recurrence rates and malignancy potential. Sphenoethmoidal recess involvement is rare and is usually due to sphenoid sinus primary disease. In the literature, no case of isolated sphenoethmoidal recess inverted papilloma has been reported yet. The present report describes an exceptional location of inverted papilloma, arising from the sphenoethmoid recess, without involving the sphenoid sinus.
Subject(s)
Adult , Humans , Male , Papilloma, Inverted/diagnosis , Paranasal Sinus Neoplasms/diagnosis , Sphenoid Sinus , Endoscopy , Papilloma, Inverted/pathology , Papilloma, Inverted/surgery , Paranasal Sinus Neoplasms/pathology , Paranasal Sinus Neoplasms/surgery , Sphenoid Sinus/pathology , Sphenoid Sinus/surgery , Tomography, X-Ray ComputedABSTRACT
O papiloma escamoso é uma neoplasia benigna. A ocorrência de lesão isolada de orelha média é rara, sendo mais comumente encontrada em associação à patologia nasossinusal. Os autores relatam um caso de papiloma escamoso acometendo apenas orelha média e discutem seus aspectos diagnósticos.
Subject(s)
Humans , Male , Aged , Ear Neoplasms/pathology , Papilloma/pathology , Biopsy , Ear Neoplasms/virology , Hearing Loss/diagnosis , Nasopharyngeal Neoplasms/pathology , Papilloma, Inverted/pathology , Papilloma/virology , Papillomavirus Infections/complications , Papillomavirus Infections/diagnosisABSTRACT
El papiloma nasal invertido es una tumoración de histología benigna, localmente agresiva, con un alta tasa de recurrencias y se ha asociado al carcinoma de células escamosa. Con las técnicas endoscópicas, se ha hecho posible una identificación precisa de la enfermedad en etapas tempranas brindadndo la posibilidad, en ciertos casos, de abordar la lesión por vía endonasal obteniendo ventajas sobre la resección tradicional en bloque (maxilectomía medial). Por otro lado la endoscopia permite un seguimiento postoperatorio en busca de recurrencias tempranas. Nosotros presentamos tres casos de papiloma nasal invertido en los cuales el diagnóstico, tratamiento y seguimiento postoperatorio se realizó con endoscopia; en dos pacientes se detectó recidiva tumoral, por lo que se realizó un maxilectomía medial en uno de ellos. La endoscopia es una nueva herramienta para el manejo integral y conservador del papiloma invertido de la nariz y senos paranasales
Subject(s)
Humans , Male , Female , Adult , Aged , General Surgery , Endoscopy , Endoscopy/statistics & numerical data , Papilloma, Inverted/pathology , Papilloma, Inverted/surgeryABSTRACT
Se presenta un caso de papiloma vesical invertido tratado por resección endoscópica, señalándose las características histológicas típicas y el comportamiento clínico benigno de este tipo de patología que mejor pudiera denominarse adeno urotelioma de Von Brunn