鼻腔-鼻窦内翻性乳头状瘤组织PCNA、bcl-2和p53的表达活性观察

目的分别检测鼻腔/鼻窦内翻性乳头状瘤（nasal invered papilloma,IP）、内翻性乳头状瘤伴不典型增生（IP with dysplasia,ID）和内翻性乳头状瘤伴恶变组织（IP with squamous cell carcinoma,SCC）中的增殖细胞核抗原、bcl-2和p53表达活性,探讨内翻性乳头状瘤恶变的可能机制。方法内翻性乳头状瘤31例、内翻性乳头状瘤伴不典型增生10例、内翻性乳头状瘤恶变5例,取活检组织,应用免疫组织化学方法分别检测增殖细胞核抗原、bcl-2和p53的表达活性,分析其病理意义。结果内翻性乳头状瘤、内翻性乳头状瘤伴不典型增生组织p53表达分别为0%、40.0%,PCNA的表达分别为25.81%、60.0%,bcl-2的表达分别为29.03%、70.0%。二者差异的组间比较以及内翻性乳头状瘤与SCC的组间比较差异有统计学意义,而内翻性乳头状瘤伴不典型增生与SCC的组间比较差异无统计学意义。结论鼻腔/鼻窦内翻性乳头状瘤的恶变,可能是其细胞增殖活性升高与凋亡活性抑制共同作用的结果。     

鼻腔及鼻窦内翻性乳头状瘤恶变相关因子研究

鼻腔及鼻窦内翻性乳头状瘤是一种黏膜上皮源性良性肿瘤,临床上较常见.容易复发、恶变足鼻内翻性乳头状瘤的突出特点.目前缺乏判断鼻内翻性乳头状瘤恶变及复发的可靠依据.近几年,随着分子生物学技术的快速发展,关于鼻内翻性乳头状瘤恶变过程中相关的细胞因子的研究有了深入的进展,这对于判断肿瘤的恶性程度及手术方式的选择都有重要的指导意义.本文就目前与鼻腔及鼻窦内翻性乳头状瘤恶变相关因子研究现状进行综述.     

鼻内翻性乳头状瘤与人乳头状瘤病毒感染

鼻内翻性乳头状瘤是鼻腔鼻窦的良性病变,具有侵袭性、高复发率及易恶变的特性,引起了人们的广泛关注。近年来人乳头状瘤病毒感染与鼻内翻性乳头状瘤的发病、恶变及复发得到人们的普遍认可。本文对近几年来人乳头状瘤病毒感染与鼻内翻性乳头状瘤的发病、恶变及其预后关系的相关研究做一综述。     

鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术50例临床分析

目的回顾性分析鼻内镜下切除鼻腔鼻窦内翻性乳头状瘤的方法及疗效。方法对50例鼻腔鼻窦内翻性乳头状瘤患者,内镜下切除鼻腔鼻窦肿物及肿物基底部黏骨膜,对侵及上颌窦,尤其是内下角者,辅助柯陆氏入路彻底切除肿瘤。结果术后随访2～8年,50例患者中治愈42例（84%）,局部复发5例（10%）、恶变3例。结论鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤疗效确切,对侵及上颌窦者辅已柯陆氏径路下内镜治疗。     

上颌窦内翻性乳头状瘤的临床分析

鼻腔鼻窦内翻性乳头状瘤是鼻科常见的良性肿瘤,占鼻肿瘤的0.5%～4.0%,具有侵袭性、高复发率、易恶变的临床特点。2005年Kamel等[1]基于鼻腔鼻窦内翻性乳头状瘤病变起源提出了新的分级系统,I型病变起源于鼻中隔或鼻外侧壁,II型病变起源于上颌窦。     

鼻腔鼻窦内翻性乳头状瘤中Survivin及Bcl-2的表达

目的：探讨细胞凋亡抑制蛋白Survivin在鼻腔鼻窦内翻性乳头状瘤中的表达及其与Bcl-2表达的相关性。方法：采用免疫组织化学Envision二步法检测30例鼻腔鼻窦内翻性乳头状瘤,10例鼻腔鳞状细胞癌及10例正常下鼻甲黏膜标本中Survivin和Bcl-2的表达。结果：鼻腔鼻窦内翻性乳头状瘤和鼻腔鳞状细胞癌组织中Survivin的表达分别为73.3%和80.0%,均显著高于正常下鼻甲黏膜组织（均P〈0.01）。鼻腔鳞状细胞癌组织中Bcl-2的表达率为90.0%,显著高于正常下鼻甲黏膜组织的表达率（20.0%）（P〈0.01）。鼻腔鼻窦内翻性乳头状瘤组织中Bcl-2的表达率为46.7%,高于正常下鼻甲黏膜,但两者之间的差异无统计学意义（P〉0.05）。Survivin表达与Bcl-2表达呈正相关（P〈0.01）。结论：Survivin在鼻腔鼻窦内翻性乳头状瘤和鼻腔鳞状细胞癌的发生、发展中起重要作用,可能成为鼻腔鼻窦内翻性乳头状瘤和鼻腔鳞状细胞癌基因治疗的靶点。Survivin可能与Bcl-2在鼻腔内翻性乳头状瘤的发展中起协同作用。     

鼻腔和鼻窦内翻性乳头状瘤癌变分析

鼻腔鼻窦内翻性乳头状瘤（ＮＩＰ）较少见，不易根治，且易癌变。１９８０～１９９１年收治鼻腔鼻窦内翻性乳头状瘤７４例，其中１６例癌变，１６例全部单侧发病，平均年龄５３．３岁，恶变率２１．６％，作者认为鼻腔鼻窦内翻性乳头状瘤术后放疗及反复多次手术是ＮＩＰ恶变的诱发因素，手术治疗采用上颌骨部分及全部切除术，累及眶内应一并行眶内容物剜除，术中应将肿瘤尽量彻底切除，并认为术中术腔内应给予液氮短时多次冷冻治疗。术后给予放射治疗，并密切随访。     

nm23-H1基因在鼻腔鼻窦内翻性乳头状瘤及其癌变组织中的表达

目的 :探讨肿瘤细胞转移抑制基因nm2 3 H1在鼻腔鼻窦内翻性乳头状瘤发生发展中的作用。方法 :采用免疫组化方法分别检测 2 5例鼻腔鼻窦内翻性乳头状瘤组织 (良性组 )、2 1例鼻腔鼻窦内翻性乳头状瘤癌变组织 (恶变组 )和 14例慢性鼻窦炎筛窦黏膜组织 (对照组 )中nm2 3 H1蛋白表达。结果 :良性组阳性细胞表达率为 72 .0 % ,明显高于癌变组 (42 .9% )和对照组 (14 .3% ) ,其差异均有统计学意义 (均P <0 .0 5 )。结论 :鼻腔鼻窦内翻性乳头状瘤癌变组织中nm2 3 H1基因的低表达 ,与肿瘤癌变及肿瘤的侵袭性生长有关     

存活素在鼻腔鼻窦内翻性乳头状瘤中表达及临床意义

目的探讨细胞凋亡抑制蛋白-存活素(Survivin)在鼻腔鼻窦内翻性乳头状瘤的表达及临床意义。方法采用免疫组化Envision二步法检测30例鼻腔鼻窦内翻性乳头状瘤,10例鼻腔鳞癌及10例正常下鼻甲黏膜标本中Survivin的表达。结果鼻腔鼻窦内翻性乳头状瘤和鼻腔鳞癌组织中survivin的表达分别为73.33%、80.00%,均显著高于正常下鼻甲黏膜组织的表达0%(P0.01)。结论 Survivin在鼻腔鼻窦内翻性乳头状瘤和鼻腔鳞癌的发生、发展中起重要作用,可能成为鼻腔鼻窦内翻性乳头状瘤和鼻腔鳞癌基因治疗的靶点。Survivin的高表达,预示SNIP的复发。     

鼻内翻性乳头状瘤发生发展机制的研究进展

鼻内翻性乳头状瘤(NIP)是鼻腔鼻窦相对较少见的良性肿瘤,随着人们对该疾病的认识和检测技术的发展,近年来其发病率呈上升趋势,因其具有易复发、易恶变、易局部侵犯等恶性肿瘤的特性而备受关注.目前认为NIP的发生及恶变与人乳头状瘤病毒(HPV)密切相关,NIP发生恶变的主要类型是鳞状细胞癌.而NIP复发的关键是手术路径、手术...     

Temporal bone and sinonasal inverted papilloma: the same pathological entity?

BACKGROUND: Inverted papilloma involving the temporal bone is an extremely rare occurrence. Reports in the literature suggest a higher recurrence rate and association with squamous cell carcinoma in Schneiderian-type papillomas of the middle ear than in sinonasal Schneiderian-type papillomas. OBJECTIVES: To investigate the expression of apoptosis-related proteins, markers of cell proliferation activity, and sex hormone receptors in temporal bone inverted papillomas and to compare this entity with sinonasal papillomas.Design and Subjects We investigated 2 rare cases of inverted papilloma of the temporal bone and a control group of 6 cases of sinonasal inverted papilloma. The expression of p53, Mib-1, p27, and progesterone and estrogen receptors was determined. RESULTS: In the 2 cases of temporal bone inverted papilloma, p53 expression was 43.75% and 4.92%; p27 expression was higher in temporal bone inverted papilloma (82.45% and 70.53%) than in the sinonasal inverted papilloma group. One of our 2 cases of temporal bone Schneiderian-type papilloma was positive for progesterone receptor. CONCLUSIONS: The expression of progesterone receptor in 1 of our 2 cases and in the only other case reported in the literature may imply some degree of hormonal dependence of temporal bone inverted papilloma. Our analysis of the expression of apoptosis-related proteins, markers of cell proliferation activity, and sex hormone receptors does not allow us to demonstrate that temporal bone and sinonasal inverted papilloma are different pathological entities.     

Evaluation of p53, p63, p21, p27, ki-67 in paranasal sinus squamous cell carcinoma and inverted papilloma

Using a molecular genetic approach, we try to confirm the molecular alterations of inverted papilloma and clarify its status as a putative precursor lesion of sinonasal squamous cell carcinoma. To better understand its genetics, we investigated the immunohistochemical protein expression patterns of cell-cycle-regulators p53, p63, p21, p27 and proliferation marker Ki-67 in 22 inverted papilloma and 9 squamous cell carcinoma of the sinonasal tract. Significantly elevated levels of p53 and p63 in squamous cell carcinoma of sinonasal tract compared with inverted papilloma were revealed. Ki-67-stained neoplastic cell nuclei were found in a significantly higher percentage of squamous cell carcinoma of sinonasal tract than in inverted papilloma, whereas no variation of p21 and p27 expression was identified. This work first examined the immunohistochemical overexpression of p63 in sinonasal inverted papilloma and squamous cell carcinoma. In conclusion, this is a first study shedding light on the expression of p63 in tumors of paranasal sinuses.     

Association between human papillomavirus infection and malignant transformation of sinonasal inverted papilloma: A systematic review and meta-analysis

PurposeAlthough sinonasal inverted papilloma malignant transformation has not been entirely understood, some studies have suggested that human papillomavirus acts as a potential oncogenic agent in the progression of sinonasal inverted papilloma to squamous cell carcinoma. The purpose of this study was to assess the association between human papillomavirus infection and sinonasal inverted papilloma transformation, taking also into account human papillomavirus types and their distribution in different geographic areas.Materials and methodsThe literature from the last 25 years was examined. The systematic review and meta-analysis were performed according to the PRISMA guidelines.ResultsA total of 163 malignant sinonasal inverted papilloma and 961 non-malignant sinonasal inverted papilloma were included in the overall analysis. From this sample it was possible to recognize a statistically significant increase in risk of malignancy of sinonasal inverted papilloma for human papillomavirus infection (OR = 2.43, 95 % CI: 1.45–4.08, I2 = 14.0 %). A positive association for patients with high-risk human papillomavirus types was noted (OR = 10.20, 95 % CI: 3.66–28.42, I2 = 15.9 %). In all the 3 geographical areas analyzed the presence of high-risk human papillomavirus significantly increased the probability of malignant transformation.ConclusionsHigh-risk human papillomavirus infection plays a key role in the malignant transformation of sinonasal inverted papilloma and its research during histological examination can be of paramount importance. More prospective studies are needed to help further tease out this association.     

Long-term results of endonasal sinus surgery in sinonasal papillomas

OBJECTIVE: To assess the value of endonasal sinus surgery in the management of sinonasal papillomas. STUDY DESIGN: Retrospective study including 43 patients operated on for sinonasal papilloma in a long-term follow-up. METHODS: In 26 cases (60%) an endonasal approach, in eight cases (19%) an external approach, and in four cases (9%) a combined procedure was performed to remove these tumors. Five septal lesions (12%) were resected under direct vision. The original sections and charts of all patients were reviewed to assess clinical data. Follow-up information was available for 42 of our patients (98%) with a mean follow-up of 62 months. RESULTS: Histologic examination revealed 34 cases of inverted papilloma (79%), five cases of exophytic papilloma (12%), and four cases of columnar cell papilloma (9%). Malignancy occurred in 4 of 43 patients (9%), and recurrences developed in 8 of 42 patients (19%). Two of these recurrences happened after endoscopic sinus surgery (two inverted papillomas), three after lateral rhinotomy (three inverted papillomas), one after a combined procedure (one inverted papilloma), and two after simple resection (two exophytic papilloma). CONCLUSIONS: In keeping with our experience, the endonasal endoscopic approach, often in combination with a medial maxillectomy, is favored for the treatment of sinonasal papilloma because of a lower recurrence rate and a better cosmetic result. In some larger tumors and lesions in difficult locations, better visualization can be obtained by a combined external and endonasal approach.     

Sinonasal inverted papilloma with malignant transformation in the middle ear: a multicentric origin?

Inverted papilloma is a rare, benign tumour representing only 0.5 to 4 per cent of all sinonasal neoplasms; its involvement of the middle ear is extremely rare. We present a case of multicentric inverted papilloma in the sinonasal region and middle ear in a 54-year-old man. The patient later developed neck metastasis secondary to malignant transformation of the inverted papilloma in the middle ear.     

鼻内镜下手术治疗鼻腔鼻窦内翻性乳头状瘤的疗效观察

目的探讨鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤的临床疗效。方法70例鼻腔鼻窦内翻性乳头状瘤患者在鼻内镜下行单纯切除或经柯-陆径路于骨膜下分离切除肿瘤,创面用电刀烧灼处理,术后使用抗生素1周预防感染。结果70例患者术后随访6个月以上,其中Ⅰ级、Ⅱ级患者治愈64例（90%）;Ⅲ级患者复发6例（10%）,经再次鼻内镜下手术彻底清除病灶后治愈。结论鼻内镜下治疗鼻腔鼻窦内翻性乳头状瘤创伤小,疗效好,有效预防术后复发;可作为治疗鼻腔鼻窦内翻性乳头状瘤的首选手术方式。     

Contribution of endoscopic laser coagulation in the treatment of multicentric sinonasal inverted papilloma. A case report

OBJECTIVE: To describe a new method of treatment of multicentric sinonasal inverted papilloma by laser endoscopic coagulation. MATERIAL AND METHODS: We report a case of multicentric sinonasal inverted papilloma involving the nasopharynx in a 62-year-old man. The treatment was a laser diod cauterisation. RESULTS: The evolution was favourable without complications or recurrence after a 16 months follow-up period. CONCLUSION: Laser endoscopic coagulation seems to be an effective treatment for multicentric sinonasal inverted papilloma especially for lesions with a difficult surgical access.     

鼻内镜下上颌骨内侧壁切除联合经鼻腔泪道置管治疗上颌窦内翻性乳头状瘤

目的 探讨鼻内镜下上颌骨内侧壁切除联合经鼻泪道置管,在上颌窦内翻性乳头状瘤手术中的应用价值。方法 回顾分析2006年1月至2010年10月采用鼻内镜下上颌骨内侧壁切除联合经鼻泪道置管治疗32例上颌窦内翻性乳头状瘤患者的临床资料。术中切除上颌骨内侧壁,彻底切除上颌窦肿瘤,经鼻泪道置入硅胶管,术后长期随访。结果 32例患者均为Krouse分期T₃期,全部彻底切除肿瘤,术后随访12~72个月,平均35个月,术腔上皮化良好,2例复发,复发率为6.3%,局部清除后随访未再复发,患者均无溢泪并发症。结论 鼻内镜下上颌骨内侧壁切除是治疗Krouse分期T₃期上颌窦内翻性乳头状瘤的良好术式,术中联合经鼻泪道置管可以预防泪道狭窄。     

Inverted papilloma-like sinonasal epithelial hyperplasia, overshadowing underlying sinonasal fibrosarcoma: a diagnostic pitfall

Proliferating invaginations of the sinonasal epithelium, simulating inverted papillomas, have been mentioned once in the literature as a reactive phenomenon overlying sinonasal fibrosarcomas. These proliferations may be so marked as to make the distinction from inverted papilloma virtually impossible. The possible result is that the examining pathologist's attention might be drawn exclusively to the epithelial component, thus causing him to overlook, especially in a small biopsy, a rather bland but distinctive sarcomatoid component which is located underneath. We report such a case of marked endophytic proliferation of sinonasal epithelium which was interpreted, in the preoperative biopsy, as an inverted papilloma with dense fibrous stroma which later, in the surgical specimen, was found to be a part of a submucosal fibrosarcoma. The diagnostic pitfall is discussed.     

Sinonasal Papillomas: Clinicopathologic Review of 40 Patients With Inverted and Oncocytic Schneiderian Papillomas

Objective To evaluate the pathological features and variations of sinonasal inverted and oncocytic papillomas and correlate the microscopic findings with the clinical behavior. Study Design A retrospective review and pathological assessment. Methods A retrospective review and pathological assessment were performed on 40 patients with a diagnosis of inverted papilloma treated by the senior author (w.l.) between 1994 and 2001. Results Forty cases were identified and reviewed. Seven patients developed recurrences (18%), and four underwent malignant transformations (10%). Pathological assessment revealed 34 (85%) inverted papillomas and 6 (15%) oncocytic schneiderian papillomas. Dysplasia was present in 26 cases (65%), including 9 cases (22%) of high‐grade dysplasia (moderate to severe). Metaplasia of the sinonasal mucosa adjacent to inverted papillomas and oncocytic schneiderian papillomas was seen in 18 (45%) cases. Recurrence developed in two patients with oncocytic schneiderian papillomas (33%) and five patients with inverted papillomas (15%). Four cases (10%) of carcinoma ex papilloma were seen; one arose from oncocytic schneiderian papilloma (17%), and three arose from inverted papilloma (9%). Oncocytic schneiderian papilloma was more often mixed with typical inverted papilloma, rather than presenting in its pure form. Conclusions Although oncocytic schneiderian papilloma is uncommon relative to inverted papilloma, the results suggest that they have higher rates of both recurrence and malignant transformation. The common admixture of oncocytic schneiderian papilloma with inverted papilloma speaks for a common etiological factor of these two lesions. A larger number of cases for analysis would be necessary to confirm the trend noted in our data. Nonetheless, pathological findings consistent with oncocytic schneiderian papilloma should be explicit in any classification system and justify aggressive treatment and careful postoperative surveillance.