Incidence of inverted papilloma in recurrent nasal polyposis

OBJECTIVES: A diagnosis of inverted papilloma in apparently normal bilateral polyps is a possible albeit rare event. The frequency of this diagnosis varies between 0.00% and 0.92%. There are no studies evaluating whether this possibility is significantly different in patients operated for recurrence when compared with those undergoing first surgery. The aim of this study is to evaluate the frequency of inverted papilloma in a series of histologic specimens obtained from patients undergoing surgery for recurrent nasal polyposis. METHODS: The authors conducted a retrospective chart and pathologic review of data from 1887 surgical interventions for removal of unremarkable bilateral nasal polyps. Frequency of inverted papilloma was assessed. RESULTS: Five cases of inverted papilloma were identified. The incidence of this diagnosis was thus 0.26% (95% confidence interval, 0.08-0.62%). Age, gender, and number of recurrences did not influence the frequency of this diagnosis. CONCLUSIONS: The occurrence of inverted papilloma in unremarkable recurrent cases of nasal polyps is rare. This rate is similar to the one observed in patients undergoing first surgery.     

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.     

鼻内镜鼻腔内翻性乳头状瘤切除术

目的：探讨鼻内镜下内翻性乳头状瘤切除术的方法及疗效。方法：30例鼻腔鼻窦内翻性乳头状瘤中，10例有前期手术史，均为单侧发病。手术根据肿瘤不同部位选择相应的手术方式。术后定期鼻内镜下换药。结果：25例鼻腔内翻性乳头状瘤患者行鼻内镜下肿瘤切除术，2例行鼻内镜下肿瘤切除术＋鼻侧切开术，3例行鼻内镜联合柯－陆氏径路行肿瘤切除术，随访3年，复发3例。结论：鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤要严格掌握手术适应证，术后定期随访，是提高手术治愈率的关键。     

接触式内镜在鼻腔和咽部疾病诊断中的应用

目的探讨接触式内镜在鼻腔及咽部多种疾病中的辅助诊断作用。方法应用接触式内镜观察慢性鼻-鼻窦炎38例,鼻息肉19例,变应性鼻炎15例,慢性鼻咽炎26例,鼻咽癌21例,咽部乳头状瘤5例。结果接触式内镜能够显示鼻腔和鼻咽部不同病变的黏膜微血管及表层细胞的形态分布特点,包括细胞形状、排列、边界、染色情况以及核的大小、核浆比例等。微血管的异常包括不规则扩张、收缩或血栓形成、血管间距拉大、血流缓慢或中断、管壁脆弱易出血等。表层细胞的主要病理改变包括鳞状上皮化生、非典型增生和鳞状细胞癌。结论接触式内镜作为一种新的无创、动态的检查方法,在临床上对鼻腔及咽部的多种疾病具有一定的辅助诊断作用。     

鼻内镜下上颌窦良性病变的手术治疗

目的:探讨鼻内镜下上颌窦良性病变的手术切除方法.方法:41例上颌窦息肉、囊肿、曲菌病、内翻性乳头状瘤等良性病变,分别采用3种不同的手术方式清除病灶,其中30例经扩大的上颌窭自然开121径路;4例经鼻内中、下鼻道双径路;7例经扩大的上颌窦自然开口及鼻腔外侧壁切除双径路.结果:术后随访6个月以上,治愈39例,2例复发,治愈率95.1%.结论:鼻内镜下经鼻腔采用3种不同的手术径路切除上颌窦良性病变,疗效肯定,创伤小,值得临床推广.     

Inverted papilloma of the nose. Apropos of a case associating polyps and an inverted papilloma of the nose]

In this article is presented a case report of a 59 years old woman with a medical history of recurrent nasal polyps (from 20 years ago). This woman presented an inverted papilloma in the middle meatus of the lateral wall of the nasal cavity simultaneously with the nasal polyps, and she was faced with surgical intranasal removal. The patient, two years later, presented again nasal polyps, but without any indication of the recurrence of the inverted papilloma. It is noticed the value of the local surgical removal of the inverted papilloma in patients who do not present extensive tumors.     

Clinical and histopathological correlation of nasal polyps: are there any surprises?

kale s .u ., mohite u ., rowlands d . & drake ‐lee a .b . (2001) Clin. Otolaryngol. 26, 321–323 Clinical and histopathological correlation of nasal polyps: are there any surprises? Nasal polypectomy is a common operation. There is debate about whether all nasal polyps removed at operation should be sent for histopathological examination. To investigate this, a prospective study was performed to check the correlation of clinical and histopathological examination. Three hundred and forty‐four nasal polypectomy specimens during the period from September 1997 to September 1999 were sent for histopathological diagnosis, with the clinical diagnosis documented on the pathology form. The clinical diagnosis was then correlated with the histological diagnosis. Three hundred and twenty‐eight specimens were diagnosed as inflammatory polyps and 16 as tumours, of which seven were malignant. There was a good correlation between the clinical and histological findings in 340 cases. There was disagreement between the forms and reports in four cases. When the notes were consulted, three cases had forms that were incorrectly filled in. There was only one unsuspected case of inverted papilloma in a polyp specimen, which looked like a benign inflammatory polyp. This study indicates there is a 99.7% correlation between clinical and histopathological diagnosis.     

鼻内窥镜在鼻内翻性乳头状瘤手术中的价值

目的 :探讨鼻内窥镜在鼻内翻性乳头状瘤手术中的价值。方法 :鼻内翻性乳头状瘤患者 2 9例中 ,采用鼻内窥镜手术者 15例 (鼻内窥镜组 ) ,经鼻侧切开手术者 14例 (鼻侧切开组 ) ,并将两种手术结果进行比较。结果 :随访 1.8年。并发症 :鼻内窥镜组 (1例 )明显低于鼻侧切开组 (5例 ) ,P <0 .0 1;住院时间 :鼻内窥镜组 (13.1d)明显短于鼻侧切开组 (2 0 .4d) ,P <0 .0 1;术中出血量 (Ⅰ～Ⅱ级 ) :鼻内窥镜组 (175ml)亦明显少于鼻侧切开组 (5 2 5ml) ,P <0 .0 1。结论 :鼻内窥镜术是治疗Ⅰ～Ⅱ级鼻内翻性乳头状瘤一种较好的方法 ,其主要优点是避免了面部切口 ;对Ⅲ～Ⅳ级病例 ,使用鼻内窥镜术应持谨慎态度 ,鼻侧切开术仍不失为安全、可靠的治疗方法     

Clinical and histopathological correlation of nasal polyps: are there any surprises?

Nasal polypectomy is a common operation. There is debate about whether all nasal polyps removed at operation should be sent for histopathological examination. To investigate this, a prospective study was performed to check the correlation of clinical and histopathological examination. Three hundred and forty-four nasal polypectomy specimens during the period from September 1997 to September 1999 were sent for histopathological diagnosis, with the clinical diagnosis documented on the pathology form. The clinical diagnosis was then correlated with the histological diagnosis. Three hundred and twenty-eight specimens were diagnosed as inflammatory polyps and 16 as tumours, of which seven were malignant. There was a good correlation between the clinical and histological findings in 340 cases. There was disagreement between the forms and reports in four cases. When the notes were consulted, three cases had forms that were incorrectly filled in. There was only one unsuspected case of inverted papilloma in a polyp specimen, which looked like a benign inflammatory polyp. This study indicates there is a 99.7% correlation between clinical and histopathological diagnosis.     

鼻内翻性乳头状瘤合并鼻息肉的诊断和治疗

目的总结合并鼻息肉的鼻内翻性乳头状瘤的临床表现、手术方法及疗效。方法分析11例获得病理证实的鼻内翻性乳头状瘤和鼻息肉并存患者的临床资料,其中术前诊断为鼻息肉术后确诊者3例;第2次、第3次术前活检确诊者分别为4例和1例;术前为鼻息肉术中冰冻病理确诊者1例,术前为鼻内翻性乳头状瘤,术后病理示鼻内翻性乳头状瘤和鼻息肉并存者2例。有血涕史和局部骨质破坏者分别为4例和2例。病变与眶壁和筛顶有正常筛房间隔行鼻内镜下肿物切除者4例,上述正常间隙消失行鼻侧切开肿物彻底切除者7例。结果9例随访16月～6年无肿瘤或鼻息肉复发,术后半年和1年后失访者各1例。结论单侧鼻腔占位病变但筛窦炎性病变局限轻微者,应警惕鼻内翻性乳头状瘤可能。多点活检是防止漏诊和误诊的重要手段。如适应证掌握适当,鼻内镜下切除和鼻侧切开肿瘤切除均可取得良好疗效。     

鼻内镜下联合低温等离子刀切除鼻腔鼻窦内翻性乳头状瘤37例

目的 回顾性分析鼻腔鼻窦内翻性乳头状瘤的临床特点,探讨鼻内镜下联合低温等离子刀切除鼻腔鼻窦内翻性乳头状瘤的可行性.方法 在鼻内镜下使用低温等离子刀切除37例鼻腔鼻窦内翻性乳头状瘤,根据Krouse分级标准:T1期8例,T2期18例,T3期11例.术后鼻内镜下随访4～10年.结果 37例均在鼻内镜下成功使用低温等离子刀切...     

Schneiderian carcinoma developing in an inverted papilloma of the palatine tonsil: an unusual case

Schneiderian papillomas are among the most common benign tumors of the nose and paranasal sinuses. These lesions frequently originate in the lateral nasal wall, and they have a tendency toward recurrence and malignant transformation. Carcinomas arise in association with schneiderian papillomas in approximately 10% of cases. Outside the sinonasal tract, the ectopic occurrence of a schneiderian papilloma is extremely rare. We describe the case of a 52-year-old man with an invasive schneiderian carcinoma that arose within an inverted papilloma in the palatine tonsil. To the best of our knowledge, no such case has been previously reported in the English-language literature.     

经鼻内镜泪前隐窝径路治疗上颌窦病变

目的 探讨经鼻内镜泪前隐窝入路在上颌窦病变手术中的应用.方法 回顾性分析2011年9月至2014年1月31例上颌窦病变行经鼻内镜泪前隐窝径路手术的病例资料,其中乳头状瘤19例(3例术后病理提示癌变),出血坏死性息肉5例,真菌性鼻窦炎3例,炎性息肉4例.手术采用控制性低血压全身麻醉,经鼻内镜下泪前隐窝入路切开鼻腔外侧壁进入上颌窦,清除上颌窦内病灶.结果 本组31例手术均顺利清除病灶,无任何并发症.3例乳头状瘤癌变病例术后转放疗科放疗,其余均于术后5~8 d痊愈出院.术后随访5～33个月, 仅1例乳头状瘤癌变者复发.结论 经鼻内镜泪前隐窝手术治疗上颌窦病变,该术式解剖并保证鼻泪管完整,可明视下清理上颌窦各壁及隐窝内病变,有利于更好地清除病变和降低复发率.     

Brodawczaki odwrócone nosa i zatok przynosowych w materiale własnym

Introduction

The aim of this work was to analyze the occurrence of inverted papilloma within the nose and paranasal sinuses, the extent of lesions and the clinical course in the patients who underwent endoscopic surgery.

Materials and methods

Between the years of 2006–2012, at the Department of Otolaryngology and Laryngological Oncology, 2295 patients were subjected to surgery due to paranasal sinus diseases. The material was based on their past medical histories. The analysis includes the age and gender of the patients, the type of surgery, and results of histopathological examinations. A surgical procedure covered the paranasal sinuses with lesions diagnosed in CT. The qualified patients had inverted papilloma in histopathological results.

Results

Among 2295 patients who were operated because of chronic inflammatory changes, inverted papilloma was histopathologically diagnosed in 49 cases. In 16 patients with inverted papilloma, inflammatory changes were present on one side only, while in 33 cases inverted papilloma was confirmed histopathologically on one side. The analysis of age and gender of the study group showed that the highest occurrence of inverted papilloma was in patients over 50 years of age. In the majority of the studied cases, inverted papilloma spread in the middle nasal concha and the maxillary or ethmoid sinus.

Conclusions

In surgery, the endoscopic technique allows for an effective removal of inverted papilloma from the nose and paranasal sinuses. According to the authors, endoscopy is the most valuable method for post-operative monitoring of recurrent inverted papilloma.     

经鼻内镜鼻内翻性乳头状瘤切除术远期疗效观察

目的探讨鼻内镜下切除鼻内翻性乳头状瘤的远期效果。方法回顾性分析1996年1月～1999年12月,经鼻内镜鼻内翻性乳头状瘤手术治疗32例的临床资料,其中超过5年随访的患者29例。结果失访3例未纳入统计。29例患者中行单纯鼻内镜手术24例,鼻内镜加柯-陆氏手术5例。经鼻内镜随访至少5年,平均随访7.4年,治愈26例(89.7%),3例复发(10.3%),其中1例癌变。结论经鼻内镜切除鼻内翻性乳头状瘤,损伤小、恢复快、疗效满意,上颌窦内病变范围广泛者鼻内镜加柯-陆氏径路有利于减少手术复发。     

All nasal polyps need histological examination: an audit-based appraisal of clinical practice

Case details were reviewed from 2021 patients treated surgically for nasal polyposis between 1991 and 1999, seen by six surgeons serving a catchment population of 805,000. The aim of this study was to determine the incidence of discrepancies between clinical and histological diagnosis. Twenty-two patients (1.1 per cent) were identified as having a lesion that differed histologically from the clinical diagnosis made at the time of surgery and which altered their further management. Amongst them were 11 cases of inverted papilloma, two of Wegener's granulomatosis; and two of sarcoid. The rest of the cases comprised three of squamous cell carcinoma, one of adenocarcinoma, one of myeloma, one of angiofibroma and one of microcystic papillary adenoma. In this series, the occurrence of malignancy, inverted papilloma, or other clinically significant pathology among the group of patients with otherwise clinically unsuspected histology justifies sending nasal polyps for routine pathologic examination. A cost-benefit analysis showed that, on the basis of 250 cases per year, the cost of laboratory and pathological services would be 12,000 Pounds, in comparison with the estimated average medicolegal cost of 51,000 Pounds per year incurred as a result of a delay in diagnosis together with the pain and suffering which would result given the case mix in this series.     

鼻内翻性乳头状瘤手术疗效观察

目的 探讨鼻内镜下切除鼻内翻性乳头状瘤(nasal inverted papilloma,NIP)的方法及疗效.方法 23例经病理和临床诊断的NIP病例.根据Krouse分级将病变分为4级:Ⅰ级13例,Ⅱ级6例,Ⅲ级3例,Ⅳ级1例.术前均行鼻内镜检查及鼻寞CT冠状状+轴位(平扫+增强)或MRI扫描.15例单纯行经鼻内镜...     

单侧鼻腔鼻窦占位性病变的临床误诊分析

目的:通过对213例单侧鼻腔鼻窦占位性病变的回顾性分析,研究该类病变的临床诊断及其误诊情况,为临床医生对此类患者的诊断和治疗提供参考。方法:结合近年来相关文献,通过对213例单侧鼻腔鼻窦占位性病变患者的诊断及误诊资料作临床分析,对被误诊患者的临床表现、影像学检查、病理作回顾性研究。结果:213例患者中,鼻息肉65例,鼻窦囊肿66例,真菌性鼻窦炎20例,良性肿瘤31例,恶性肿瘤28例,鼻腔异物3例;左侧鼻腔鼻窦116例,右侧鼻腔鼻窦97例。误诊情况:213例中,将恶性肿瘤误诊为鼻息肉12例,误诊率5.63%;鼻腔异物误诊为鼻窦炎2例,误诊率0.94%;内翻性乳头状瘤误诊为鼻息肉6例,误诊率8.45%;真菌性鼻窦炎误诊为化脓性鼻窦炎5例,误诊率2.35%;鼻窦囊肿误诊为鼻窦炎8例,误诊率3.75%。结论:详询病史,仔细专科检查,包括鼻内镜、鼻窦三维CT、鼻窦三维MRI及活组织病理检查等对判断该类病变的部位和性质至关重要,有助于早期诊治,并减少误诊误治。     

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.     

Unilateral polyposis: evaluation of preoperative tests

The aim of this paper is to study a group of patients with occupancy of a nasal fossal, apparently by polyps, and being the other side of the nose normal. Evaluating on the one hand the true incidence of unspecific polyposis and, of other diagnosis, and on the other hand to compare the preoperative radiological findings with those seen during surgery. MATERIAL AND METHODS: A prospective study of 23 consecutive patients was carried out over a period of 30 months at the ENT Department of the Dr. Peset Hospital, in Valencia. A CT scan and preoperative biopsy was performed in all cases, the results of these being later compared with the surgical findings and the final histopathologic diagnosis. RESULTS AND CONCLUSIONS: A discrepancy between the preoperative biopsy and final diagnosis was found in 26% of the patients. The incidence of polyposis was 52%, inverted papilloma 26%, malignant tumours 13% and other diagnosis 8.6%. There is a good correlation between preoperative CT scans and surgical findings in those cases of polyposis and inverted papilloma, but not in those of malignant tumours as CT scans often underestimated these lesions.