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.     

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.     

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.     

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 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.     

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.     

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.     

Inverted papillomas of the nose and the paranasal sinuses

A series of 21 patients with inverted papillomas of the nose and/or the paranasal sinuses is presented. In 19 patients the tumour arose from the lateral nasal wall or paranasal sinuses, in 2 it arose from the nasal septum. Nine patients had been previously treated by nasal polypectomy. None of the patients with recurrences after primary surgical treatment showed any evidence of a progression from benign to malignant lesions. Only 14% of the patients suffered from recurrence, and it seems likely that this is because extensive surgical extirpation was recommended as primary treatment in most cases. We feel justified in recommending early and radical surgery.     

Inverted papillomas of the nose and paranasal sinuses in children

Inverted papillomas are uncommon lesions in the nose and paranasal sinuses, especially in the pediatric age group. We report the occurrence of one case in a 13-year-old Chinese female. Review of the literature and conclusions about management of these lesions in children are provided.     

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.     

Schneiderian papilloma of the nose and paranasal sinuses: the University of Ottawa experience.

Schneiderian papillomata of the nose and the paranasal sinuses are uncommon neoplasms. Although histologically benign, malignancy can occur. The likely etiologic agent is the human papilloma virus. We reviewed the cases treated at University of Ottawa-affiliated hospitals from 1969-1989. There were 35 patients consisting of 26 men and nine women with an average age of 55.8 years. The most common presenting symptom was unilateral nasal obstruction (71.4%). This was caused in most cases by an ipsilateral polypoid mass (82.9%). CT scan study was helpful in delineating the size and extent of the lesion. Four cases of malignancy were found (11.4%). Whether malignant transformation had occurred or whether a synchronous or metachronous malignancy had been serendipitously discovered is open to debate. Thorough examination with biopsy is mandatory to obtain a definitive histologic diagnosis. Intranasal papilloma-plucking (polypectomy) is useful for biopsy purposes but grossly inadequate as definitive treatment. The high recurrence rate is due to inadequate resection. Radical surgery consisting of medial maxillectomy via the lateral rhinotomy approach has the lowest recurrence rate (7.1%) and is the treatment of choice.     

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.