ABSTRACT
BACKGROUND: The purpose of this work is to evaluate our results in the treatment of the nasal inverted papillomas with an endoscopic approach using a retrospective case series. METHODS: Between 1993 and 2000 we treated 27 patients with nasal inverted papillomas. All patients underwent endoscopic nasal surgery under general anesthesia. None of the inverted papillomas extended outside of the paranasal sinuses. All tissue samples underwent polymerase chain reaction and hybridization in situ to detect genetic sequences of the human papilloma virus and Epstein Barr virus. RESULTS: The study population consisted of 16 men and 11 women with a median age of 52 years (range, 22-77 years). Ten patients (37%) had undergone a previous nasal surgery. The median follow-up was 5 years (range, 2-8 years). None of the patients presented with bilateral nasal involvement or a synchronous carcinoma. Seven patients underwent an additional surgical approach (two endoscopic approaches via a Caldwel-Luc approach, four sublabial approaches via a Caldwel-Luc approach, and one external ethmoidectomy). There were no surgical complications. Two patients (7%) had recurrent papilloma 4 and 6 years after surgery and again underwent endoscopic resection. The amplification both by polymerase chain reaction and hybridization in situ for human papilloma virus and Epstein Barr virus were negative in the specimens from all patients. CONCLUSIONS: According to the literature and our own experience, we believe that the initial surgical management of primary and recurrent inverted papillomas limited to the nasal cavity and paranasal sinuses should be endoscopic sinus surgery.
Subject(s)
Endoscopy , Nose Neoplasms/surgery , Papilloma, Inverted/surgery , Adult , Aged , Female , Herpesvirus 4, Human/isolation & purification , Humans , In Situ Hybridization , Male , Middle Aged , Neoplasm Recurrence, Local , Nose Neoplasms/diagnostic imaging , Nose Neoplasms/microbiology , Papilloma, Inverted/diagnostic imaging , Papilloma, Inverted/microbiology , Papillomaviridae/isolation & purification , Polymerase Chain Reaction , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The relationship between sinonasal inverted papilloma (IP) and various strains of human papilloma virus (HPV) has been examined previously. Yet there is little consensus regarding the incidence or role of HPV in IP. The possible role of Epstein-Barr virus (EBV), which, like HPV, is a DNA virus linked to human lymphoid and epithelial malignancies, was investigated. METHODS: The polymerase chain reaction (PCR) was used to detect EBV genomic sequences in surgical specimens of IP, in benign nasal polyps, and various control tissues. The IP specimens were similarly examined for the presence of HPV types 6, 11, 16, and 18. RESULTS: EBV DNA was found in 13 of 20 IP specimens (65%) and none of the 10 control tissues. Nine of the 20 specimens contained HPV DNA, and 5 of 20 specimens contained both EBV and HPV. CONCLUSIONS: These results imply a previously unsuspected role for Epstein-Barr virus in the pathogenesis of sinonasal inverted papilloma.
Subject(s)
Genome, Viral , Herpesvirus 4, Human/genetics , Nose Neoplasms/microbiology , Papilloma, Inverted/microbiology , Paranasal Sinus Neoplasms/microbiology , DNA, Viral/analysis , DNA, Viral/genetics , Genes, Viral/genetics , Herpesviridae Infections , Humans , Nasal Polyps/genetics , Nasal Polyps/microbiology , Nose Neoplasms/genetics , Papilloma, Inverted/genetics , Papillomaviridae/classification , Papillomaviridae/genetics , Paranasal Sinus Neoplasms/genetics , Polymerase Chain Reaction , Tumor Virus InfectionsABSTRACT
The frequency of human papillomavirus (HPV) in sinonasal papillomas seems to vary considerably. The highest frequencies have been reported by investigators using in situ DNA or RNA hybridization. Few studies have used polymerase chain reaction, and in these reports the frequency of HPV detection is rather low. We have investigated the presence of HPV in sinonasal papillomas using the polymerase chain reaction with a set of degenerated consensus primers, which amplify the vast majority of the known HPV types. Human papillomavirus was found in three of 14 papillomas. By in situ hybridization the same three papillomas were positive for HPV type 6/11.
