Risks of malignancy in inverted papilloma of the nose and paranasal sinuses

PURPOSE OF REVIEW: The majority of inverted nasal papilloma are benign and treatment is by complete local surgical removal. There is an associated real, but small risk of malignancy, which may coexist at the time of presentation or develop at a later time. This article reviews some of the recent publications addressing the association of inverted papilloma with malignancy. RECENT FINDINGS: Neither the etiology of inverted papilloma nor the factors responsible for malignant transformation are fully elucidated to date. Inverted papilloma is associated with squamous cell carcinoma in approximately 10% of the cases. Malignancy may occur synchronously or metachronously. SUMMARY: Based on the literature, the rates of synchronous and metachronous carcinoma are 7.1 and 3.6%, respectively, although rates may be exaggerated due to a referral bias to tertiary centres. A thorough removal of all diseased mucosa is curative and a meticulous histological examination of the entire specimen is necessary. The working risk is approximately 10%. Recurrent disease and metachronous carcinoma can develop after a prolonged period of time. As most recurrences are due to incomplete resection, it is mandatory to perform a close follow-up, with biopsies performed when indicated. Life-long follow-up is recommended.     

Experience with endonasal endoscopic surgery of inverted papilloma of the nose and paranasal sinuses

BACKGROUND: The inverted papilloma of the nasal cavity and the paranasal sinuses is a benign but locally aggressive neoplasm with a high recurrence rate and an unknown risk of malign transformation. This unsteadiness of biological behaviour requires a permanent control of the outcome of the available surgical treatments to ensure the utmost reliability for the patients. METHODS: In our investigation we analysed the surgical results in 54 patients with inverted papilloma of the last 30 years with an average followup of 55 months. 25 of them were endoscopically treated. The other group of 29 patients was treated by traditional surgical techniques using an extra-nasal approach. RESULTS: Using the endonasal-endoscopic technique we observed a recurrence rate of 48% whereas the other group treated by an extra-nasal approach reached a recurrence rate of only 24% and did not show any multiple recurrences. A malign transformation was found in two patients (< 5%) within the first 8 months after the first resection. CONCLUSION: In consequence patients with inverted papilloma have to be informed of the different surgical techniques and their recurrence rates. Especially an endonasal-endoscopic treatment of the maxillary sinus has to be carefully considered.     

Inverting papilloma of the nose and paranasal sinuses

A series of 30 patients with inverted papillomas of the nose and/or the paranasal sinuses is presented. The inverted papilloma is a rare tumor with an overall incidence varying from 0.5% to 4% of all primary nasal tumors. The incidence of inverted papilloma is much more common in the fifth to seventh decades. An association between inverted papilloma and carcinoma is well established. In the large series of patients, the incidence of malignancy associated with inverted papilloma ranges from 1% to 13%, and in our series 10%. Treatment of inverted papilloma is always surgical. The incidence of recurrence is directly related to the method of surgical treatment. Among our 20 patients who were treated by limited surgery, there was recurrence in 14 cases (70%). By contrast, medial maxillectomy and ethmoidectomy via lateral rhinotomy reduced the recurrence rate dramatically. In our opinion this approach is the surgery of choice in the treatment of inverted papilloma.     

Inverted papilloma of the nose and paranasal sinuses

The authors present 23 cases of inverted papilloma treated in the Department of Otolaryngology of S. Zeromski's Hospital in Kraków. The symptoms, methods of treatment and results are discussed.     

Inverting papilloma of the nose and paranasal sinuses

Inverting papilloma of the nose and paranasal sinuses has been classified as a true neoplasm by most authors. It is distinct from the ordinary nasal polyps in that it has a different cause, different histologic features, a higher recurrence rate, and is occasionally associated with carcinoma. This study includes 57 patients seen over a 30-year period who had inverting papilloma and for whom the history, clinical and radiologic findings, treatment methods, pathologic sections, and recurrences were analyzed. Features associated with higher recurrence rate were epithelial atypia and extent of lesions. Females showed higher recurrence rates than males. External approaches (lateral rhinotomy) reduced recurrence remarkably compared with transnasal removal (13 percent versus 45 percent). Four patients had associated carcinoma with inverting papilloma, and more extensive operations were performed in these cases; one patient died of the tumor. Radical aggressive treatment and careful follow-up are advocated because of the higher recurrence rate after inadequate removal and because of possible malignant transformation.     

A case of inverted papilloma of the nose and sinuses

Two cases of inverted papilloma with unilateral nasal obstruction since 2 years, bleeding from the nose and headache are described. Surgical treatment was applied. Histological examination revealed inverted papilloma.     

Endoscopic surgery in treatment of inverted papilloma nose et paranasal sinuses in the older patient

Inverted papilloma is a benign neoplasm of uncertain ethiology. The tumour is considered locally aggressive, its tendency to invade adjacent paranasal structures and high recurrence rate causes. In this work was described one case of 102 year's old patient with unilateral nasal obstruction since 5 month and headache. Endoscopy surgery was applied. Histological examination revealed inverted papilloma.     

Management of inverted papillomas of the nose and paranasal sinuses

PURPOSE: Inverted papillomas (IPs), although histologically benign, are aggressive lesions that may recur after an excision. The objective of this study was to compare the surgical treatment options for IPs with an emphasis on the experience of our institution with midfacial degloving (MFD) and medial maxillectomy. MATERIALS AND METHODS: A retrospective review of the charts of patients with IP treated by MFD and medial maxillectomy was performed. An analysis of the recurrence rates of IPs in the literature for endoscopic surgery and lateral rhinotomy was also performed. RESULTS: Ninety-eight medial maxillectomy procedures via MFD were performed for IPs with a minimum of 2 years' follow-up (median = 5.1 years). Two patients were found to have recurrences (2.1%). The literature review revealed an average recurrence rate of 15.7% for lateral rhinotomy as compared with that of 19.6% for endoscopic surgery. CONCLUSION: Midfacial degloving balances acceptable cosmetic results with low recurrence rates. It allows for adequate exposure and resection without the scar of a lateral rhinotomy incision.     

Inverted papilloma of the nose and paranasal sinuses in children.

Inverted papillomas are rare nasal and sinus neoplasms in children. The disturbing biological characteristics of these tumors seen in adults, including malignant degeneration and the high frequency of recurrence, have been similarly observed in the pediatric population. Therefore, inverted papilloma in children mandates similar treatment to that proven effective in adults, including wide excision and careful histopathological examination of any tissue excised. Radiation therapy should be reserved for those tumors associated with carcinoma. Since recurrences can occur after long periods of time, life-long follow-up is warranted.     

Inverted papilloma of nose and paranasal sinuses —surgical dilemma

Inverted Papilloma is a benign neoplasm orginating from the schneiderian membrane of nose and paranasal sinus cavities. It has varied clinical and histological involving lateral nasal wall, septum, ethmoids, maxillary and sphenoid sinuses and at times involves skull base. Interesting three cases are reported because of varied presentation of inverted papilloma.     

Endoscopic management of inverted papillomas of the nose and paranasal sinuses

We performed endoscopic resection on six patients who had inverted papillomas of the nasal cavity. Disease was completely cleared in four patients after a single procedure, while two others--both of whom had bilateral disease--required repeat surgery. At follow-up, which ranged from 6 months to 5 years, all patients were disease-free. We believe that endoscopic surgery is ideally suited for the treatment of appropriately selected patients who have limited disease and who are likely to adhere conscientiously to a regular follow-up program.     

Inverted papilloma of the nose and paranasal sinuses in childhood and adolescence

Inverted papilloma of the nose and paranasal sinuses is a tumor not usually associated with childhood. These five cases from the Massachusetts Eye and Ear Infirmary provide the only series in the literature. The patients ranged in age from 6 to 20 years. One case involved the septum exclusively; the patient experienced a recurrence. The other four cases were of sinus origin. One of these patients also experienced recurrences before definitive surgery. Another presented with a simultaneous squamous cell carcinoma. Evaluation of these cases demonstrates that the same successful, comprehensive surgical management advised for adults is justifiable in this younger age group.     

Inverted papilloma of the nose and paranasal sinuses: diagnosis and treatment

The authors present a retrospective study of 6 patients with inverted papilloma, which appeared in the material of ENT Clinic in Wroc?aw in years 1996-2001. In the group of treated patients, we can recognize 5 men and one woman at the age between 42 to 82. Average age amounted to 62 years. At all the patients the papilloma inversum was diagnosed completely accidentally, during histopathological examination, after having polypectomy or Calwell-Luca operation. Operating treatment was proceeded by performing the CT or NMR test. In four cases the Denker's operation was done, in one case More's and in another one we performed the endoscopy operation (limited changes to ethmoidal labyrinth). The patients stay under the observation for 8 months to even 5 years. In one case we observed a relapse, which occurred after 8 months (patient after the Moure's operation). In all the rest cases a relapse was not identify.     

鼻腔鼻窦内翻性乳头状瘤的综合治疗及预防复发的效果

目的总结鼻腔鼻窦内翻性乳头状瘤(nasal cavity and paranasal sinuses inverted papilloma,NIP)的临床特点,探讨鼻内镜手术结合局部药物治疗NIP的疗效和术后复发的预防。方法选取2000～2005年间入院治疗的33例NIP患者,在施行鼻内镜手术切除肿瘤的同时进行平阳霉素局部治疗,并进行鼻内镜下随访。根据Krouse分期,T1级5例,T2级17例,T3级11例。结果33例均在鼻内镜下彻底切除肿瘤,无并发症发生。在随访15～60个月期间,均未见复发和恶变病例。结论鼻内镜手术结合局部药物治疗T1～T3级NIP安全、微创,且能够有效控制术后复发,应作为首选的治疗方法。     

鼻腔鼻窦内翻性乳头状瘤的外科治疗

目的 :总结鼻腔鼻窦内翻性乳头状瘤外科治疗经验。方法 :收集自 1976年 2月至 1997年 10月间行外科治疗的 2 6例鼻腔鼻窦内翻性乳头状瘤的临床资料并进行回顾性分析。结果 :2 6例鼻腔鼻窦乳头状瘤中 8例有癌变 ,癌变率为 30 .8%。均行外科治疗。随访 2～ 5年局部复发 5例 ,其中 3例死亡 (均为乳头状瘤合并有癌变者 )。局部复发率为 19.2 % (5 / 2 6 )。结论 :术中连同上颌骨内壁切除及筛窦整块切除是治疗该病的最佳方法 ,内窥镜鼻窦切除术适用于局限性病变。     

A very rare case of low-grade angiosarcoma of the nose and paranasal sinuses

Angiosarcomas of the nose and paranasal sinuses are extremely rare. Histologically angiosarcomas are divided into two groups: low and high-grade. We present a case of angiosarcoma of apparent low-grade malignancy localized within the nasal cavity and paranasal sinuses in a 74-year old woman treated by radiotherapy due to middle ear chemodectoma 21 years ago. She was surgically treated via the lateral rhinotomy. During the 23 months follow-up no recurrence or epistaxis have been observed.