鼻腔鼻窦内翻性乳头状瘤人类乳头状瘤病毒DNA检测

为了解鼻腔鼻窦内翻性乳头状瘤与人类乳头状瘤病毒（ＨＰＶ）之间的关系，采用聚合酶链反应，对３８例患者的４４个鼻腔鼻窦内翻性乳头状瘤的病理组织蜡块进行ＨＰＶ－ＤＮＡ的检测。结果显示，３８例中３０例患者的３０个瘤组织蜡块呈ＨＰＶ阳性，总感染率为６８．２％，其中３０例次ＨＰＶ１１型阳性（６８．２％），１８例次ＨＰＶ１６型阳性（４０．９％），２例次ＨＰＶ１８型阳性（４．５％），其中１８例ＨＰＶ１１，１６、２     

鼻腔鼻窦内翻性乳头状瘤的手术治疗

鼻腔鼻窦内翻性乳头状瘤是鼻腔良性肿瘤，但因其侵袭性强、复发率高及有一定的恶变率而受到临床的重视。外科手术治疗是鼻腔鼻窦内翻性乳头状瘤的主要治疗方法，过去常规运用鼻外径路方法，主要包括鼻侧切开术和面正中掀翻术切除肿瘤。近年部分学者对鼻腔鼻窦内翻性乳头状瘤采用鼻内镜手术治疗，取得良好的近期疗效。     

鼻腔,鼻窦内翻性乳头状瘤的研究进展

鼻腔、鼻窦内翻性乳头状瘤（NIP）组织中某些类型的乳头状瘤病毒的基因表达显著增强，恶变率较高，治疗上首选手术切除。本前应进行CT或MRI检查以明确病变范围。对于体积小、范围局限的NIP可以选经鼻腔、或柯－陆氏径路、或在内窥镜下切除；而体积大、范围广的NIP则以经鼻侧切开径路切除为宜，以减少术后复发。     

鼻腔—鼻窦内翻性乳头状瘤复发与恶变

鼻腔 -鼻窦内翻性乳头状瘤在组织学上虽为良性肿瘤 ,但是 ,局部呈侵袭性生长 ,手术后容易复发 ,而且有恶变的可能性。本文复习最近 10年的有关文献 ,仅就内翻性乳头状瘤复发 ,恶变和放射治疗问题综述如下     

鼻腔鼻窦内翻性乳头状瘤

内翻性乳头状瘤约占乳头状瘤的70%,约占全部鼻腔鼻窦肿瘤的0.5%～4%,其临麻特征是有复发倾向、破坏周围解剖结构和骨质重塑、以及与鳞状细胞癌相关。单侧鼻堵是最常见的临床症状。肿瘤分期依据病变在CT上的侵及范围。累及鼻腔外侧壁、上颌窦和筛窦多见。既往治疗的经典方式是鼻侧切开术和鼻腔外侧壁(上颔窦内侧壁)切除术。伴随着鼻内镜外科技术的发展和成熟,国内、外有关应用内镜技术切除内翻性乳头状瘤的报道渐多。考虑到内翻性乳头状瘤的生物学特点,手术治疗的目的是应用精细手术解剖技术,将病变黏膜在骨膜下层彻底切除。     

鼻腔鼻窦内翻性乳头状瘤18例分析

本文报告所收治鼻腔鼻窦内翻性乳头状瘤１８例，均经手术切除。其中３例癌变者２例死于癌复发，１例死于肺转移癌。１５例无癌变者随访中，术后５例出现复发，分别行局部肿瘤切除或ＣＯ２激光气化。就其诊断中注意点，治疗原则，复发原因及处理，恶变的预后等进行了分析。     

经鼻内镜行鼻腔鼻窦内翻性乳头状瘤切除术

目的：探讨经鼻内镜行鼻腔鼻窦内翻性乳头状瘤(IP)治疗的效果。方法：回顾性分析我科1996年1月～2002年1月在鼻内镜下行手术治疗的36例IP病人的临床资料。结果：随访6个月～6年，仅2例在手术后复发，其余34例在随访期内均未见复发，治愈率为94．4％。结论：经鼻内镜手术治疗IP是一种较好的方法，该术式避免了面部切口，术中能保留鼻腔鼻窦正常结构和黏膜，创伤小，有利于鼻腔功能的恢复。但并不能完全取代传统的鼻外径路手术，因而必须掌握好手术适应证。     

鼻腔—鼻窦内翻性乳头状瘤复发与恶变的治疗

目的 探讨鼻腔-鼻窦内翻性乳头状瘤复发与恶变的临床特点与治疗方法。方法 回顾性分析1990－2000年我院收治的鼻腔－鼻窦内翻性乳头状瘤复发和恶变患者的临床资料。结果 22例肿瘤复发患者既往均有鼻腔－鼻窦手术史，其中复发1次者13例，复发2次者7例，复发3次者1例，复发4次者1例，复发时间从3个月－11年。22例中，经鼻腔入路，经上颌窦根治径路，经鼻侧切开径路的复发率分别为73.3%，42.9%和33.3%，10例采用了内镜或内镜辅助手术，经随访1－5年，未见肿瘤再次复发。8例肿瘤恶变患者，4例接受了鼻侧切开肿瘤切除术，1例柯－陆手术，手术后均给予放射治疗（40－70Gy)，这5例经随访2－6年未见肿瘤复发，另外3例，1例失随访，2例死亡。结论 积极、彻底的内镜下手术（包括内镜＋外部切口的联合入路）是治疗内翻性乳头状瘤（包括复发肿瘤）的首选方法，对于肿瘤恶变患者应采取广泛手术切除加手术后放射治疗，但预后不佳。     

鼻腔-鼻窦内翻性乳头状瘤复发与恶变的治疗

目的　探讨鼻腔 鼻窦内翻性乳头状瘤复发与恶变的临床特点与治疗方法。方法　回顾性分析 1990～ 2 0 0 0年我院收治的鼻腔 鼻窦内翻性乳头状瘤复发和恶变患者的临床资料。结果2 2例肿瘤复发患者既往均有鼻腔 鼻窦手术史 ,其中复发 1次者 13例 ,复发 2次者 7例 ,复发 3次者 1例 ,复发 4次者 1例 ,复发时间从 3个月～ 11年。 2 2例中 ,经鼻腔入路 ,经上颌窦根治径路 ,经鼻侧切开径路的复发率分别为 73 3% ,4 2 9%和 33 3% ,10例采用了内镜或内镜辅助手术 ,经随访 1～ 5年 ,未见肿瘤再次复发。 8例肿瘤恶变患者 ,4例接受了鼻侧切开肿瘤切除术 ,1例柯 陆手术 ,手术后均给予放射治疗 (40～ 70Gy) ,这 5例经随访 2～ 6年未见肿瘤复发 ,另外 3例 ,1例失随访 ,2例死亡。结论　积极、彻底的内镜下手术 (包括内镜 +外部切口的联合入路 )是治疗内翻性乳头状瘤 (包括复发肿瘤 )的首选方法 ,对于肿瘤恶变患者应采取广泛手术切除加手术后放射治疗 ,但预后不佳     

ZEB2在鼻腔鼻窦内翻性乳头状瘤中的表达及意义

目的 探讨ZEB2蛋白在鼻腔鼻窦内翻性乳头状瘤(SNIP)中的表达及其与SNIP发生、发展及癌变的关系.方法 采用免疫组织化学方法检测ZEB2蛋白在51例SNIP(观察组)和20例增生鼻甲组织(对照组)中的表达差异,分析ZEB2蛋白表达与SNIP患者临床病理参数之间的关系.结果 观察组中ZEB2蛋白的表达水平高于对照组...     

Etiology of sinonasal inverted papilloma: A narrative review

ObjectiveSinonasal inverted papilloma (IP) is a benign and uncommon tumor of the nasal cavity and paranasal sinuses with a tendency for recurrence and even malignant transformation. Though the morphology and clinical behavior of this lesion has been well described, its etiology remains controversial.MethodsComputerized searches were performed in PubMed, Scopus, and Google scholar through May 2015. In this review, etiologic factors including human papilloma virus (HPV), Epstein–Barr virus (EBV), cell cycle related proteins and angiogenic factors, occupational and environmental exposures, and chronic inflammation, will be discussed.ResultsMany studies indicate that HPV has been detected in a significant percentage of IP, while EBV has not been shown to be significantly associated. Certain cell cycle regulatory factors and angiogenic proteins contribute to the dysregulation of proliferation and apoptosis, and facilitate migration and tumor invasion. Occupational exposures, such as welding and organic solvents, have been implicated, and smoking seems more critical to recurrence and dysplasia rather than initial IP occurrence. Chronic inflammation may also have a causative relationship with inverted papilloma, but the mechanism is unclear.ConclusionsThough etiology of sinonasal IP remains controversial, the studies reviewed here indicate a role for viral infection, cell cycle and angiogenic factors, environmental and occupational exposure, and chronic inflammation. Further study on etiologic factors is necessary for clinical guidance and therapeutic targets.     

鼻腔鼻窦内翻性乳头状瘤与外周血炎症标志物的相关性研究

目的探讨鼻腔鼻窦内翻性乳头状瘤(SNIP)与外周血液炎症标志物的相关性。方法回顾分析2019年2月至2021年3月于河南省人民医院耳鼻咽喉科接受鼻窦内镜手术,经组织病理学诊断为鼻腔鼻窦内翻性乳头状瘤的62例患者作为实验组。选取同期62例健康体检者作为对照组。对两组的临床资料进行回顾性分析,对比分析两组术前外周血细胞成分计数及中性粒细胞/淋巴细胞比值(NLR),血小板/淋巴细胞比值(PLR)等之间的差异。将实验组根据是否复发、癌变进一步分为SNIP组(38例),复发组(14例)及癌变组(10例),分别进行多重比较分析。结果实验组与对照组的外周血中性粒细胞(P<0.001)、嗜酸性粒细胞计数(P<0.001),中性粒细胞/淋巴细胞计数比(NLR)(P=0.016),血小板/淋巴细胞计数比(PLR)(P=0.005)差异有统计学意义。建立Logistic回归分析模型发现,NLR的增加(P<0.001)、PLR的减少(P=0.002)以及嗜酸性粒细胞计数的增加(P=0.013)差异有统计学意义。实验组进一步多重比较分析,嗜碱性粒细胞计数在三组间总体差异有统计学意义,其中SNIP和复发组(P=0.045),癌变和复发组(P=0.017)在嗜碱性粒细胞计数比较差异有统计学意义。结论外周血嗜酸性粒细胞、中性粒细胞计数及NLR、PLR与SNIP具有相关性,并且可能成为SNIP的外周血液炎症标志物,NLR的增加、PLR的减少以及嗜酸性粒细胞计数的增加可能是SNIP的危险因素。     

鼻内翻性乳头状瘤中Fascin的表达及与微血管密度的关系

目的:探讨Fascin在鼻腔鼻窦内翻性乳头状瘤中的表达及其与微血管密度(MVD)的关系。方法:采用免疫组织化学方法检测30例鼻腔鼻窦内翻性乳头状瘤、12例鼻腔鳞状细胞癌及10例正常下鼻甲黏膜标本中Fascin的表达水平,计数CD34标记的肿瘤MVD。结果:鼻腔鼻窦内翻性乳头状瘤和鼻腔鳞状细胞癌组织中Fascin的表达分别为56.6%和83.3%,均显著高于正常下鼻甲黏膜组织20.0%(均P<0.01)。CD34标记的MVD值在下鼻甲、鼻腔鼻窦内翻性乳头状瘤、鼻腔鳞状细胞癌分别为23.64±2.74、45.10±5.45、74.76±7.32,两两比较差异均有统计学意义(均P<0.01)。Fascin表达与MVD计数呈正相关(P<0.01)。结论:Fascin的高表达以及血管生成与鼻腔鼻窦内翻性乳头状瘤的生物学行为密切相关,Fascin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,Fascin可能与血管生成在鼻腔内翻性乳头状瘤的发展中起协同作用。     

鼻腔鼻窦内翻性乳头状瘤的临床分期及术式选择

鼻腔鼻窦内翻性乳头状瘤(sinonasal inverted papilloma,SNIP)是鼻腔最常见的良性肿瘤,三个特征使SNIP与其它鼻腔肿瘤有很大的不同:局部破坏性大,复发率较高,有癌变可能。SNIP分期至关重要,其在SNIP术式选择以及预后评估方面具有公认的价值,但目前还没有普遍接受的分期系统。手术是SNIP首选治疗方式,术式可分为鼻外入路、鼻内镜入路以及联合入路,但是切除SNIP的最佳术式仍然存在争议。本文对SNIP分期系统以及术式管理的最新进展进行综述。     

HPV感染与鼻内翻性乳头状瘤复发及恶变相关的Meta分析

 目的探讨人乳头状瘤病毒（HPV）与鼻腔鼻窦内翻性乳头状瘤（SNIP）发生、复发及恶变的关系。方法检索Pubmed、Web of science、 Embase、Cochrane Library、CNKI、维普、中国知网及万方等数据库,查找2000~2017年国内外公开发表的HPV与SNIP发生、复发及恶变相关的所有病例对照研究文献,应用RevMan 5.3统计软件对各研究原始数据进行统计分析。结果Meta分析示SNIP组HPV感染率明显高于对照组(P<0.01,OR=19.72,95%CI为7.91~49.18);复发组HPV感染率明显高于对照组(P<0.01,OR=3.10,95%CI为1.90~5.08);恶变组HPV感染率明显高于对照组（P<0.01,OR=2.09,95%CI为1.41~3.09）。结论HPV感染与SNIP的发生、复发及恶变密切相关。     

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。     

A clinical analysis of sinonasal squamous cell carcinoma: a comparison of de novo squamous cell carcinoma and squamous cell carcinoma arising from inverted papilloma

Abstract

Background: Sinonasal squamous cell carcinoma (SCC) is a rare tumor arising either de novo or in association with inverted papillomas (IPs).

Objectives: The aim of this study was to investigate and compare the oncological features and prognosis of patients with sinonasal SCCs based on their etiology.

Material and methods: The medical records of 117 patients who had been diagnosed with de novo SCC or those arising from IP (IP-SCC) were retrospectively reviewed. In situ hybridization analyses to detect HPV 16/18DNA and p16 immunohistochemistry were also performed in 10 cases with IP-SCC.

Results: The three-year disease-specific survival (DSS) rate was higher in cases with T1, 2 and 3 than in cases with T4 in both tumor groups. T4 cases with de novo SCC had a better DSS than those with IP-SCCs. HPV16/18 was not detected in any of the 10 IP-SCCs.

Conclusions and significance: T4 cases with de novo SCC tended to have a better DSS than those with IP-SCC. Since some T4 patients with IP-SCC were found to have a highly aggressive disease, careful treatment planning should be performed. High-risk HPV may not play a vital role in the carcinomatous transformation of most IP-SCC cases.     

E-cadherin和ZEB2在鼻腔鼻窦内翻性乳头状瘤中的表达及其临床意义

目的 探讨E-cadherin mRNA和ZEB2 mRNA在鼻腔鼻窦内翻性乳头状瘤(SNIP)中的表达及其临床意义.方法 采用荧光定量PCR法检测E-cadherin mRNA和ZEB2 mRNA在51例SNIP和20例增生鼻甲组织中的表达,探讨E-cadherin mRNA和ZEB2 mRNA表达与SNIP患者临床...     

Sinonasal inverted papilloma associated with small cell neuroendocrine carcinoma: A case report and literature review of rare malignancies associated with inverted papilloma

We report a rare case of sinonasal inverted papilloma (IP) associated with small cell neuroendocrine carcinoma (SNEC). To our knowledge, this is the first report to describe SNEC found during the treatment of sinonasal IP. Surgery and five cycles of cisplatin plus etoposide with concurrent intensity modulated radiation therapy were performed. Neither local recurrence nor distant metastasis was noted during 6 years of post-diagnostic follow-up. The prognosis of SNEC is very poor. Treatment planning for sinonasal IP should consider a possible association with this rare but aggressive malignancy, whose treatment is completely different from that of squamous cell carcinoma, a malignancy which is commonly associated with IP.We also performed a PubMed review of the literature to identify the incidence and pathological diagnosis of associated malignancy. Among a total of 5286 cases of sinonasal IP (61 studies), the incidence of associated malignancy was 8.02% in squamous cell carcinoma, 0.19% in transitional cell carcinoma, 0.04% in mucoepidermoid carcinoma, 0.02% in verrucous cell carcinoma and 0.02% in adenocarcinoma. The incidence of associated malignancy was significantly higher in East and Southeast Asia (11.0%) and North America (10.4%) than in Europe (3.9%) (p = 0.04 and p = 0.03, respectively; T-test).     

ErbB1 and ErbB2 overexpression in patients with sinonasal inverted papilloma and inverted papilloma with squamous cell carcinoma in China

Abstract

Background: Currently, the expression patterns of epidermal growth factor receptor (EGFR) family genes in sinonasal inverted papilloma (SNIP) and inverted papilloma with squamous cell carcinoma (IPwSCC) are not clear.

Objective: This study aimed to investigate the expression of EGFR family members and their ligands in SNIP and IPwSCC and to analyze their correlations with SNIP histological grade and Krouse stage.

Materials and methods: Data from 25 cases of inverted papilloma patients in China were collected and divided into 16 cases in the SNIP group and 9 in the IPwSCC group. In addition, eight cases of normal nasal mucosa (NNM) were collected and used as the control group. The expression levels of EGFR family members and their ligands in the NNM and SNIP groups and EGFR family members in the IPwSCC group were evaluated using immunohistochemistry and qRT-PCR. In addition, their correlations with the SNIP histological grade and Krouse stage were analyzed. The statistical analysis was performed using the GraphPad Prism 7.0 statistical software.

Results: The ErbB1 and ErbB2 mRNA and protein expression levels were significantly higher in the SNIP group than in the NNM group (p?<?.01). The ErbB1 and ErbB2 protein expression levels were significantly higher in the IPwSCC group than those in the NNM and SNIP groups (p?<?.01). The ErbB1 and ErbB2 mRNA and protein expression levels in the SNIP group were positively correlated with the SNIP dysplasia grade.

Conclusion: Upregulation of ErbB1 and ErbB2 expression may be associated with SNIP pathogenesis and carcinogenesis.