A case of sinonasal inverted papilloma with malignant transformation and distant metastasis: a 10-year follow-up report / 临床耳鼻咽喉头颈外科杂志

Sinonasal inverted papilloma（SNIP） is a kind of benign tumor originating from the nasal cavity and paranasal sinuses, accounting for 70% of papillomas. The incidence of the disease is more common in males, with an average age of 50-60 years. It is most likely to occur in unilateral maxillary sinus and ethmoid sinus, followed by sphenoid sinus and frontal sinus.It has the characteristics of local invasion, high recurrence rate and malignant tendency, and most malignant transformation into squamous cell carcinoma. Endoscopic nasal resection and appropriate adjuvant therapy can help to reduce the recurrence rate and inhibit further deterioration. We report the results of a 10-year follow-up of a SNIP patient, including the clinical manifestations, recurrence course and treatment plan during the 10 years. The patient underwent multiple nasal endoscopic surgeries, and had a recurrence of multiple focal attachment pattern, and finally had direct invasion and distant metastasis. Tumor recurrence and further deterioration persisted despite the use of a comprehensive treatment.

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.

A Study on the Expression of p53 and the Detection of Human Papilloma Virusin the Sinonasal Inverted Papilloma Associated with Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been some reports suggesting that the malignant and benign clinical courses are separable on the basis of HPV subtypes in the sinonasal inverted papilloma. The E6 protein of high risk HPV subtype including types 16 and 18 is known to be associated with p53. The viral E6 protein-p53 complex is responsible for the functional loss of p53 which then becomes immunohistochemically negative. The aim of this study was to determine the prevalence and types of HPV in this neoplasm and evaluate the relationship between expressions of the oncogenes and HPV. MATERIALS AND METHOD: The material was composed of 11 cases of inverted papilloma and 7 cases which were associated with carcinoma. Immunohistochemical staining for p53 was performed. A molecular study of the E6 gene of HPV DNA types 6, 11, 16 and 18 was also performed with separate nest-PCR on squamous cell lesions stainned p53 and papillomatous lesions by use of microdissection technique with paraffin embedded materials. RESULTS: The carcinomatous and dysplastic areas were diffusely positive for p53 in all cases associated with carcinoma, whereas the control group was negative for p53. HPV types 6 and 11, generally known as the lower risk types were presented in the 80% of all cancers and papilloma lesions. A HPV DNA type 18 was solely positive in 2 cases on the p53 overexpressed lesion, associated with carcinoma. CONCLUSION: p53 and HPV may be involved in the pathogenesis of malignant transformation in the inverted papilloma. Therefore, it can be disproved that the HPV subtypes are directly related to either benign or malignant clinical course. However, functional loss of the wild type p53 gene is deeply associated with malignant transformation. In addition to the classical E6 of HPV 16,18-p53, another mechanism could be involved in the functional inactivation of p53.

Role of p53, Ras p21 and HPV Type 16, 18 on Malignant Transformaton in Inverted Papilloma of Nose and Paranasal Sinus / 대한이비인후과학회지

Mutation in p53 and p21 genes is the most common specific genetic change found in human cancers and has been investigated in a great number of neoplastic lesion. There have been some reports dealing with relationship between human papillomavirus(HPV) and papilloma associated carcinoma. But the roles of p53, ras oncoprotein and HPV have not been fully described in malignant transformation of inverted papilloma. The aim of this study was to demonstrate the mutated oncogenes immunohistochemically and evaluate relationship between expression of the oncogenes and HPV. The materials compromised 13 cases of the inverted papilloma and 6 cases associated with carcinoma. Immunohistochemical staining for p53 and ras oncogene was performed and molecular study of HPV DNA type16 and 18 was also performed with PCR on the paraffin embedded material. The carcinomatous and dysplastic areas were diffusely positive for p53 in 5 of 6 cases associated with carcinoma, whereas control group was negative for p53. And p21 immunohistochemical staining was diffusly positive in both group. A HPV DNA type 16 was negative, but type 18 was positive in 2 cases associated with carcinoma. The results indicated that p53 and HPV type 18 may be involved in pathogenesis of malignant transformation in inverted papilloma.