Carcinoma arising in oncocytic Schneiderian papilloma

Two men aged 54 and 73 years, respectively, had oncocytic Schneiderian papilloma (OSP) containing synchronous carcinoma at the time of first biopsy. In both cases, invasive carcinoma involved a small proportion of excised tissue and was in continuity with dysplastic surface epithelium. Our cases document that the epithelial component of OSP can undergo malignant transformation. The focal involvement of OSP with carcinoma underscores the need to examine all excised tissue microscopically.     

Office-based intralesional cidofovir injections for nasal septal papilloma: a pilot study.

OBJECTIVES: To determine if nasal septal papilloma is responsive to intralesional cidofovir injections. METHODS: Five adult males, ages 37 to 57, presented with nasal septal or columellar papilloma. Three lesions had been previously excised with the laser and recurred. The lesions were injected with cidofovir on a monthly basis until complete resolution or any residual lesion was excised afterwards with the laser. RESULTS: All patients achieved disease remission sustained over 10 to 24 months. Overall doses were much lower than those described for laryngeal papillomatosis and no toxic effects were observed. CONCLUSIONS: Office-based intralesional injections of cidofovir may show benefit in the treatment of nasal septal papilloma. EBM rating: C-4.     

鼻内镜下上颌窦（扩大）内壁切除术在鼻内翻性乳头状瘤手术中的应用

目的探讨鼻内镜下上颌窦（扩大）内壁切除术在鼻内翻性乳头状瘤手术中的应用价值。方法回顾分析2002年1月～2006年12月采用鼻内镜下上颌窦（扩大）内壁切除术治疗鼻内翻性乳头状瘤10例的临床资料。结果10例均在鼻内镜下完全切除。10例随访12～72个月,平均30个月;术后仅1例术后1年后复发;10例均无溢泪发生。结论鼻内镜下上颌窦（扩大）内壁切除术在鼻内翻性乳头状瘤手术中的应用是可行的,基本接近鼻侧切开的手术范围;最大优点是可避免面部瘢痕、创伤小、手术视野清晰、能够准确完整地切除肿瘤、术后复发率低。     

鼻内镜下手术治疗上颌窦鼻内翻乳头状瘤的临床疗效观察

目的探讨鼻内镜下手术治疗上颌窦鼻内翻乳头状瘤的治疗效果。方法选取我院2008年1月-2013年12月收治的上颌窦鼻内翻乳头状瘤患者做为研究对象,按照人院顺序随机分为治疗组与对照组,治疗组应用鼻内镜下手术治疗,对照组患者应用传统鼻侧切开术。结果治疗组患者的临床数据优于对照组,差异有统计学意义（P〈0．05）。跟踪随访2～3年,治疗组患者的恶变与复发率低于对照组,差异有统计学意义（P〈0．05）。结论应用鼻内镜下手术治疗上颌窦鼻内翻乳头状瘤的效果显著,术中微创治疗,术后无并发症发生,值得临床推广应用。     

Is bowel preparation before colonoscopy a risky business for the kidney?

Acute phosphate nephropathy after bowel preparation with oral sodium phosphate (OSP) for colonoscopy has emerged as an important clinical entity. In 2004, five cases of nephrocalcinosis and irreversible renal failure after bowel preparation with OSP were reported. More recently, several retrospective studies have shown that the incidence of acute kidney injury after OSP use is in the range of 1-4%, similar to the incidence of contrast nephropathy in the general population. The degree of renal failure is not generally as severe as in the first reported cases, but irreversible damage can still occur. Millions of people worldwide undergo screening colonoscopies for colon and rectal cancer after the age of 50, so careful patient selection and monitoring for possible complications is essential when OSP is used. In addition to educating patients about the possibility of renal damage, physicians should routinely watch for considerable weight loss during bowel preparation and correct the fluid deficit as needed. Carrying out a renal function panel, which includes serum phosphorus level, is prudent after colonoscopy. Alternative bowel cleansing agents are needed because calcium phosphate precipitation is inevitable after OSP use even in the normal kidney.     

鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤

目的探讨鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤的方法及可行性,观察其疗效。方法回顾性分析2008年1月～2012年12月57例鼻腔鼻窦内翻性乳头状瘤的临床资料,均行鼻内镜下切除手术。根据病变程度和范围,选择经典式鼻内镜手术,鼻内镜中鼻道、下鼻道联合上颌窦开窗术,鼻内镜辅助下Caldwell—Luc手术。观察术后复发率。结果随访1～3年,（23±9）月。复发率10．5％（6／57）,其中经典式鼻内镜手术9．7％（3／31）,鼻内镜中鼻道、下鼻道联合上颌窦开窗术10．0％（2／20）,鼻内镜辅助下Caldwell—Lue手术16．7％（1／6）。复发6例均行二次鼻内镜手术,随访6—12个月,平均7．5月,无再次复发。结论鼻内镜下手术治疗鼻腔鼻窦内翻性乳头状瘤手术损伤小,术后复发率低,临床疗效较好。     

Possible influence of cerebrospinal fluid pressure on the growth of a third ventricle choroid plexus papilloma

A case of histologically proven benign choroid plexus papilloma of the third ventricle in a 4-month-old male child is reported. The clinical symptoms and the neuroradiologic findings were those of a supratentorial hydrocephalus. A shunting procedure was performed after refusal by the family of a direct surgical approach. Subsequently there was a four- to fivefold increase in volume of this tumor in less than 4 months under decreased cerebrospinal fluid pressure. The purpose of this report is first to add a case to 27 cases of papilloma of the choroid plexus of third ventricle reported in the medical literature. Secondly to underline a possible influence of intraventricular pressure on the growth of a histologically benign intraventricular papilloma. Subsequently, the question of radiation therapy may be raised, if total removal of the papilloma is not obtained, especially in view of decreased cerebrospinal fluid pressure provided by the previous shunting procedure.     

Primary choroid plexus papilloma located in the suprasellar region: case report.

A 34-year-old woman with primary choroid plexus papilloma occurring in the suprasellar region is reported. No connection with the ventricular system was found during intraoperative observations. The findings of pathological examinations such as hematoxylin and eosin staining, transthyretin (prealbumin) immunoreactivity, and electron microscopy were consistent with choroid plexus papilloma. Radiologically, it was extremely difficult to differentiate from tuberculum sellae meningioma. To our knowledge, this is the first case of primary choroid plexus papilloma in this location reported in the literature.     

Papillomatosis of the gallbladder with carcinoma

A case of widespread papillomatosis of the gallbladder, accompanied with an area of carcinoma in the presence of calculosis is reported. The question whether papilloma of the gallbladder should be regarded as a precancerous lesion, and what r?le concomitant lesions play in the pathogenesis of papilloma and its degeneration, are briefly discussed. It is felt that calculosis represents a considerable risk factor in the malignant transformation of papilloma, and the surgical treatment of all polypoid affections of the gallbladder is advised.     

Comparison between open simple prostatectomy and green laser enucleation of the prostate for treating large benign prostatic hyperplasia: a single-centre experience

Purpose

This study sought to compare perioperative outcomes and morbidities for open simple prostatectomy (OSP) and endoscopic green laser enucleation of the prostate (GreenLEP).

Methods

In a single department, all consecutive patients who underwent OSP between January 2005 and December 2010 were retrospectively reviewed, and all consecutive patients undergoing GreenLEP between July 2013 and January 2017 were prospectively enrolled. Perioperative data, information regarding early postoperative complications for up to 6 months and outcomes were collected and retrospectively compared.

Results

Overall, 204 patients were enrolled in each group. The baseline characteristics of patients in both groups were comparable. Intraoperative time was significantly longer for the OSP group than for the GreenLEP group (67 versus 60 min; p < 0.0001). The OSP group had significantly longer catheterisation (5 versus 2 days; p < 0.0001) and hospitalisation times (7 versus 2 days; p < 0.0001) than the GreenLEP group. The overall rate of complications was significantly higher after OSP than after GreenLEP (37.2 versus 20.6%; p = 0.0003); both Clavien–Dindo grade 3a complications (8.8 versus 0.98%) and Clavien–Dindo grade 3b complications (2.4 versus 3.4%) were observed. The transfusion rate was higher after OSP than after GreenLEP (8.3 versus 0.5%; p = 0.0001). The rehospitalisation rate was similar for both groups (7.8 versus 8.3%; p = 0.99).

Conclusions

The results of this single-centre cohort study confirm those of similar prior investigations addressing endoscopic enucleation of the prostate. Compared with OSP, GreenLEP may have a more desirable perioperative profile with lower morbidity. In contrast, GreenLEP and OSP were associated with similar 6-month rehospitalisation rates.

     

Unique characteristics of malignant schneiderian papilloma

PURPOSE: To ascertain the characteristics unique to malignant schneiderian papilloma (MSP). METHODS: A case-control study of all schneiderian papilloma (SP) patients treated between 1978 and 1997 was conducted. Comparison was made between patients with MSP and patients with benign SP (BSP). RESULTS: A diagnosis of SP was made in 72 patients. Malignant changes, all of them the inverted papilloma subtype, were found in 8 of these patients. Three were diagnosed carcinoma in situ, and 5 were defined as invasive squamous cell carcinoma. At presentation, the MSP patients had significantly larger tumor spread into the ethmoid and sphenoid sinuses. The recurrence rate was significantly lower in SP patients treated with extensive surgical procedures. An association was found between the presence of malignant lesions and positive smoking history, subjective awareness of a nasal mass, and ethmoid and sphenoid sinus involvement. Also, histologic multicentricity was a feature more often seen in MSP than BSP and was a significant correlate with malignancy. CONCLUSION: The physician evaluating a patient with SP should be aware of the features described and of their possible association with a malignant lesion.     

The pathology of head and neck tumors: Nasal cavity and paranasal sinuses,part 5

Nasal polyps and epithelial papillomas of the sinonasal tract often manifest similar clinical signs and symptoms. The similarity ends, however, when one considers their disparate biologic behavior. Polyps are associated with atopy, infection, and some metabolic, systemic disorders, whereas papillomas are enigmatic in pathogenesis and do not have an association with possible precursor disorders. While recurrences of nasal polyps may be an annoyance for the patient, such recurrences lack the local aggressiveness of the papilloma. Malignancies are rare in nasal polyps, whereas the frequency of malignancies in papillomas is both statistically and biologically significant. In this report, selected aspects of nasal polyps are considered and serve to contrast with the clinicopathologic evaluation of epithelial papillomas.     

Comparative assessment of aluminum and lead concentrations in serum and tissue bioptates in patients with laryngeal papilloma or cancer

A comparative assessment of toxic element concentrations in serum and tissue bioptates in patients with laryngeal papilloma or cancer was performed. Examinations were conducted in 60 patients (40 men and 20 women) aged 20-88 years (average 59 +/- 05). Patients were divided into 3 groups; 20 patients with laryngeal papilloma were in group I, 20 with laryngeal cancer were in group II, and 20 with deviated nasal septums were included as a control group (III). Diagnosis of laryngeal papilloma (removed by direct microlaryngoscopy--Kleinsasser method) and laryngeal cancer (removed by the Rethi method) was histopatologically confirmed in patients from groups I and II, respectively. Patients in the control group received functional surgery to repair deviated nasal septums. Serum and tissue samples were obtained from all patients before surgery. Aluminum and lead concentrations were analysed by inductively coupled plasma atomic emission spectrometry (ICP-AES) using a Spectroflame M spectrometer. The considerable rise of aluminum and lead concentration in tissue bioptates and aluminum in serum in groups I and II in comparison to the control group suggests that these elements may play a significant part in the aetiology and development of precancerous lesions and laryngeal cancers. Measuring toxic chemical element concentrations in tissue bioptates can be useful in the diagnosis and estimation of development of precancerous lesions of the larynx as well as laryngeal cancer. Toxic elements concentration may play a significant role in carcinogenesis and may determine trends in cancer aetiology.     

Indications for the Caldwell-Luc approach in the endoscopic era.

OBJECTIVE: Caldwell and Luc described the Caldwell-Luc operation more than 100 years ago as the surgical treatment for maxillary sinus disease. During the last decades less radical interventions using endoscopic approach have mainly replaced the classical procedures done for chronic and recurrent maxillary sinusitis. STUDY DESIGN AND SETTING: Between 1991 and 2002, 62 patients had the Caldwell-Luc approach for different indications. RESULTS: Twenty (32%) patients had chronic sinusitis, 16 (26%) patients had inverted papilloma, 9 (15%) patients had suffered from nasal polyposis, 4 patients (6%) had dentigerous cyst, 4 (6%) patients had fungal ball, and 9 (15%) patients were operated for other indications. CONCLUSIONS: The use of this surgical approach is rational in cases of fungal disease and in endoscopic medial maxillectomy for treating inverted papilloma. In all other cases, the preferred approach should now be endoscopic.     

A choroid plexus papilloma of the third ventricle in the neonatal period--a case report

The incidence of choroid plexus papilloma is about 0.5% of all intracranial tumors, but choroid plexus papilloma in the third ventricle is rare. Fortuna reported 56 cases of choroid plexus papilloma of the third ventricle in 1979. Among them, the neoplasm of the third ventricle in the neonatal period was not found. This report is a case of choroid plexus papilloma of the third ventricle in the neonatal period. A 34 day-old female was admitted to our service with complaints of head enlargement, vomiting, and convulsive seizures on January 8, 1981. Enlarged head had been noticed by her family within the first two weeks. On admission, a marked congenital hydrocephalus was diagnosed by CT scan with symmetrical dilated ventricles and no abnormal high or low density area, and V-P shunt was performed on the next day. But several days later, she suffered from progressive abdominal distension, which was disclosed due to CSF overproduction by a choroid plexus papilloma. When the tumor was recognised by enhanced CT scan, her general condition was too poor to attempt a surgical procedure, and she died on March, 19, 1981. Histologically the neoplasm was a typical choroid plexus papilloma of the third ventricle. So far as we know, this case is the first one of the choroid plexus papilloma of the third ventricle in the neonatal period.     

逆行颊肌黏膜瓣一期修复鼻腔内翻性乳头状瘤切除术后创面

目的 介绍逆行颊肌黏膜瓣一期修复经鼻内镜切除鼻腔内翻性乳头状瘤术后创面的方法。方法 应用鼻内镜经鼻孔完整切除鼻腔内翻性乳头状瘤，采用患侧面动脉前颊支为蒂的逆行颊肌黏膜瓣，经口鼻隧道转移到鼻腔，一期修复肿瘤切除术后创面。结果 共治疗3例，术后颊肌黏膜瓣全部完全成活，无并发症发生。结论 逆行颊肌黏膜瓣用于修复侵及鼻阈的鼻腔内翻性乳头状瘤切除术后创面，解决了继发鼻腔瘢痕挛缩狭窄的问题。与鼻内镜下肿瘤切除手术同期完成，提高了手术质量，减少了需二期手术矫正继发畸形的可能性。本手术不仅可以修复各种鼻腔肿物切除术后创面，预防鼻腔瘢痕性狭窄形成，而且可以用于治疗既往已经形成的鼻腔瘢痕性狭窄。     

Inverted papilloma of the urinary bladder in a girl

We report a case of inverted papilloma of the urinary bladder in a 10-year-old girl. She was referred to us with intermittent asymptomatic gross hematuria. A polypoid, pedunculated mass, which had a thin and long stalk, approximately 6 x 20 mm in diameter, was observed by cystscopic examination at the right paratrigone. The lesion was resected endoscopically. Histological findings were compatible with the trabecular type of inverted papilloma. There have been only 3 cases reported of inverted papilloma in children, and no report has previously been published concerning a girl. Since the biological potential of pediatric inverted papilloma remains unclear, we believe that our patient should undergo periodic and detailed urological examinations.     

The septal translocation procedure: an alternative to lateral rhinotomy

Lesions deep in the nasal vault with contiguous sinus involvement often required a lateral rhinotomy for exposure. This procedure affords excellent surgical access, but requires a significant external incision. An alternative sublabial technique, with dislocation of the nasal septum into the opposite nasal passage, provides excellent surgical exposure for these same lesions, while external facial incisions are avoided. The text outlines the surgical technique and representative uses in optic nerve decompression, inverted papilloma, giant rhinolith, angiofibroma, and a variety of nasosinus and nasopharyngeal malignant lesions.     

Complications when the bony nasal dorsum is reduced by means of a rasp

Summary A case of aesthetic rhinoplasty is reported. A sharp back-cutting rasp was used to lower the bony nasal dorsum [2]. A poor postoperative result was obtained after six months because of small irregularities (steps on the dorsum) secondary to reossification of the rasped bone. To avoid this complication, just after removing the nasal hump with the rasp, the cavity is irrigated with a lavish quantity of saline in order to remove all the debris.