Bilateral inverted papilloma: A report of two cases and review of the current literature

Inverted papilloma is locally aggressive tumour which typically presents as a unilateral nasal polyp. Whilst it has a malignant potential it rarely transforms and in its benign form the main concern originates from its locally aggressive nature and substantial propensity to recur. Bilateral disease can also be due to inverted papilloma, sometimes due to direct extension of the tumour, but it can also occur as two distinct lesions. Here we report two cases of bilateral involvement, review the current literature and highlight some important issues on the management and follow-up of this well known neoplasm.     

Ki-67和增殖细胞核抗原在鼻腔内翻性乳头状瘤组织中的表达及意义

目的 探讨鼻腔内翻性乳头状瘤组织中Ki-67抗原和增殖细胞核抗原(PCNA)的表达及差异,以寻找能较好准确灵敏表达鼻腔内翻性乳头状瘤增殖活性的指标。方法 应用免疫组化S-P法检测30例鼻腔内翻性乳头状瘤、15例鼻息肉及10例鼻腔鳞状细胞癌组织中Ki-67和PCNA的表达。显微镜下(400×)分别计数Ki-67、增殖细胞核抗原(PCNA)阳性细胞数占计数细胞总数的百分比,作为Ki-67、PCNA阳性指数(Ki-67-LI和PCNA-LI)。结果 鼻息肉、鼻腔内翻性乳头状瘤及鼻腔鳞癌组织中Ki-67阳性指数及PCNA阳性指数分别为:2.3±2.1和5.4±5.2;11.3±4.1和29.9±10.2;35.1±6.9和62.8±17.7,统计分析表明差异均有显著性(P<0.01)。结论 Ki-67-LI和PCNA-LI与肿瘤病理类型有很好的一致性,二者可分别作为反映鼻腔内翻性乳头状瘤增殖活性的指标。     

Giant intraductal papilloma of the breast: a case report

A case of an unusually large solitary intraductal papilloma of the breast is reported. This benign neoplasm presented as a 15-cm breast mass, enlarging over a 2-year period. The case illustrates that benign intraductal papilloma may rarely present as a large breast mass and therefore should be considered in the differential diagnosis of very large breast lesions.     

Metastatic atypical choroid plexus papilloma: a case report

Choroid plexus papillomas (CPPs) are rare adult tumours and metastatic disease is even less common, more typically associated with choroid plexus carcinoma. We present the case of a 32-year-old patient with multiple metastases arising along the length of the neuraxis 3 years after resection of an atypical fourth ventricular CPP. Metastatic deposits were found from the mid-brain to the lumbar cistern and the patient underwent repeat excision of the fourth ventricular tumour, partial resection of a cervico-thoracic deposit and craniospinal radiotherapy. Possible explanations for the rarity of atypical CPP include unclear diagnostic criteria leading to under-representation in reported cases. We review the current literature on metastatic CPP and discuss the role of surgery and adjuvant therapy in relation to both typical and atypical disease.     

Intracystic papilloma in the breast of a male given long-term phenothiazine therapy: A case report

We experienced a very rare case of intracystic papilloma in a 57-year-old man who came to our hospital complaining of a left subareolar mass and nipple discharge. The patient had a history of chronic schizophrenia, necessitating long-term treatment with phenothiazines. His serum prolactin levels were elevated. Mammography demonstrated a well defined mass with microcalcifications. Ultrasonography revealed a cyst with an intracystic component. The inner lesion of the mass enhanced on contrast-enhanced computed tomography. The carcinoembryonic antigen concentration of the cyst fluid was 400 ng/mL and no malignant cells were found by aspiration biopsy cytology. Excisional biopsy was performed under local anesthesia. Pathological examination revealed the intracystic component to be intracystic papilloma. There are ten reports of male intracystic papilloma including ours. We report the second case of a patient given long-term phenothiazine therapy, which is known to increase serum prolactin levels.     

膀胱内翻性乳头状瘤临床诊疗分析(附43例报告)

目的:探讨膀胱内翻性乳头状瘤的临床表现、病理类型及临床诊治方法。方法:回顾性分析2004年3月至2011年6月,我院收治膀胱内翻性乳头状瘤43例,其中男35例,女8例,平均年龄57岁。临床表现主要为无痛性肉眼血尿,下尿路症状及体检发现。诊断依据泌尿系超声,膀胱镜检及病理检查,41例行经尿道膀胱肿瘤切除(TURBT),其中4例合并良性前列腺增生者同时行经尿道前列腺切除术,膀胱部分切除术1例,未手术治疗仅行膀胱灌注1例。结果:35例随访12个月-64个月,平均25个月。5例复发,其中4例再次行TURBT术,1例行膀胱全切治疗。结论:膀胱内翻性乳头状瘤是良性肿瘤,多见于男性,TURBT是膀胱内翻性乳头状瘤的首选治疗方法,预后良好,复发率低,膀胱灌注未见明显降低其复发率。但需定期随访。     

Radiotherapy for mucosal melanomas

Twelve patients who were primarily irradiated at the Princess Margaret Hospital (PMH) for mucosal melanomas of the head and neck and 6 patients irradiated for mucosal melanomas of the vagina and anorectal region are reported. The PMH results of irradiation of mucosal melanomas of the head and neck are combined with the literature results for this type of melanoma. A total of 24 patients who had 25 areas irradiated are considered. The complete remission rate locally is 72% (18 of 25 areas treated). Seven of the 18 patients who achieved complete local remission subsequently relapsed locally (9 to 144 months post treatment); 11 are in maintained complete local remission (9 to 54 months). Four died of intercurrent disease without melanoma, 5 are alive and well post irradiation, one recurred regionally and was salvaged surgically and one died of distant metastases without local or regional relapse. Only 1 of 7 patients who failed to respond to irradiation was salvaged with subsequent surgery, the others all died very rapidly following unsuccessful irradiation. Analysis of local control versus fraction size revealed that 6 of 7 patients treated with a fraction size of 400 rad or more achieved complete remission as compared to 5 of 18 treated with a fraction size of 399 rad or less. The results of primary irradiation for mucosal melanomas of the head and neck are compared with the literature on radical surgery, it is concluded that in view of the poor results of radical surgery that large dose per fraction irradiation should be seriously considered as the initial treatment of choice for primary mucosal melanomas of the head and neck. Four patients with vaginal melanomas were treated at the PMH, all achieved complete remission locally, 2 recurred at 18 and 28 months, one is alive and well at 3 years and one died of intercurrent disease at 1 1/2 years. Two patients with anorectal melanoma had transient palliative benefit from irradiation. Since the treatment of both vaginal and thick (greater than 2 mm) anorectal melanoma is essentially palliative it is suggested that irradiation should be considered as an alternate treatment to radical treatment in these conditions.     

鼻内镜下鼻腔内翻性乳头状瘤电凝电刀手术治疗后初步观察

目的：探讨鼻内窥镜下电凝电刀手术治疗鼻腔内翻性乳头状瘤的方法和初步疗效。方法：对2008年11月至2010年12月诊治的20例鼻腔内翻性乳头状瘤的临床资料进行回顾性分析,全部患者均接受鼻内窥镜下鼻腔乳头状瘤切除术的手术方案。按Krouse分级,其中1级局限于鼻中隔患者3例和2级病变位于鼻腔上颌窦口周围患者10例,病变侵及筛窦5例,均全程采用电凝电刀完成手术治疗,属3级病变的既往手术复发者2例,病变累及全组鼻窦伴轻度骨质破环2例,采用电刀电凝结合电动吸切器完成手术治疗,手术过程均在全麻鼻内窥镜下进行。结果：除2例复发的属3级病变的鼻腔乳头状瘤病例,均完成肿瘤根治切除,术中出血较少,除2例复发性内翻性乳头状瘤患者出血约150ml外,其余18例原发性患者出血量为10-50ml,中位数出血量35ml。手术时间短,为20-60min,术中术野清晰,无颅-额-眶手术并发症,术后1天抽取纱条,3天后出院,3个月后复查见术腔完全上皮化。随访3-6个月,中位随访时间4个月,20例鼻腔乳头状瘤病例术前鼻塞,血性脓涕,头痛等症状均缓解,无复发病例。结论：电凝电刀手术治疗鼻腔内翻性乳头状瘤具有手术损伤小,手术时间短,手术视野清晰,对病变的基底及安全边缘切除彻底,不易造成瘤组织的血行播散,术中及术后出血少,围手术期不良反应轻,术后不易复发等优点,对于1级和2级病变可做到肿瘤完整切除,是一种较好的微创治疗鼻腔内翻性乳头状瘤的方法。     

鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤的临床效果观察

目的 探讨鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤(SNIP)的临床效果.方法 回顾性分析93例行鼻内镜手术治疗的SNIP患者的临床资料,对患者进行Krouse分期,比较不同手术方法(单纯鼻内镜手术、鼻内镜联合改良柯-陆氏手术、鼻内镜联合鼻外进路手术)的治疗效果及术后复发情况.结果 所有患者均一次性完成手术,手术时间47~196 min,平均(94.3±25.9)min;术中出血量34~281 ml,平均(97.3±29.0)ml;术后随访时间26~62个月,平均(39.4±10.9)个月.19例KrouseⅠ期患者均采用单纯鼻内镜手术治疗,复发1例(5.26%).45例KrouseⅡ期患者中,32例采用单纯鼻内镜手术治疗,复发2例(6.25%);13例采用鼻内镜联合改良柯-陆氏手术治疗,复发1例(7.69%),两种手术方法的复发率比较,差异无统计学意义(P>0.05).25例KrouseⅢ期患者中,10例采用单纯鼻内镜手术治疗,复发6例(60.00%);15例采用鼻内镜联合改良柯-陆氏手术治疗,复发1例(6.67%),两种手术方法的复发率比较,差异有统计学意义(P<0.05).4例KrouseⅣ期患者均采用鼻内镜联合鼻外进路手术治疗,复发1例(25.00%).结论 鼻内镜手术治疗SNIP效果较好,复发率低,应根据患者肿瘤分期制定手术方案,并于术后定期复查以有效预防肿瘤复发.     

鼻内镜下鼻腔内翻性乳头状瘤电凝电刀手术治疗后初步观察

目的:探讨鼻内窥镜下电凝电刀手术治疗鼻腔内翻性乳头状瘤的方法和初步疗效。方法:对2008年11月至2010年12月诊治的20例鼻腔内翻性乳头状瘤的临床资料进行回顾性分析,全部患者均接受鼻内窥镜下鼻腔乳头状瘤切除术的手术方案。按Krouse分级,其中1级局限于鼻中隔患者3例和2级病变位于鼻腔上颌窦口周围患者10例,病变侵及筛窦5例,均全程采用电凝电刀完成手术治疗,属3级病变的既往手术复发者2例,病变累及全组鼻窦伴轻度骨质破环2例,采用电刀电凝结合电动吸切器完成手术治疗,手术过程均在全麻鼻内窥镜下进行。结果:除2例复发的属3级病变的鼻腔乳头状瘤病例,均完成肿瘤根治切除,术中出血较少,除2例复发性内翻性乳头状瘤患者出血约150ml外,其余18例原发性患者出血量为10-50ml,中位数出血量35ml。手术时间短,为20-60min,术中术野清晰,无颅-额-眶手术并发症,术后1天抽取纱条,3天后出院,3个月后复查见术腔完全上皮化。随访3-6个月,中位随访时间4个月,20例鼻腔乳头状瘤病例术前鼻塞,血性脓涕,头痛等症状均缓解,无复发病例。结论:电凝电刀手术治疗鼻腔内翻性乳头状瘤具有手术损伤小,手术时间短,手术视野清晰,对病变的基底及安全边缘切除彻底,不易造成瘤组织的血行播散,术中及术后出血少,围手术期不良反应轻,术后不易复发等优点,对于1级和2级病变可做到肿瘤完整切除,是一种较好的微创治疗鼻腔内翻性乳头状瘤的方法。     

膀胱内翻性乳头状瘤的诊断与治疗（附12例报告）

目的提高膀胱内翻性乳头状瘤（inverted papilloma of the bladder,IPB）的诊治水平。方法回顾性分析我院12例膀胱内翻性乳头状瘤患者的临床资料,结合文献资料进行探讨。结果 12例患者接受经尿道膀胱肿瘤电切术（TURBt）治疗,患者术后均恢复良好,无严重并发症。4例伴有前列腺增生者,同时行TURP术,术后排尿良好。术后病理明确诊断为膀胱内翻性乳头状瘤,其中小梁型9例、腺体型3例。4例同时行TURP者,术后前列腺组织病理为良性前列腺增生。术后均给予膀胱灌注化疗。术后随访6月-8年,未见肿瘤复发及恶性变。结论 IPB多见于男性,膀胱颈部和三角区多发,呈良性肿瘤特点生长,预后良好。诊断依赖于膀胱镜检查及术后病理检查。TURBt是IPB的标准治疗方法 ,术后给予膀胱灌注化疗有利于预防复发。     

Metastasis of a histologically benign choroid plexus papilloma: case report and review of the literature

Summary Cerebrospinal metastases of benign choroid plexus papillomas (CPPs) are extremely rare. We report a case of 32-year-old woman who presented with a 6-month history of vertigo and intermittent headache. Plain CT scan of the cranium revealed a partly calcified tumor filling the fourth ventricle and its right recess. Cranial MRI showed an inhomogeneously contrast-enhancing tumor and leptomeningeal enhancement encasing the brain stem. Complete resection of the tumor was carried out, and seedings to the floor of the fourth ventricle and cervico-medullary junction were found during the operation. While intraoperative frozen section suggested pathology of papillary ependymoma or CPP, to our surprise, final histological examination revealed a benign choroid plexus papilloma. One month after the first operation, a metastatic nodule was found in the spinal subarachnoidal space at the level of T8-9. Two months after the first operation, on follow-up MRI of the cranium, the leptomeningeal enhancement encasing the brain stem had resolved spontaneously. This special case helps increase our understanding of benign CPPs and expands our differential diagnostic consideration of lesions with similar manifestations.     

Sinonasal inverted papilloma associated with squamous cell carcinoma

Background

The aims of the study were to review single-institution experiences with sinonasal inverted papilloma associated with squamous cell carcinoma (IP/SCC), to analyze the presence of human papillomavirus (HPV) and to evaluate the role of radiotherapy.

Patients and methods

Five patients with IP/SCC were identified in the prospective institutional databases (1995–2005) and HPV status was determined in all five tumors.

Results

Four out of five patients had T3-4 tumors; no nodal involvement was seen in any of them. Four patients had curative surgery, supplemented in three of them with radiotherapy. Debulking surgery was performed in the patient with a non-resectable tumor followed by radical radiotherapy. Tumor was controlled locally in three patients at 8, 46 and 58 months post-surgery. Local failure occurred in two patients: after endoscopic resection of a T1 tumor (the recurrent tumor was successfully salvaged with additional surgery) and in a patient with an inoperable tumor. No regional or distant metastases occurred. HPV status was determined in all five tumors and three of them were found positive for HPV type 11.

Conclusions

In operable sinonasal IP/SCC, upfront surgery and postoperative radiotherapy to the tumor bed with dose levels comparable to those used for invasive SCC are recommended. For non-resectable disease, radical radiotherapy to a dose of 66–70 Gy could be of benefit.     

Detection of human papillomavirus DNA in benign and malignant sinonasal neoplasms

Infections with human papillomaviruses are divided basically into three different infection types: those producing specific clinically visible lesions, those remaining subclinical, and those being latent. The assumed infection type thought to be present in tissue specimens has influence on the conclusions that can be made from an analysis, i.e. whether or not the HPV infection has a causal relationship with other epidemiological or molecular investigation observations. To determine whether HPV DNA detection in different entities of the upper aerodigestive tract represents a coincidental, persistent/latent or specific infection, 20 clinically intact mucosa specimens of the upper aerodigestive tract, 20 sinonasal polyps, 26 inverted papillomas, and 20 squamous cell carcinomas of the paranasal sinuses were investigated. HPV DNA was not detectable in specimens derived from clinically intact mucosa or in nasal polyps. Yet, three out of 26 inverted papillomas were HPV-positive, each showing double infection with HPV6 and 11. Four out of 20 squamous cell carcinomas were HPV16 positive. To our knowledge, we are presenting the first study contemporaneously analyzing benign as well as malignant non-proliferative and proliferative mucosal entities whilst applying identical methodical standards. The data corroborate the hypothesis that HPV DNA demonstration in tissue specimens represents a specific infection of the mucosa of the upper aerodigestive tract. It can thus be assumed that there is a causative involvement of HPV infections in the alteration of cell proliferation and in the case of infection with high risk HPV types even on progression to malignant transformation.     

Increased expression of matrix metalloproteinase-2 and 9 and human papilloma virus infection are associated with malignant transformation of sinonasal inverted papilloma

BACKGROUND AND OBJECTIVES: In this study, we identified matrix metalloproteinase (MMP)-2 and 9 expression in exophytic papilloma (EP), inverted papilloma (IP) with dysplasia, IP with carcinoma, and invasive squamous cell carcinoma (SCC). We also compared the presence of MMP-2 and 9 with human papilloma virus (HPV) infection. METHODS: The nasal tissue were stained with monoclonal antibodies to MMP-2 and 9. The results were analyzed using quantitative immunohistochemical analysis. In situ hybridization studies for HPV DNA for 6/11, 16/18, and 31/33 were also performed on the tissue. RESULTS: Significant increase of MMP-2 and 9 were observed in IP with moderate and severe dysplasia, IP with carcinoma, and invasive SCC compared to control nasal mucosa. Among IP, HPV 6/11-positive was present in 41% and HPV 16/18-positive was present in 31%. In HPV 6/11 and 16/18-positive IP, significant increase of MMP-2 and 9 were observed. CONCLUSIONS: Precancerous lesions of IP exhibited elevated levels of MMP-2 and 9 and these expression may be associated with early events in IP carcinogenesis. HPV infection would be an early event in a multistep process of malignant formation of IP.     

鼻腔鼻窦内翻性乳头状瘤恶变患者的临床特征和预后因素分析

目的探讨鼻腔鼻窦内翻性乳头状瘤(SNIP)恶变患者的临床特征,分析影响预后的因素。方法选取2009年5月至2013年5月间收治的伴有恶变症状的SNIP患者15例,分析SNIP恶变患者的临床特征、治疗方式及效果,统计影响患者预后的主要因素。结果 15例患者均获随访,随访时间为13⁵8个月,中位随访时间23个月;生存时间858个月,中位随访时间23个月;生存时间8⁹5个月,中位生存期为60.6个月。15例SNIP恶变患者中,接受单一方法治疗患者的5年生存率为40.0%(2/5),接受综合方法治疗患者的5年生存率为90.0%(9/10),两组差异有统计学意义(P<0.05)。Logistic回归分析结果表明,临床分期、远处转移及治疗方式是影响SNIP预后的独立危险因素(均P<0.05)。结论 SNIP恶变率较低,但缺乏特异性,临床分期、远处转移及治疗方式是影响患者预后的独立危险因素,临床应采取综合治疗方法改善患者的预后。     

Malignant melanoma of the nasal cavity-A case report

Mucosal melanoma of the nasal cavity is a rare tumour. Here we have reported a case of 54-year-old male patient presented with the black mass coming out from right nasal cavity and occasional slight bleeding from the mass. The tumour was excised by lateral rhinotomy. The surgery was followed by radiotherapy.     

鼻腔鼻窦内翻性乳头状瘤CD44蛋白的表达及意义

目的：检测探讨鼻腔鼻窦内翻性乳头状瘤CD44蛋白的表达及临床意义。方法：采用SP免疫组化染色方法,检测42例鼻腔鼻窦内翻性乳头状瘤及35例鼻腔鼻窦鳞状细胞癌CD44s、CD44V6及p53蛋白的表达。结果：（1）CD44s在鼻腔鼻窦内翻性乳头状瘤及鼻腔鼻窦鳞状细胞癌表达阳性率分别为85．7％（36／42）和37．1％（13／35）,两组表达有非常显著性差异（P〈0．01）;（2）CD44V6在鼻腔鼻窦内翻性乳头状瘤及鼻腔鼻窦鳞状细胞癌表达阳性率分别为45．2％（19／42）和22．8％（8／35）,两组表达有显著性差异（P〈0．05）;（3）p53在鼻腔鼻窦内翻性乳头状瘤及鼻腔鼻窦鳞状细胞癌表达阳性率分别为21．4％（9／42）和51．4％（18／35）,亦具有非常显著性差异（P〈0．01）。结论：CD44蛋白在鼻腔鼻窦内翻性乳头状瘤高度表达,在鼻腔鼻窦内翻性乳头状瘤恶变过程中可能起一定作用。     

64例鼻腔及副鼻窦内翻性乳头状瘤及癌变的临床病理分析

目的　探讨 6 4例鼻腔和副鼻窦内翻性乳头状瘤的临床、病理诊断的特点以及与预后的关系。方法　采用AB及网状纤维染色法观察该瘤粘液细胞和基底膜 ,计算瘤细胞核分裂相数 ,收集有关临床病理资料 ,并随访。结果　 (1)此瘤好发于成年男性 ,病程较长 ;临床常以鼻塞流脓涕及鼻衄为主要症状。 (2 )瘤组织呈乳头状或实巢状向粘膜间质内生长为其组织学特征。 (3)瘤细胞不典型增生Ⅱ级、Ⅲ级及核分裂相 >5个 10HF患者易复发。 (4)瘤细胞不典型增生Ⅲ级核分裂 10～ 2 5 10HF患者易癌变。结论　根据临床和组织学特征提出瘤细胞不典型增生 ,核分裂相数目多少是预测肿瘤复发和恶变的重要指标 ,复发是导致恶变的重要指标之一。     

鼻腔非何杰金淋巴瘤的放射治疗

 目的:分析鼻腔非何杰金淋巴瘤(NHL)治疗方法和疗效。 方法:1975年6月～1993年3月收治30例鼻腔NHL。 单纯放疗16例, 综合治疗(放疗＋化疗)14例。 照射剂量:<45Gy15例, ≥45Gy15例。 结果:全组5年生存率为70.8％(17/24)。 病变局F民于鼻腔和超出鼻腔组的5年生存率分别为85.7％和50.0％。 单纯放疗组和放疗＋化疗组的5年生存率分别为57.1％和90.0％。 照射剂量<45Gy和≥45Gy的5年生存率分别为64.3％和80.0％。 建议:病变局限于鼻腔者不必做颈部预防性照射。 对病变超出鼻腔或有区域淋巴结受侵者, 应采用放疗与化疗综合治疗。