Clinical report: cylindrical cell papilloma of the paranasal sinus

Summary We report a case of cylindrical cell papilloma of the paranasal sinuses. This tumor originated in the medial wall of the left maxillary sinus of a 69-year-old man and extended to the surrounding tissues. Pathological study of tissue sections from the tumor showed typical findings of cylindrical cell papilloma with no evidence of associated malignancy. Histochemical and electron microscopic examinations revealed a large number of mitochondria in the cytoplasm of the tumor cells. The tumor was removed through a Denker's approach. The patient did well following surgery and there has been no sign of recurrence in a 2-year follow-up study.     

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.     

Biologically aggressive papillomas of the nasal cavity: the role of radiation therapy

Five patients were irradiated at the University of Florida for advanced and/or recurrent papillomas of the nasal cavity and paranasal sinuses from December 1969 through December 1981. Three patients were irradiated either before or after resection and two patients were treated with radiation therapy alone. Two patients had pure inverted papilloma, one patient had inverted papilloma associated with a focus of squamous cell carcinoma, and two patients had cylindrical cell papillomas. Four patients are alive and continuously disease free at 3, 3, 4, and 11 years following treatment. One patient died of intercurrent disease nine years following treatment without evidence of recurrent tumor.     

Preoperative staging of sinonasal inverted papilloma by magnetic resonance imaging

OBJECTIVES/HYPOTHESIS: Sinonasal inverted papilloma is a rare but locally aggressive benign tumor. Inverted papilloma tends to recur after surgical resection and is occasionally associated with squamous cell carcinoma. Radical en bloc resection by lateral rhinotomy and medial maxillectomy has been recommended for initial management; however, endoscopic sinus surgery is effective in selected cases. To determine adequate surgical approaches, a staging system for inverted papilloma based on extent and location of the tumor has been advocated. The study investigated whether preoperative assessment by magnetic resonance imaging (MRI) accurately predicts the extent of inverted papilloma. STUDY DESIGN: Magnetic resonance imaging was retrospectively reviewed in 21 cases of inverted papilloma without knowledge of the surgical and pathological findings. METHODS: Patients were categorized into stages based on MRI findings, according to the staging system proposed by Krouse. The involvement of inverted papilloma in each sinus was also assessed. RESULTS: Stages graded by MRI were coincident with postoperative staging verified by surgical and pathological findings in 18 of the 21 cases (86%), which included 1 case of stage T1, 3 cases of stage T2, and 14 cases of stage T3. Two cases of stage T2 were judged as T3, and one case of T3 was judged as T2 by MRI. Positive predictive value of MRI diagnosis for tumor involvement was 68% to 89% in each sinus, and negative predictive value was more than 93%. CONCLUSION: In most cases, MRI assessment of inverted papilloma can accurately predict the extent of tumor involvement. Preoperative staging of inverted papilloma by MRI may be useful for planning an appropriate surgical approach.     

路易斯寡糖-X及CD24在鼻内翻性乳头状瘤中的表达

目的探讨路易斯寡糖-X(sialyl Lewis-X,SLeX)和CD24的表达与鼻内翻性乳头状瘤(nasal inverted papilloma,NIP)病理特征的关系。方法对11例NIP组织标本进行HE染色,并用SleX及CD24单克隆抗体进行免疫组织化学染色分析。结果11例NIP患者中,1例(9.1%)为重度不典型增生,但尚未突破基底膜。SleX特异性染色定位于细胞膜,NIP组中有9例(81.8%)阳性表达,对照组中有1例(16.7%)阳性表达(P<0.05)。CD24特异性染色定位于细胞膜及细胞浆,NIP组中有8例(72.7%)阳性表达,对照组中只有少量淋巴细胞阳性表达,鼻黏膜上皮细胞阴性表达。结论部分NIP在诊断时就伴有重度不典型增生,同时有CD24表达,是一种交界性肿瘤。SleX在NIP中的表达及基质炎性细胞的浸润提示其与炎性反应关系密切。     

Inflammation and the pathogenesis of inverted papilloma

BACKGROUND: Despite existing clinical and histopathological evidence, the role of inflammation in the pathogenesis of inverted papilloma (IP) is not well understood The goal of this study was to describe the inflammatory cell component present in sinonasal papilloma (SP), with the intention of further defining the existence of inflammation in IP and perhaps gaining insight into IP pathophysiology. METHODS: Computerized database analysis was performed to identify all patients with SP who underwent surgery at the Cleveland Clinic Foundation between 1995 and 2001. Histopathological features of all SP were reviewed and semiquantitative analysis of the inflammatory cells present was performed. IP was histopathologically graded into four categories by the extent of inflammatory infiltrate and cellular atypia. Statistical analysis of the inflammatory cell component present in the epithelial layer of exophytic papilloma and IP was performed. RESULTS: SP was classified into three types: cylindrical papilloma (5% [2/41]), exophytic squamous papilloma (34% [14/ 41]), and IP (61% [25/41]). Twenty-eight instances of IP in 25 patients were identified. Altogether, 11% were grade I (3/28), 54% were grade II (15/28), 25% were grade III (7/28), and 11% were grade IV (3/28). The inflammatory cell population was significantly greater in IP compared with other SPs and greater in grades I and II IP when compared with grade III and IV IP. CONCLUSION: Inflammatory cells were identified as a significant cell population in IP, whereas it was less commonly encountered in other forms of SP. The proposed IP staging system may serve as the foundation for improved understanding of IP and, ultimately, may help to predict recurrence or apparent malignant transformation.     

Evaluation of p53, p63, p21, p27, ki-67 in paranasal sinus squamous cell carcinoma and inverted papilloma

Using a molecular genetic approach, we try to confirm the molecular alterations of inverted papilloma and clarify its status as a putative precursor lesion of sinonasal squamous cell carcinoma. To better understand its genetics, we investigated the immunohistochemical protein expression patterns of cell-cycle-regulators p53, p63, p21, p27 and proliferation marker Ki-67 in 22 inverted papilloma and 9 squamous cell carcinoma of the sinonasal tract. Significantly elevated levels of p53 and p63 in squamous cell carcinoma of sinonasal tract compared with inverted papilloma were revealed. Ki-67-stained neoplastic cell nuclei were found in a significantly higher percentage of squamous cell carcinoma of sinonasal tract than in inverted papilloma, whereas no variation of p21 and p27 expression was identified. This work first examined the immunohistochemical overexpression of p63 in sinonasal inverted papilloma and squamous cell carcinoma. In conclusion, this is a first study shedding light on the expression of p63 in tumors of paranasal sinuses.     

Endoscopic surgery for recurrent inverted papilloma

OBJECTIVES/HYPOTHESIS: Inverted papilloma of the nose and paranasal sinuses is noted for its high rate of recurrence. The feasibility of endoscopic treatment for inverted papilloma has been shown in the literature; however, reports discussing the efficacy of endoscopic surgery for recurrent diseases are rare. The study determined the effectiveness of endoscopic surgery for recurrent inverted papilloma and described when endoscopic medial maxillectomy was indicated. STUDY DESIGN: Retrospective. METHODS: Seventeen patients with recurrent inverted papilloma were treated over a 10-year period. Krouse's staging system was used for tumor grading. Because of the extent of the tumor in the majority (70.6%) of the patients, en bloc resection could not be regularly achieved; therefore, sequential segmental endoscopic surgery was the chosen treatment. Some diseases that extensively involved the maxillary sinus were treated by the combination of endoscopic medial maxillectomy (EMM) and sequential segmental surgery (SSES) to extirpate the whole disease. RESULTS: Efficacy was evaluated strictly by radiographic study. Successful treatment was accomplished in 14 (82.4%) patients. Three (17.6%) patients had residual disease; each required one revision surgery. None of the patients had recurrence at the time of writing. There were no major complications or associated malignancies encountered in the patients. CONCLUSION: Endoscopic surgery is an effective treatment for recurrent inverted papilloma. Precise determination of the sites of tumor origin and attachment during the operation is the key to the successful treatment. Recurrent inverted papilloma tends to behave more aggressively and has a higher postoperative recurrence rate than the primary lesion. Stage III disease had a higher recurrence rate (27.3%) than that of other stages (0%).     

Endonasal endoscopic surgical treatment of paranasal sinus inverted papilloma--first experiences.

PURPOSE: Surgical excision is generally regarded as the treatment of choice for inverted papilloma. However, the approach and extent of surgery has been subject of much debate. The purpose of this study is to evaluate the results of endoscopic sinus surgery in the treatment of paranasal sinus inverted papilloma. PATIENTS AND METHODS: Thirteen cases of inverted papilloma of the paranasal sinuses treated via endoscopic sinus surgery were evaluated. The follow-up averaged from 9 months to 48 months with a mean of 27 months. RESULTS: A close follow-up of all patients was maintained. Seventy-seven per cent (10/13) of the patients had no recurrence after the initial endoscopic procedure. Three patients had recurrences of their tumor within 11 months after surgery, which means a rate of 23% (3/13). In 2 patients, the recurrences were treated endoscopically. In one patient, recurrence and malignant transformation (squamous cell carcinoma) developed after 36 months, which means that the associated carcinoma rate was 7% (1/13). This patient underwent radical maxillectomy and postoperative radiotherapy. None of the patients died of inverted papilloma. CONCLUSION: Endoscopic sinus surgery is a viable treatment alternative for paranasal sinus inverted papilloma in selected cases. This approach should be performed by experienced surgeons and a close follow-up is mandatory. When the disease is more extensive, it should be approached by radical surgery, e.g. en-bloc excision by medial maxillectomy via lateral rhinotomy or mid-facial degloving.     

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.     

Management of inverted papilloma via Denker's approach

Denker's approach was used in the management of 78 patients presenting with an inverted papilloma of the nasal sinus complex between the years 1986 and 1993 at the University Teaching Hospital in Rotterdam. The recurrence rate was 9% with a mean follow-up after surgery of 56 months. There was minimal morbidity and no mortality associated with the procedure. Three patients had a squamous cell carcinoma associated with the inverted papilloma. The results of our study indicate that Denker's approach has a similar or lower recurrence rate than an open external approach to papilloma and is a safe procedure with minimal morbidity.     

Apoptosis and p53 in inverting papilloma of the sinonasal tract

The objective of this study was to identify apoptotic bodies and p53 positivity in inverting papilloma lesions to study these two as biomarkers in premalignant lesions. Archival specimens of 15 patients with inverting papilloma between the years 1992 and 1995 were retrieved. In situ end labeling technique was used to identify apoptotic bodies. Immunohistochemistry was used to detect p53 in the same specimens. The clinical course was evaluated conducting a retrospective chart review in these patients. Compared to normal epithelium, inverting papilloma lesions had a greater proportion of apoptotic bodies, which was nearly statistically significant (average 0.506/100 cells for inverting papilloma compared with 0.1/100 cells for the normal surrounding tissue). Four cases of inverting papilloma were p53 positive. There was, however, no association between p53 positive staining and the apoptotic rate. The minimum follow-up for patients was 2 years. All had a uniformly good clinical outcome with only one patient who was p53 positive showing concurrent squamous cell carcinoma. We concluded that inverting papilloma contained a higher average number of apoptotic bodies compared with normal surrounding sinonasal tissue. This showed a trend toward a positive between the apoptotic rate and premalignancy, suggesting both increased cellular proliferation and increased cell death may occur in such lesions. In this study p53 did not show a positive association with the apoptotic rate, suggesting that p53 may not be directly involved in the apoptotic regulatory pathway in inverting papillomas.     

Management of inverted papilloma via Denker’s approach

Denker’s approach was used in the management of 78 patients presenting with an inverted papilloma of the nasal sinus complex between the years 1986 and 1993 at the University Teaching Hospital in Rotterdam. The recurrence rate was 9% with a mean follow-up after surgery of 56 months. There was minimal morbidity and no mortality associated with the procedure. Three patients had a squamous cell carcinoma associated with the inverted papilloma. The results of our study indicate that Denker’s approach has a similar or lower recurrence rate than an open external approach to papilloma and is a safe procedure with minimal morbidity.     

Endoscopic removal of sinonasal inverted papilloma including endoscopic medial maxillectomy

OBJECTIVES/HYPOTHESIS: Surgical excision is regarded as the treatment of choice for sinonasal inverted papilloma. Resection can be performed endoscopically or through an external approach. Debate exists about which approach to use. The study presents different endoscopic techniques for various tumor locations and reviews the results. STUDY DESIGN: A prospective study and an integrated literature review. METHODS: Seventeen consecutive patients with inverted papilloma who underwent endoscopic surgical excision, including medial maxillectomies and modified Lothrop procedures, were analyzed. Preoperative symptoms, computed tomography and magnetic resonance imaging findings, operative findings, tumor stage, and outcomes were recorded. RESULTS: Thirteen male and four female patients presented with inverted papilloma between December 1993 and October 2001. Nasal obstruction was the most common presenting symptom (50%). Sixty-five percent of tumors were either stage II or stage III. Endoscopic resection was the primary treatment in 14 patients. Of the three patients who were secondarily treated endoscopically, one had recurrence and was subsequently found to have focus of squamous cell carcinoma. The overall recurrence rate was 6% and the incidence of malignancy was 6% (1 of 17). Recurrence rate for primary resections was zero (0 of 14). Five patients underwent endoscopic medial maxillectomies, and one patient with frontal sinus inverted papilloma was successfully treated with a modified endoscopic Lothrop procedure. CONCLUSIONS: Endoscopic sinus surgery is a viable treatment alternative for sinonasal inverted papilloma. Recurrence rates for primary treatment are comparable to external approaches. Close follow-up of patients is mandatory because recurrence may be associated with malignancy.     

Molecular pathologic study of human papillomavirus infection in inverted papilloma and squamous cell carcinoma of the nasal cavities and paranasal sinuses

Nasal inverted papilloma is a rare benign tumor occasionally associated with squamous cell carcinoma. To determine the etiological role of human papillomavirus in inverted papilloma, and to clarify the relationship between human papillomavirus and malignant transformation of this benign tumor, we retrospectively analyzed inverted papillomas from 26 patients, 7 of whom had squamous cell carcinoma. We used an immunohistochemical method and molecular pathologic techniques, or dot-blot hybridization of DNA extracted from paraffin-embedded tissues, in situ hybridization, and polymerase chain reaction. Human papillomavirus was detected in 5 of 26 patients (19%), 3 patients with human papillomavirus 11 and 2 patients with human papillomavirus 16. The latter 2 patients had inverted papillomas associated with squamous cell carcinoma. We speculate that human papillomavirus may be related to the malignant transformation of inverted papillomas.     

鼻内镜下鼻腔内翻性乳头状瘤低温等离子射频手术治疗的初步观察

目的 探讨鼻内镜下低温等离子射频手术治疗鼻腔内翻性乳头状瘤的方法 和初步疗效.方法 回顾性分析2008年7月至2009年1月诊治的8例鼻腔内翻性乳头状瘤患者的临床资料,全部患者均在鼻内镜下实施手术.按Krouse分级,其中Ⅰ级病变1例和Ⅱ级病变6例完全采用低温等离子射频完成手术,Ⅲ级病变1例采用电动吸割器结合低温等离子射频完成手术.结果 术中出血少,除1例复发性鼻腔内翻性乳头状瘤患者出血约200 ml外,余7例患者出血量为2～50 ml,中位数出血量为44 ml.手术时间短,为15～50 min,中位数手术时间为31 min.术后疼痛轻微,术后第2天出院.术后2个月术腔完全上皮化,无并发症.随访2～6个月,中位随访时间4个月,8例均未见复发.结论低温等离子射频手术治疗鼻腔内翻性乳头状瘤具有出血少,损伤小,手术时间短,术后疼痛轻微等优势,对于Ⅰ、Ⅱ级病变可做到肿瘤整块彻底切除,是一种微创治疗鼻腔内翻性乳头状瘤的手术方法 .     

鼻内镜下鼻腔内翻性乳头状瘤低温等离子射频手术治疗的初步观察

目的 探讨鼻内镜下低温等离子射频手术治疗鼻腔内翻性乳头状瘤的方法 和初步疗效.方法 回顾性分析2008年7月至2009年1月诊治的8例鼻腔内翻性乳头状瘤患者的临床资料,全部患者均在鼻内镜下实施手术.按Krouse分级,其中Ⅰ级病变1例和Ⅱ级病变6例完全采用低温等离子射频完成手术,Ⅲ级病变1例采用电动吸割器结合低温等离子射频完成手术.结果 术中出血少,除1例复发性鼻腔内翻性乳头状瘤患者出血约200 ml外,余7例患者出血量为2～50 ml,中位数出血量为44 ml.手术时间短,为15～50 min,中位数手术时间为31 min.术后疼痛轻微,术后第2天出院.术后2个月术腔完全上皮化,无并发症.随访2～6个月,中位随访时间4个月,8例均未见复发.结论低温等离子射频手术治疗鼻腔内翻性乳头状瘤具有出血少,损伤小,手术时间短,术后疼痛轻微等优势,对于Ⅰ、Ⅱ级病变可做到肿瘤整块彻底切除,是一种微创治疗鼻腔内翻性乳头状瘤的手术方法 .     

鼻内镜下鼻腔内翻性乳头状瘤低温等离子射频手术治疗的初步观察

目的 探讨鼻内镜下低温等离子射频手术治疗鼻腔内翻性乳头状瘤的方法 和初步疗效.方法 回顾性分析2008年7月至2009年1月诊治的8例鼻腔内翻性乳头状瘤患者的临床资料,全部患者均在鼻内镜下实施手术.按Krouse分级,其中Ⅰ级病变1例和Ⅱ级病变6例完全采用低温等离子射频完成手术,Ⅲ级病变1例采用电动吸割器结合低温等离子射频完成手术.结果 术中出血少,除1例复发性鼻腔内翻性乳头状瘤患者出血约200 ml外,余7例患者出血量为2～50 ml,中位数出血量为44 ml.手术时间短,为15～50 min,中位数手术时间为31 min.术后疼痛轻微,术后第2天出院.术后2个月术腔完全上皮化,无并发症.随访2～6个月,中位随访时间4个月,8例均未见复发.结论低温等离子射频手术治疗鼻腔内翻性乳头状瘤具有出血少,损伤小,手术时间短,术后疼痛轻微等优势,对于Ⅰ、Ⅱ级病变可做到肿瘤整块彻底切除,是一种微创治疗鼻腔内翻性乳头状瘤的手术方法 .     

鼻内镜下鼻腔内翻性乳头状瘤低温等离子射频手术治疗的初步观察

目的 探讨鼻内镜下低温等离子射频手术治疗鼻腔内翻性乳头状瘤的方法 和初步疗效.方法 回顾性分析2008年7月至2009年1月诊治的8例鼻腔内翻性乳头状瘤患者的临床资料,全部患者均在鼻内镜下实施手术.按Krouse分级,其中Ⅰ级病变1例和Ⅱ级病变6例完全采用低温等离子射频完成手术,Ⅲ级病变1例采用电动吸割器结合低温等离子射频完成手术.结果 术中出血少,除1例复发性鼻腔内翻性乳头状瘤患者出血约200 ml外,余7例患者出血量为2～50 ml,中位数出血量为44 ml.手术时间短,为15～50 min,中位数手术时间为31 min.术后疼痛轻微,术后第2天出院.术后2个月术腔完全上皮化,无并发症.随访2～6个月,中位随访时间4个月,8例均未见复发.结论低温等离子射频手术治疗鼻腔内翻性乳头状瘤具有出血少,损伤小,手术时间短,术后疼痛轻微等优势,对于Ⅰ、Ⅱ级病变可做到肿瘤整块彻底切除,是一种微创治疗鼻腔内翻性乳头状瘤的手术方法 .     

鼻内镜下鼻腔内翻性乳头状瘤低温等离子射频手术治疗的初步观察

目的 探讨鼻内镜下低温等离子射频手术治疗鼻腔内翻性乳头状瘤的方法 和初步疗效.方法 回顾性分析2008年7月至2009年1月诊治的8例鼻腔内翻性乳头状瘤患者的临床资料,全部患者均在鼻内镜下实施手术.按Krouse分级,其中Ⅰ级病变1例和Ⅱ级病变6例完全采用低温等离子射频完成手术,Ⅲ级病变1例采用电动吸割器结合低温等离子射频完成手术.结果 术中出血少,除1例复发性鼻腔内翻性乳头状瘤患者出血约200 ml外,余7例患者出血量为2～50 ml,中位数出血量为44 ml.手术时间短,为15～50 min,中位数手术时间为31 min.术后疼痛轻微,术后第2天出院.术后2个月术腔完全上皮化,无并发症.随访2～6个月,中位随访时间4个月,8例均未见复发.结论低温等离子射频手术治疗鼻腔内翻性乳头状瘤具有出血少,损伤小,手术时间短,术后疼痛轻微等优势,对于Ⅰ、Ⅱ级病变可做到肿瘤整块彻底切除,是一种微创治疗鼻腔内翻性乳头状瘤的手术方法 .