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.     

Oncocytic schneiderian papilloma. A case report

Cylindrical cell papilloma is the rarest of three morphologically distinct papillomas that occur in the nose and paranasal sinuses. We report a case of a woman affected of a right sinonasal mass who was removed with the final histopatological diagnosis of oncocytic schneiderian papilloma. We review the literature clinical findings, treatment and evolution.     

Inverted schneiderian papilloma of the supraglottis: Case report

Inverted schneiderian papillomas are rare benign tumors, most often arising from the sinonasal mucosa. We describe a case of a 59‐year‐old female with an inverted papilloma of the supraglottis. This is the first reported case of a supraglottic‐presenting inverted papilloma. Although rare, this case demonstrates that these tumors should be considered during workup of supraglottic laryngeal masses. Laryngoscope, 127:2830–2832, 2017     

Schneiderian papillomas and carcinomas: a retrospective study with special reference to p53 and p16 tumor suppressor gene expression and association with HPV

Schneiderian papillomas are uncommon benign tumors of the sinonasal area. They are prone to local aggressiveness and recurrence, and some undergo malignant progression. We analyzed specimens obtained from 67 Chinese patients who had presented to the ENT department of a regional hospital with biopsy-proven schneiderian papilloma. Seven of these patients had either synchronous or metachronous carcinoma, 1 of whom had pure carcinoma in situ. For each case, we documented the morphology, immunohistochemical expression of tumor suppressor genes p53 and p16, and any association with human papillomavirus (HPV) infection as detected by either polymerase chain reaction or in situ hybridization techniques. We found that severe dysplasia and p53 positivity were strongly associated with malignant progression. Association with HPV was demonstrated in 22 of the 67 patients (33%); the association was strongest among patients with exophytic papillomas and carcinomas. The effect of HPV in papilloma oncogenesis probably begins during the early phase, while other factors are responsible for progression to carcinoma. We conclude that p53-positive, dysplastic schneiderian papillomas warrant aggressive surgical treatment.     

Schneiderian papillomas of the pharynx

Sixteen cases of schneiderian-type mucosal papillomas arising in the nasopharynx and oropharynx are reported. The patients include 11 men and 5 women ranging in age from 45 to 79 years (median 62 years). In 12 patients, the papilloma was discovered as an incidental finding, and 2 patients complained of nasal airway obstruction. In the remaining 2 cases, information regarding the cause that led to discovery was unavailable. None of the patients had a prior or concurrent history of sinonasal (schneiderian) papillomas. Histologically, all of the tumors were identical to sinonasal inverted papillomas. Transnasal or transoral surgical excision was the treatment of choice. In 4 of the patients, recurrent tumor occurred within 6 months of initial resection, necessitating additional surgery. Extended follow-up information was available in 9 cases. Eight of the 9 patients are alive and have been free of disease over periods ranging from 15 to 201 months (median 114 months) from diagnosis. One patient was found to have a separate nasopharyngeal squamous cell carcinoma 14 months after the diagnosis of the schneiderian-type papilloma. This patient died secondary to the squamous cell carcinoma 30 months after his initial evaluation.     

Oncocytic schneiderian papilloma confined to the sphenoid sinus detected by FDG-PET

We report a 55-year-old man with oncocytic schneiderian papilloma confined to the sphenoid sinus, which was initially detected by positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) at a very early stage. Based on CT and MRI findings, we suspected that the tumor was most likely benign; however, positive uptake in FDG-PET suggested malignancy. The patient underwent endoscopic resection of the tumor, and the histopathological diagnosis turned out to be oncocytic schneiderian papilloma. FDG-PET is thought to be a powerful tool to search for malignant lesions, but the present case demonstrates the fallibility of this technique. This should be taken into consideration when interpreting FDG-PET images.     

Intraductal papilloma of the parotid gland]

BACKGROUND: This rare intraductal papilloma of the salivary glands is classified as an adenoma of the subgroup ductal papillomas. The nature of intraductal papillomas has not been fully researched. It is assumed that the intraductal papilloma arises from the excretory duct reserve cell population. Since the lesion was first described, 9 cases have been reported. CASE REPORT: An additional case of intraductal papillomas of the parotid gland is presented: a 62-year-old woman with a solid and well displaceable tumor of the left preauricular region. After a standard superficial parotidectomy was performed the histological examination revealed an intraductal papilloma. RESULT AND CONCLUSION: The case represents the first published case in German literature. This study presents a review of the literature and a discussion of the histopathologic characteristics and possible histogenesis of the intraductal papilloma. Regular follow-up has not revealed any recurrence of the disease 15 months after resection. The treatment of choice is local excision or removal.     

Cell proliferation and p27Kip1 expression in endophytic schneiderian papillomas

OBJECTIVE: To clarify epithelial cell proliferation and p27Kip1 expression along the stepwise histological changes from endophytic schneiderian papillomas to associated carcinomas. STUDY DESIGN: Retrospective investigation involved surgical specimens from 58 patients. METHODS: Immunohistochemical assessment involved the nuclear Ki67 antigen expressed in proliferating cells. Further, the cyclin-dependent kinase (cdk) inhibitor p27Kip1 was assessed. Binding of p27Kip1 to the cyclin E-cdk2 complex inhibits this kinase, which results in cell cycle arrest. The expression rates of both proteins were compared between nonpapillomatous nasal mucosa, endophytic schneiderian papillomas, carcinoma in situ, and invasive squamous cell carcinomas. Statistics involved the Wilcoxon and Mann-Whitney u tests. Significance was set at P <.05. RESULTS: Comparable cell proliferation rates were observed between non-papillomatous nasal mucosa and cylindrical cell papillomas. Significant increases in cell proliferation were found along the stepwise series of histological changes involving non-papillomatous nasal mucosa, columnar epithelium in inverted papillomas, transitional and squamous metaplasia in inverted papillomas, and dysplastic inverted papillomas (P <.05, respectively). A tendency toward increased cell proliferation in carcinoma in situ compared with dysplastic inverted papillomas was present; however, this was not statistically significant. The expression rates of p27Kip1 were comparable between non-papillomatous nasal mucosa and all histological subtypes within nondysplastic endophytic schneiderian papillomas. Significantly reduced p27Kip1 expression was found in surface cells in dysplastic compared with non-dysplastic inverted papillomas, as well as in the total number of cells in carcinoma in situ compared with dysplastic inverted papillomas (P <.05, respectively). CONCLUSIONS: Inverted papillomas but not cylindrical cell papillomas show increased cell proliferation compared with nonpapillomatous nasal mucosa. Stepwise increases in cell proliferation accompany the consecutive histological changes within inverted papillomas. Among them, increased cell proliferation along with the development of dysplasia and carcinoma in situ is associated with reduced p27Kip1 expression.     

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.     

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.     

Respiratory epithelial adenomatoid hamartoma of the maxillary sinus

A case of respiratory epithelial adenomatoid hamartoma of the maxillary sinus is reported. Glandular hamartomas involving the sinonasal tract have received only limited documentation in the literature. The differential diagnosis of adenomatoid hamartoma includes schneiderian papilloma of the inverted type and adenocarcinoma. Limited but complete surgical resection is the treatment of choice.     

Nasal contact endoscopy for the in vivo diagnosis of inverted schneiderian papilloma and unilateral inflammatory nasal polyps

BACKGROUND: Inverted schneiderian papilloma is an entity surrounded by controversies ranging from its etiology to the indication of treatment. Any method that permits histopathological analysis without damage to the tissue studied deserves to be investigated. In this study, we tested a new noninvasive method, i.e., nasal contact endoscopy. METHODS: The main alterations visible on nasal contact endoscopy were described in 11 patients with inverted papilloma and in 8 patients with unilateral inflammatory nasal polyps. The characteristics showing the differentiation between the two entities were defined and these findings were presented to inexperienced examiners. RESULTS: The significant characteristics for differentiation between the two diseases were the presence of vacuolized cells, cellular heterogeneity, cell clusters, a ciliated respiratory epithelium, and vascular patterns. Two of the three examiners showed a statistically significant high rate of correct diagnosis. CONCLUSION: Nasal contact endoscopy may be an effective method for the differential diagnosis between inverted schneiderian papilloma and inflammatory polyps even when the examiner is inexperienced.     

An inverted papilloma with intracranial extension

Inverted papilloma can be found in the lateral wall of the nose, the ethmoidal sinus, the maxillary sinus, the sphenoidal sinus and the frontal sinus. To our knowledge there are no reports of papillomas with intracranial extension. This case report describes the history of a patient with long-standing inverted papillomas, which eventually grew intracranially. The treatment of this patient and the treatment of inverted papilloma in general are discussed.     

Naso-sinusal inverse papilloma: a case report]

The authors reports a case of inverted papilloma in a man of 59. The presenting symptom was unilateral nasal obstruction which developed over a period of five years. The characteristic feature of inverted papillomas is slow local growth with a tendency to cause absorption of bone and to recur, and also a potential for malignant change. Treatment is only surgical, and consists of wide and complete local excision to avoid recurrence, using either the para-latero-nasal approach or a degloving technique. The etio-pathogenesis of inverted papillomas is probably viral. DNA of papillomavirus origin has been identified in the cells of an inverted papilloma by using techniques of in situ hybridisation.     

Schneiderian papilloma of the nasopharynx

We report a rare case of a schneiderian papilloma of the nasopharynx. Because this tumor is locally invasive, has a tendency to recur, and can undergo malignant transformation, it should be completely excised. It is possible to completely remove such a tumor in a minimally invasive way by using a combination of transnasal and transoral approaches and high-resolution angled endoscopes and other suitably designed instruments.     

Detection of human papillomavirus in temporal bone inverted papilloma by polymerase chain reaction

There is debate about the role of human papillomavirus in the induction of rare inverted papillomas involving the temporal bone and in the higher recurrence rates and association with squamous cell carcinoma of temporal bone inverted papillomas compared with sinonasal inverted papillomas. An exhaustive review of the literature revealed that eight cases of temporal bone inverted papilloma have been analysed for human papillomavirus. None of the cases studied with in situ hybridization proved positive. Only one case was found to be positive using the more sensitive polymerase chain reaction assay. We present the first two cases of Schneiderian-type papilloma involving the temporal bone to be analysed by type-specific polymerase chain reaction methods for human papillomavirus.     

Detection of Human Papillomavirus in Temporal Bone Inverted Papilloma by Polymerase Chain Reaction

There is debate about the role of human papillomavirus in the induction of rare inverted papillomas involving the temporal bone and in the higher recurrence rates and association with squamous cell carcinoma of temporal bone inverted papillomas compared with sinonasal inverted papillomas. An exhaustive review of the literature revealed that eight cases of temporal bone inverted papilloma have been analysed for human papillomavirus. None of the cases studied with in situ hybridization proved positive. Only one case was found to be positive using the more sensitive polymerase chain reaction assay. We present the first two cases of Schneiderian-type papilloma involving the temporal bone to be analysed by type-specific polymerase chain reaction methods for human papillomavirus.     

Dissemination of squamous papilloma by surgical manipulation: A case report

The occurrence of multiple squamous cell papilloma in the upper and lower aerodigestive tract is well documented. While apparent inoculation to other areas in the lower respiratory tract at the time of bronchoscopy or tracheotomy is a frequently described occurrence, there have, however, been no reports of transmission of papilloma outside the respiratory tract as a result of surgical manipulation. The purpose of this paper is to report a case of squamous papilloma of the external auditory canal and tympanic membrane which resulted from apparent inoculation at the time of surgery for nasal cavity and nasopharyngeal papillomas together with myringotomies. This supports the hypothesis that an infectious agent, e.g., a virus could be the causative agent and that inoculation to other sites as a result of manipulation is possible. In light of our experience with this case we recommend specific guidelines for the handling of these patients and the protection of surgeons, anesthesia and operating room personnel. Hopefully this report will heighten awareness of papillomas as a potentially transmittable entity to sites outside the respiratory tract, and encourage others to approach these clinical situations with caution.     

Human papilloma virus and p53 expression in carcinomas associated with sinonasal papillomas: a Danish Epidemiological study 1980-1998

OBJECTIVES: To determine a putative role and relation between human papilloma virus (HPV) and p53 in the etiology of sinonasal carcinomas associated with papillomas. STUDY DESIGN: The study group consists of all patients with sinonasal carcinomas associated with papillomas diagnosed in Denmark from 1980 to 1998. After reviewing our national pathological files, tumor tissues from 36 patients were collected, comprising 15% of the total cases of sinonasal carcinomas. In 35 cases a squamous cell carcinoma was demonstrated and in one case an adenocarcinoma was evident. Inverted papilloma was associated with carcinoma in 31 cases and exophytic papillomas in 5 cases. The material was investigated for HPV using polymerase chain reaction analyses with two sets of consensus primers (GP5+/GP6+ and MY09/MY11). The HPV-positive cases were submitted to dot-blot hybridization to establish the HPV type. Using immunohistochemistry, the p53 expression was determined. A p53 overexpression is defined as positive staining in 10% or more of the tumor cells. RESULTS: Among 30 examined cases of carcinomas associated with inverted papillomas, 4 cases were HPV-positive (13%). P53 overexpression was not shown among the HPV-positive cases, whereas p53 overexpression was seen in 21 of the 24 (88%) examined HPV-negative cases. Among the 5 carcinomas associated with exophytic papillomas, HPV was demonstrated together with p53 overexpression in 3 cases (60%). In addition, one case more was with p53 overexpression. CONCLUSION: An inverse relation between HPV and p53 overexpression in sinonasal carcinomas associated with inverted papillomas appears to have been demonstrated. HPV and p53 might also have an etiological role among the carcinomas associated with exophytic papillomas.     

A sinonasal inverted papilloma of mixed histology: implications for management of all sinonasal papillomas

Sinonasal papillomas are classically categorized by their histology. Inverted, cylindrical, and fungiform are the three subtypes used to describe these lesions, and their medical and surgical management is often based on the specific subtype. We describe a case of a sinonasal papilloma with all three subtypes represented within the same surgical specimen. To our knowledge, this represents the first such case in the literature and has implications for the management of all sinonasal papillomas.