Pediatric inverted papilloma of the middle ear: Case report and review of the literature

Inverted papilloma of middle ear is a very rare clinical entity. It has been reported only in the adult population. We report a middle ear inverted papilloma in an 11-year-old male. To the best of our knowledge it is the first pediatric inverted papilloma of middle ear. The patient had a history of chronic suppurative otitis media and the lesion was found during preoperative evaluation for a tympanoplasty procedure. Total excision of the lesion and a tympanoplasty operation was accomplished. We reviewed the middle ear inverted papilloma cases regarding the age distribution, pathophysiology, treatment and prognosis.     

Pharyngeal squamous cell papilloma in adult Japanese: comparison with laryngeal papilloma in clinical manifestations and HPV infection

A number of reports have investigated the relationship between laryngeal papilloma and human papilloma virus (HPV) infection. On the other hand, it is unclear whether the HPV infection is involved in the occurrence of pharyngeal papilloma. We hypothesized that HPV infection was involved in the occurrence of pharyngeal papilloma similarly to laryngeal papilloma. To verify this hypothesis, we investigated the presence of HPV infection. Furthermore, clinical manifestations of pharyngeal papilloma, which had rarely been reported, were discussed. A male-to-female ratio, solitary or multiple occurrences, and koilocytosis were examined in cases with pharyngeal papilloma. HPV DNA was examined with unfixed surgically resected specimens of pharyngeal papilloma. A screening test by the liquid-phase hybridization method was carried out for the HPV high-risk group (16, 18, 31, 33, 35, 39, 45, 51, 56, 58, 59, and 68) and HPV low-risk group (6, 11, 42, 43, 44). As a control, 15 cases with laryngeal papilloma for which the same screening test was carried out were employed. Pharyngeal papilloma occurred as a solitary lesion more often, whereas laryngeal papilloma occurred as multiple tumors more frequently. The HPV infection rate was 0% in pharyngeal papilloma cases, which was in stark contrast with 66.7% in the HPV low-risk group in laryngeal papilloma cases. Pharyngeal papilloma occurred as a solitary lesion in females more frequently. Contrary to our hypothesis, the involvement of HPV infection was unlikely in the occurrence of pharyngeal papilloma.     

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.     

A case of Schneiderian middle-ear and sinonasal papilloma with intracranial complications

Unlike Schneiderian papilloma, a widespread benign epithelial neoplasm arising in the sinonasal tract mucosa of the nasal cavity, paranasal sinus, trachea, and larynx, middle-ear Schneiderian papilloma is extremely rare. We report a case of recurrent Schneiderian papilloma spreading to the bilateral middle ear and right paranasal sinus, and eventually causing cerebellar complications. A-52-year old woman seen for episodes of inarticulateness was first, found to have middle right ear and right ethmoid papilloma, that occurred thereafter is the middle left ear. This bilateral middle-ear papilloma is, to our knowledge, the only case reported thus far, and fell into a low-risk malignant formation group based on HPV-DNA testing. Given previous cases, we concluded that ours warranted meticulous follow-up because recurrence and malignancy are more common in multiple-site middle-ear papilloma as in our case rather than papilloma of the middle ear alone.     

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.     

Effect of human papilloma virus expression on clinical course of laryngeal papilloma

Conclusion. Our observations suggest that human papilloma virus (HPV) 6/11 is the main causative agent of laryngeal papilloma and that detection of active HPV DNA expression may be helpful in identifying patients with aggressive recurrent laryngeal papilloma. Objectives. HPV is assumed to be the main causative agent of this disease. We investigated the expression of the entire genotype of HPV in cases of laryngeal papilloma and correlated their expression with the clinical course of the disease. Subjects and methods. Seventy cases of laryngeal papilloma were evaluated for the presence of the HPV genome by in situ hybridization (ISH) using wide-spectrum HPV DNA probe. Specific types of HPV infection were determined by DNA ISH using type-specific HPV DNA probes (HPV 6, 11, 16, 18, 31, 33). Separate analyses were conducted comparing viral types, frequency of recurrences and duration of disease-free periods. Results. We detected HPV DNA in 40 of the 70 laryngeal papilloma cases (57%). In particular, HPV DNA was detected in 75% of the juvenile types. There were significant associations between HPV and laryngeal papilloma (p<0.01). Among the HPV-positive cases, major specific types were HPV 6/11 (97%). Significant associations were also noted between viral expression and clinical course.     

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.     

Malignant oncocytic papilloma. An infrequent type of sinonasal papilloma

Oncocytic scheneiderian papilloma (OSP), or cylindrical cell papilloma, is the less frequent of the three morphologically distinct papillomas occurring in the nose and paranasal sinuses. We report a case of a patient with an OSP and review on the diagnostic and prognostic implications of this type of tumor.     

Medical treatment of nasal squamous papilloma with imiquimod cream

Warts are common lesions. The prevalence and incidence of squamous papilloma of the nasal vestibulum are not known, and it is not certain how often human papilloma viruses are involved. Numerous medical or surgical treatment modalities have been reported in the literature with variable, sometimes unsatisfactory results. Imiquimod cream is a topically applied immunomodulator. It is used for warts and other skin tumours on different locations of the body. We report results of six patients treated with imiquimod five per cent cream for nasal squamous papilloma.     

A rare location of bilateral inverted papilloma of the nose and paranasal sinuses

Inverted papilloma is a rare benign sinonasal tumour, characterized by a potentially invasive nature. The lateral nasal wall represents the most common site of origin, whereas paranasal sinuses are involved by extension quite frequently. In contrast, primary sinus inverted papillomas have rarely been reported. Although the midfacial degloving approach has historically been the procedure of choice, recent technological advances have rendered endoscopic sinus surgery a safe procedure with equivalent success rates and low probability of papilloma recurrence. We present a rare case of bilateral inverted papilloma arising from the sphenoid septum and extending towards both the sphenoid and posterior ethmoid sinuses and the posterior section of both nasal cavities, while it slenderizes the sella turcica by compression and elevates the pituitary gland. The bilateral inverted papilloma was successfully removed with a transnasal endoscopic procedure. There is no evidence of recurrence for a follow up period of 1.5 years postoperatively. We conclude that it is a rare entity, which can be treated successfully with endoscopic sinus surgery in the hands of an experienced otorhinolaryngologist.     

Inverted papilloma and squamous cell carcinoma.

Since 1960, 15 patients with histologically proven inverted papilloma of the nose and paranasal sinuses have been treated at the University Hospital, City Hospital, and V. A. Hospital in Boston. Eight of these patients have been found to have squamous cell carcinoma in the pathological specimens; four of these patients have died of carcinoma. Wide surgical excision, usually through a lateral rhinotomy with exenteration of the invaded sinus as indicated, was the therapy of choice. In spite of the published incidence of carcinoma in inverted papilloma of approximately 7-24 per cent, we have found a much higher rate. We therefore, suggest that meticulous microscopic examination of multiple sections of inverted papilloma specimens be carried out in a search for evidence of squamous cell carcinoma. Inverted papilloma should be treated as a premalignant lesion by appropriate radical surgery.     

Effect of human papilloma virus expression on clinical course of laryngeal papilloma

Conclusion. Our observations suggest that human papilloma virus (HPV) 6/11 is the main causative agent of laryngeal papilloma and that detection of active HPV DNA expression may be helpful in identifying patients with aggressive recurrent laryngeal papilloma. Objectives. HPV is assumed to be the main causative agent of this disease. We investigated the expression of the entire genotype of HPV in cases of laryngeal papilloma and correlated their expression with the clinical course of the disease. Subjects and methods. Seventy cases of laryngeal papilloma were evaluated for the presence of the HPV genome by in situ hybridization (ISH) using wide-spectrum HPV DNA probe. Specific types of HPV infection were determined by DNA ISH using type-specific HPV DNA probes (HPV 6, 11, 16, 18, 31, 33). Separate analyses were conducted comparing viral types, frequency of recurrences and duration of disease-free periods. Results. We detected HPV DNA in 40 of the 70 laryngeal papilloma cases (57%). In particular, HPV DNA was detected in 75% of the juvenile types. There were significant associations between HPV and laryngeal papilloma (p<0.01). Among the HPV-positive cases, major specific types were HPV 6/11 (97%). Significant associations were also noted between viral expression and clinical course.     

Expression and localization of hepatocyte growth factor and its receptor c-Met in inverted papillomas

CONCLUSIONS: The results suggest that elevated c-Met expression in combination with the co-expression of hepatocyte growth factor (HGF) in the epithelial cells of inverted papilloma may proliferate the epithelial cells of inverted papilloma. OBJECTIVES: HGF and its receptor, c-Met, have been identified in a variety of neoplastic and normal tissue types, implicating these factors in tissue regeneration and tumor progression. We investigated the expression and distribution of HGF and c-Met in normal nasal mucosa and inverted papilloma, to evaluate the possible influence of HGF and c-Met on the development of inverted papilloma. MATERIALS AND METHODS: Normal inferior turbinate mucosa and inverted papilloma were examined for expression of HGF and c-Met using RT-PCR, immunohistochemistry and Western blot analysis. RESULTS: Using immunohistochemistry, moderate to high levels of HGF and c-Met protein were localized in epithelial cells in inverted papillomas tested in the present study. In normal turbinate mucosa immunopositive HGF was detected in the submucosal glands where faint staining was found. However, c-Met was noted in the epithelial cells and submucosal glands of normal turbinate mucosa. RT-PCR and Western blot analysis showed that the expression levels of HGF and c-Met were increased in inverted papilloma in comparison with the normal turbinate mucosa.     

Transitional papilloma of the nasal cavity and paranasal sinuses. Clinical course, viral etiology and malignant transformation

Transitional papilloma is a rare but not uncommon tumor with an overall incidence varying between 0.5 and 4% of all primary nasal tumors. The probability of recurrence is high, between 20 and 62%, even after adequate therapy. Malignancies are associated with transitional papilloma in 2-13% of cases. A series of 21 patients with transitional papilloma of the nose and/or paranasal sinuses is presented. Human papillomavirus (HPV) structural proteins and DNA types were found in 13 cases (62%) of transitional papillomas studied. None of the 9 nasal polyps and none of the 9 squamous cell carcinomas of paranasal sinuses studied as control material contained HPV DNA. We found 4 recurrent papillomas (19%) during the 2-year observation time. All recurrences were HPV-positive. The incidence of malignant transformation was 14% in this series. Treatment of transitional papilloma is always surgical. In our opinion medial maxillectomy and ethmoidectomy via sublabial rhinotomy is the surgery of choice in the treatment of transitional papilloma.     

气管切开术与儿童复发性呼吸道乳头状瘤病气管内扩散的 …

目的 探讨气管切开术与儿童复发性呼吸道乳头状瘤病的关系,介绍避免气管切开和处理喉、气管乳头状瘤的经验。方法 １９９２年５月至１９９７年７月收治患儿６２例。男３２例,女３０例。发病年龄１个月至８岁４个月,平均２岁２个月。除４例放弃继续治疗外,其他患儿共接受喉肿物摘除术、支撑镜下喉显微激光手术和／或支气管镜检查、气管内肿物摘除术１６３次。结果 ２１例气管切开并长期戴管的患儿中１７例（８０．９％）发生气     

Biological and clinical significance of p75NTR expression in laryngeal squamous epithelia and laryngocarcinoma

Intraductal papilloma arising in the major salivary gland is uncommon. We treated intraductal papilloma of the parotid gland in a 41-year-old man with a 3-week history of a painless mass in his right parotid gland. Radiologic imaging studies revealed a well-circumscribed solitary mass, 1 cm in diameter, at the posterior edge of the right parotid superficial lobe. Complete excision of the mass was performed under general anesthesia. Pathologically, the mass consisted mainly of a cystically dilated salivary duct filled with dark brown muddy components and a cluster of growing papillary cells, leading to the diagnosis of intraductal papilloma. The literature on intraductal papillomas of the major salivary glands is reviewed, with particular focus on preoperative diagnosis of this condition.     

Intraductal papilloma in the parotid duct

Intraductal papilloma arising in the major salivary gland is uncommon. We treated intraductal papilloma of the parotid gland in a 41-year-old man with a 3-week history of a painless mass in his right parotid gland. Radiologic imaging studies revealed a well-circumscribed solitary mass, 1 cm in diameter, at the posterior edge of the right parotid superficial lobe. Complete excision of the mass was performed under general anesthesia. Pathologically, the mass consisted mainly of a cystically dilated salivary duct filled with dark brown muddy components and a cluster of growing papillary cells, leading to the diagnosis of intraductal papilloma. The literature on intraductal papillomas of the major salivary glands is reviewed, with particular focus on preoperative diagnosis of this condition.     

Sinonasal inverted schneiderian papilloma

Inverted papilloma of paranasal sinuses are rare disorders of fifth & sixth decade of life, have been characterised by their usually benign histologic features, their ability to grow rapidly with bone destruction, und their tendency to recur if not adequately treated. We hereby report such an uncommon case of Schneiderian papilloma in a young patient and its management with a brief review of literature.     

Apoptosis and p53 in inverting papilloma of the sinonasal tract

The objective of this study was to identify apoptotic bodies and p53 positivity in inverting papilloma lesions to study these two as biomarkers in premalignant lesions. Archival specimens of 15 patients with inverting papilloma between the years 1992 and 1995 were retrieved. In situ end labeling technique was used to identify apoptotic bodies. Immunohistochemistry was used to detect p53 in the same specimens. The clinical course was evaluated conducting a retrospective chart review in these patients. Compared to normal epithelium, inverting papilloma lesions had a greater proportion of apoptotic bodies, which was nearly statistically significant (average 0.506/100 cells for inverting papilloma compared with 0.1/100 cells for the normal surrounding tissue). Four cases of inverting papilloma were p53 positive. There was, however, no association between p53 positive staining and the apoptotic rate. The minimum follow-up for patients was 2 years. All had a uniformly good clinical outcome with only one patient who was p53 positive showing concurrent squamous cell carcinoma. We concluded that inverting papilloma contained a higher average number of apoptotic bodies compared with normal surrounding sinonasal tissue. This showed a trend toward a positive between the apoptotic rate and premalignancy, suggesting both increased cellular proliferation and increased cell death may occur in such lesions. In this study p53 did not show a positive association with the apoptotic rate, suggesting that p53 may not be directly involved in the apoptotic regulatory pathway in inverting papillomas.     

Immune stimulation for the treatment of papilloma

OBJECTIVES: There is no curative therapy for recurrent respiratory papillomatosis. Unmethylated dinucleotides of cytosine and guanine (CpG) are potent immune stimulants that have shown efficacy against tumors as monotherapy, as vaccine adjuvants, and in combination with chemotherapies. We examined the therapeutic effect of CpG oligodeoxynucleotides in the treatment of papillomavirus in a cottontail rabbit model (CRPV). METHODS: Twenty rabbits were infected with CRPV; 10 were treated with 11 weekly CpG inoculations while treatment control rabbits received intralesional saline solution. Eight rabbits (4 treatment, 4 control) were rechallenged with CRPV 17 weeks after the initial viral challenge and monitored for new papilloma development. RESULTS: Papillomas developed in all 20 rabbits (100%) within 4 weeks of infection. The diagnosis was confirmed histologically. There was no difference in the average tumor burden between the treatment and control groups after 11 weeks of CpG treatments or after 9 additional weeks of observation. There was no difference between the groups in papilloma size at the site of the injections, nor was there eradication of papillomas at remote sites in either group. No new papillomas developed in any of the 8 animals that were rechallenged. CONCLUSIONS: We have reproduced an effective mammalian papilloma model for preclinical immunotherapeutic testing. Despite the potency of CpG in triggering host immunity, CpG oligodeoxynucleotide did not show a therapeutic effect against the large papilloma burdens tested in this study. The lack of effect suggests that either enhanced papilloma antigen presentation or targeting of immune-evasive mechanisms used by the papillomas is needed to treat bulky disease with an immunotherapeutic strategy.