Endoscopic surgery for inverted papilloma with carcinoma change of lacrimal drainage apparatus and nasal cavity

Dear Sir,Iam Dr.Yin-Hung Chang from the Department of Otolaryngology,Taipei Tzu Chi Hospital,the Buddhist Tzu Chi Medical Foundation.I would like to present a case of inverted papilloma with carcinoma change of lacrimal drainage apparatus and nasal cavity that had been successfully treated by endoscopic surgery.Lacrimal drainage apparatus tumors are rare but important

Recurrent inverted papilloma coexisted with skull base lymphoma: A case report

BACKGROUND Inverted papilloma is an uncommon neoplasm in the nasal cavity.It is a histologically benign tumor,but has a high recurrence and local invasion rate.In addition,nasal or skull base lymphoma is another rare neoplasm.The coexistence of these two tumors in one case makes the diagnosis and related treatment difficult.CASE SUMMARY We report a case of an immunocompetent patient,who had a history of inverted papilloma 20 years ago.The patient presented with an infiltrated mass lesion in the nasal cavity with extension to the frontal base.The repeated biopsies revealed inverted papilloma without any malignant transformation.After the patient underwent a frontobasal craniotomy with total tumor excision,the final pathological examination revealed nasal inverted papilloma coexisting with diffuse large B-cell lymphoma of the skull base.CONCLUSION Based on this case report,while managing a case of an aggressive recurrent inverted papilloma,not only squamous cell carcinoma transformation,but also other invasive malignancy,such as lymphoma,should be considered.

Clinical Variants, Rates of Post-Operative Recurrence and Malignant Transformation of Sino-Nasal Inverted Papilloma

Background: Inverted Papilloma (IP) is the most common benign neoplasms arising from the mucosal lining of the of the Sino-Nasal tract with single or multifocal attachment sites. The high propensity to recur, local aggressive behavior and possibility of malignant transformation attract considerable interest. Objective: To assess the factors affecting Sino-nasal IP, malignant transformation rate, and post-operative recurrence rate. Methods: A retrospective study was carried out on all cases diagnosed as Sino-Nasal Papilloma between January 2010 and December 2020 at Salmaniya Medical Complex, Bahrain. Data gathered from medical records were analyzed using SPSS. A total of 49 Sino-Nasal Papilloma cases were recorded of which 37 were IP. Factors affecting Sino-Nasal IPs are presented. Results: Sino-Nasal IP was recorded in 37 cases, composed of 28 males and 9 females with first presentation average age of 45.86 years. These involved 20 cases in the left side, 14 in the right side and 3 were bilateral. Recurrence in males and females was found to be 35.7% and 33%, respectively, with an average of 12.6 months. The symptoms include nasal blockage (97.3%), epistaxis and postnasal drip (13.5% each), headache (8.1%) and hyposmia and rhinorrhea (5.4%, each). The main recurrence was at stage T2 (60.5%), while in smokers (26.7%) and non-smokers (50%). Malignant transformation occurred in one patient only (2.6%). Conclusion: IP is the most common type of SNP with male predominance. The recurrence rate is high with an average of a year and the malignant transformation occurred in 2.6 % of the cases.

Value of magnetic resonance imaging including dynamic contrast-enhanced magnetic resonance imaging in differentiation between inverted papilloma and malignant tumors in the nasal cavity

Background Distinguishing inverted papilloma （IP） from malignant tumors in the nasal cavity is difficult in a substantial number of cases,thus hindering the administration of appropriate therapeutic strategies.This study aimed to evaluate whether magnetic resonance imaging （MRI）,including dynamic contrast enhanced MRI （DCE-MRI）,could improve differentiation between IP and malignant tumors,and to identify which MRI features were the best in discriminating IP from malignant tumors in the nasal cavity.Methods Non-enhanced,static,and dynamic contrast enhanced MRI was performed in 88 patients with an IP or a malignant tumor in the nasal cavity that had been confirmed by histological results.MRI features of IP and malignant tumors including side,margin,T1 signal intensity,T1 homogeneity,T2 signal intensity,T2 homogeneity,lobulation signs,convoluted cerebriform pattern,extra-sinonasal involvement,pattern of enhancement,Tpeak,Tmax,Clmax,and TIC type were evaluated and correlated with histological findings.Results There were significant differences between IP and malignant tumors in T2 homogeneity,Iobulation signs,convoluted cerebriform pattern,extra-sinonasal involvement,Tpeak,Tmax and TIC types.A convoluted cerebriform pattern had a higher sensitivity and specificity in diagnosis of IP while washout-type TIC had a higher sensitivity and specificity in diagnosis of malignant tumors in the nasal cavity.Non-enhanced combined with static and dynamic enhancement MRI was significantly superior to non-enhanced combined with static enhancement MRI in the differentiation of IP and malignant tumors in the nasal cavity.Multivariate logistic regression analysis identified that the best MRI features were a convoluted cerebriform pattern,extra-sinonasal involvement,and washout-type TIC for both observers （Wang XY and Zhang ZY）.Conclusion Non-enhanced and static combined with dynamic contrast-enhanced MRI improves differentiation of IP and malignant tumors in the nasal cavity.

Increased expression of fascin associated with malignant transformation of sinonasal inverted papilloma

Background Fascin, an actin binding protein, usually expressed at a low level in normal epithelium, but is significantly increased in transformed epithelial cells and several common carcinomas. In this study, we examined the expression of fascin by immunohistochemistry in sinonasal epithelium with chronic inflammation （control group）, exophytic papilloma （EP）, inverted papilloma （IP） with dysplasia and cancerated IP （including caminoma in situ and invasive squamous cell carcinoma, SCC）, and furthermore investigated the relationship between fascin expression and formation of malignant IP. Methods Fascin expression was immunohistochemically detected using monoclonal antibody against fascin in 86 paraffin embedded tissues, including 10 cases of sinonasal mucosa with chronic inflammation, 10 of EP, 45 of IP with dysplasia （45 cases were divided into three groups： IP with mild dysplasia, IP with moderate dysplasia, and IP with severe dysplasia, 15 cases each）, and 21 of cancerated IP. Results The level of fascin expression was significantly higher in the neoplastic tissue than that in control group. Fascin expression increased gradually with the progression from sinonasal epithelium with chronic inflammation, IP with mild dysplasia, IP with moderate dysplasia, IP with severe dysplasia, to cancerated IP, and significant difference of fascin expression was observed between any two groups of the five. Conclusion Precancerous lesions of IP exhibit elevated levels of fascin that may be associated with carcinogenesis of IP. Fascin may play a role in the formation of IP and EP.

Survival Outcome of Squamous Cell Carcinoma Arising from Sinonasal Inverted Papilloma

Background： Sinonasal inverted papilloma （IP） is a rare benign tumor of the nasal cavities and paranasal sinuses. It is destructive or bone-rcmodeling, tends to recur alter surgical resection, and has a significant malignant potential. The present study aimed to pertbnn a retrospective analysis of patients with squamous cell carcinoma （SCC） arising from IP, including characteristics, survival outcome, and predictors of associated malignancy. Methods： The medical records of 213 patients diagnosed with IP from January 1970 to January 2014 were retrospectively reviewed. Eighty-seven patients were diagnosed with SCC/IP; their clinical characteristics, treatments, and survival outcomes were analyzed. Results： Of the 87 patients with SCC/IP, the 5- and 10-year overall survival outcomes were 39.6% and 31.8%, respectively. Twenty-nine of these patients received surgery and 58 received combined surgery and radiation. Of the patients with stages III-IV, the 5-year survival rate was 30.7% for those treated with surgery only and 39.9% for those given the combination treatment （P = 0.849）. Factors associated with significantly poor prognosis were advanced-stage, metachronous tumors, or with cranial base and orbit invasion. Age, synchronous or metachronous tumors, and pathological stage were independent risk factors for mortality, shown by multivariate analysis. Conclusion： Patients with SCC/IP had low overall survival outcomes. Advanced age, stage, and metachronous tumors are the main factors affecting prognosis. Treatment planning should consider high-risk factors to improve survival outcome.

Benign Nasosinus Tumors: Epidemiological, Clinical, Morphological, Therapeutic, and Evolutionary Aspects at the Adolphe SICE General Hospital in Pointe-Noire (Congo-Brazzaville)

Introduction: Benign nasosinus tumors (BNST) of epithelial origin are relatively rare and arise from the various lining tissues of the nasal and sinus cavities, and from glands developed from these epithelial invaginations. These include nasosinusal polyps, pleiomorphic adenoma and inverted papilloma. The aim of our study was to investigate the epidemiological, clinical, morphological, therapeutic, and evolutionary particularities of these three clinical entities, including two tumors with the potential for progressive malignancy (pleiomorphic adenoma and inverted papilloma) and one strictly benign tumor with a favorable evolution (nasosinus polyp or Schneider polyp). Materials and Methods: This was a retrospective, analytical, cross-sectional study conducted from January 1, 2006 to December 31, 2019 (13 years), in the Department of Otolaryngology and Cervicofacial Surgery at Adolphe SICE Hospital, Pointe-Noire, Congo-Brazzaville. Results: During the study period, 74 patients were registered for a nasosinus tumor, of which 23 were benign tumors of epithelial origin (31%) distributed as follows: 15 cases of nasosinus polyp, 5 cases of pleomorphic adenoma and 3 cases of inverted papilloma. The mean age was 42.5 for polyps, with an estimated median of 38, and 42.9 for the other two entities (pleomorphic adenoma and inverted papilloma), with an estimated median of 41. Nasosinus allergy accounted for 17% of cases, followed by chronic sinusitis (12%);however, in 49% of cases, the patient’s history was not specified. There was no sexual predominance, the sex ratio being 1.08. Occupation, socio-economic level, and education had no impact on the development of these tumors. Most of our patients (52%, 12 cases) had a consultation delay of more than one (1) year, whatever the histological nature of the tumor. The complete nasosinus syndrome (NSS) included nasal obstruction, rhinorrhea, epistaxis, and anosmia, and was found in 19 cases (83%), most often reflecting a nasosinus polyp. CT scans were performed in all patients, with hyperdense images predominating in 22 cases. Management of benign nasosinus tumors was mainly surgical. Postoperative management was straightforward in 15 cases (65%). Conclusion: Benign nasosinus tumors are dominated by nasosinus polyps. Management of these tumors is essentially surgical, with the best clinical outcome.

The pathology of urinary bladder lesions with an inverted growth pattern

Inverted lesions in the urinary bladder have been the source of some difficulty in urological pathology. The two common ones are von Brunn＇s nests and cystitis cystic/cystitis glandularis, which are considered normal variants of urothelium. Apart from them, a number of other rare urothelial lesions with inverted growth pattern occur in the urinary bladder. Some of them are only reactive conditions, just as pseudocarcinomatous hyperplasia. Some are benign tumors, namely inverted papilloma. Whereas others are malignant neoplasms, including inverted papillary urothelial neoplasm of low malignant potential （PUNLMP）, non-invasive inverted papillary urothelial carcinoma （low-grade and high-grade）, and invasive urothelial carcinoma （inverted, nested and big nested variants）. Because of the overlapping morphological features of all the inverted lesions mentioned above, even between high-grade invasive carcinoma and psendoearcinomatous hyperplasia which are only a kind of reactive conditions, it is very important for the surgical pathologist to recognize and be familiar with these inverted lesions in urinary bladder. In this article, we review these spectrums of inverted lesions of the urinary bladder. Emphasis is placed on histogenesis, morphology, differential diagnosis of these lesions, and the pathologic grading of the non-invasive inverted neoplasms, such as inverted papilloma, inverted PUNLMP, non-invasive inverted papillary urothelial carcinoma with low-grade, and non-invasive inverted papillary urothelial carcinoma with high-grade.

鼻腔鼻窦内翻性乳头状瘤

内翻性乳头状瘤约占乳头状瘤的70%,约占全部鼻腔鼻窦肿瘤的0.5%～4%,其临麻特征是有复发倾向、破坏周围解剖结构和骨质重塑、以及与鳞状细胞癌相关。单侧鼻堵是最常见的临床症状。肿瘤分期依据病变在CT上的侵及范围。累及鼻腔外侧壁、上颌窦和筛窦多见。既往治疗的经典方式是鼻侧切开术和鼻腔外侧壁(上颔窦内侧壁)切除术。伴随着鼻内镜外科技术的发展和成熟,国内、外有关应用内镜技术切除内翻性乳头状瘤的报道渐多。考虑到内翻性乳头状瘤的生物学特点,手术治疗的目的是应用精细手术解剖技术,将病变黏膜在骨膜下层彻底切除。

上颌窦内翻性乳头状瘤的临床分析

鼻腔鼻窦内翻性乳头状瘤是鼻科常见的良性肿瘤,占鼻肿瘤的0.5%～4.0%,具有侵袭性、高复发率、易恶变的临床特点。2005年Kamel等[1]基于鼻腔鼻窦内翻性乳头状瘤病变起源提出了新的分级系统,I型病变起源于鼻中隔或鼻外侧壁,II型病变起源于上颌窦。

鼻腔鼻窦内翻性乳头状瘤研究进展

鼻腔鼻窦内翻性乳头状瘤为临床较为常见的肿瘤,发病率在鼻肿瘤中约占0.4%～4.7%,除了影响通气、鼻出血,还具有浸润性生长、术后易复发、恶变等生物学行为。其病因、发病机制尚未明了,特殊生物学行为的发生机制亦在探究当中,不少文献已作出相关报道,下面就上述问题的研究现状做一综述。

经鼻内镜联合下鼻道进路手术治疗上颌窦良性病变

鼻内镜手术以其科学的理论基础和良好的临床效果在国内外得到广泛开展,基本上己经取代柯陆手术。尽管借助各种角度鼻内镜及器械,有时上颌窦内仍然有无法窥视和处理的区域。在临床实践中发现,鼻内镜手术处理某些上颌窦病变有时存在操作死角,看得见但够不着,如何规避这些局限,将给一些疾病治疗带来更好的效果。我们对2005年1月～2009年6月共收治上颌窦良性病变患者512例,其中109例采用鼻内镜联合下鼻道进路手术治疗,疗效显著,现报道如下。

鼻内翻性乳头状瘤中Ki-67的表达及与微血管密度的关系

1.1临床资料。收集1999年1月～2005年7月手术切除确诊为鼻内翻性乳头状瘤（nasal inverted papilloma,NIP）标本存档蜡块36例,男22例,女8例;鼻息肉（nasal polyps,NP）14例,男9例,女5例：鼻腔鳞状细胞癌（nasal squamous cell caminoma，NSCC）10例，男77例，女3例。

鼻内镜下切除鼻腔及鼻窦内翻性乳头状瘤

鼻内翻性乳头状瘤是耳鼻咽喉科常见的良性肿瘤．但少数可能恶变，手术后易复发．传统治疗采取鼻侧切开术或经鼻内进路切除肿瘤，我院于1989年1月～2004年12月采用鼻内镜技术治疗48例鼻腔及鼻窦内翻性乳头状瘤，报告如下。

The serum squamous cell carcinoma antigen level in inverted sinonasal papilloma and nasal polyps patients

Objective:To clarify whether the serum squamous cell carcinoma antigen(SCCA)levels of patients with inverted papilloma(IP)are different from patients with nasal polyps(NP)and rhinitis.Materials and methods:Serum SCCA levels were measured in 30 patients with IP and 30 patients with NP at one day before surgery and seven days after surgery and measured in 28 patients with rhinitis.Results:Elevated serum SCCA levels(>1.5 ng/ml)were found in 80.0%of patients in the IP group,6.7%of patients in the NP group and 14.3%of patients in the rhinitis group,which was a significant difference.The medians of serum SCCA levels in the IP,NP and rhinitis groups were 3.9,0.8 and 1.1 ng/ml,respectively,which was a significant difference.The SCCA level in IP group was not significantly correlated according to Krouse Staging.There was a significant difference in serum SCCA levels between the pre-and postoperative stages in the IP group,at 3.9 and 0.8 ng/ml,respectively,while in the NP group the levels were 0.8 and 1.0 ng/ml,not significantly different.With regard to the IP diagnosis in the IP and NP group based on the SCCA level(>1.5 ng/ml),sensitivity and specificity was 80.0%and 93.3%,respectively.Conclusions:The serum SCCA level in patients with IP was elevated and then it decreased after surgery.This was different from NP and rhinitis patients who mostly had normal levels,which did not change.

中耳癌伴同侧上颌窦内翻性乳头状瘤恶变1例

1临床资料患者,男,56岁。因左耳听力下降伴流脓1年,加重伴疼痛2个月于2008-07-10入院。患者于1年前无明显诱因出现左耳听力下降、流脓症状,听力下降呈进行性加重,影响工作及生活。4个月前出现左侧鼻塞,在外院行＂左侧鼻腔、左侧上颌窦肿瘤切除术＂,术后未行病理检查。2个月前左耳听力下降、流脓症状进一步加重并出现左耳剧烈疼痛。

鼻腔恶性黑色素瘤与内翻性乳头状瘤共存1例

1 临床资料患者,男,84岁,因双侧鼻腔阻塞3年,加重1年于2017-03-13入院。患者3年前无明显诱因出现双侧鼻腔通气不畅,左侧鼻腔呈持续性阻塞,右侧鼻腔呈间断性部分阻塞,流白色黏性涕,量少,无明显嗅觉减退,无鼻痛,无鼻腔出血,无涕中带血及颜面部蚁走感,无视物模糊,无发热及全身乏力,未重视及正规诊治。

Schneiderian papilloma occasionally found in the lacrimal sac

Schneiderian papilloma is a kind of benign tumor that generally arises in the nasal and paranasal sinus mucosa. Here we present a case of Schneiderian papilloma found in the lacrimal sac.

鼻腔鼻窦内翻性乳头状瘤病因学研究

鼻腔鼻窦内翻性乳头状瘤（inverted papilloma，IP）是鼻腔鼻窦的良性病变，其特点为局部呈破坏性生长、发展快、手术后容易复发及少数恶性变等。迄今为止，鼻腔鼻窦内翻性乳头状瘤的病因和发病机制仍不清楚，为进一步研究IP的病因及发病机制，本文将近年来病因学相关文献做一综述。

鼻腔鼻窦内翻性乳头状瘤复发因素

鼻腔鼻窦内翻性乳头状瘤是一种黏膜上皮源性良性肿瘤，临床上较常见，发病率占鼻腔鼻窦良性肿瘤的首位。手术是最基本的治疗措施，但容易复发，其复发率各家报道差距很大，从0～78％不等。目前关于鼻腔鼻窦内翻性乳头状瘤复发机制仍不清楚。