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.

Conservative endoscopic surgery in inverted papilloma. Preliminary report

Inverted papilloma is noted for recurrence and occasional association with malignancy, leading most authors to recommend lateral rhinotomy as the initial surgical approach in all cases; however, conservative surgery has been reported to be effective in selective cases. Endoscopic control was used in the surgical treatment of three cases of inverted papilloma. In all three cases, the lesions were unilateral and localized, with limited extension into the sinonasal region, and they were not associated with malignancy or recurrent (as proved by endoscopy, computed tomography, and histopathologic examination). Total removal of the mass was achieved through a conservative intranasal approach. Endoscopic follow-up for periods ranging between 12 and 39 months, with an average of 23 months, failed to identify any recurrence. These findings point to the feasibility of applying this conservative endoscopic approach for total excision of limited lesions of inverted papilloma.

Different options for treatment of inverting papilloma of the nose and paranasal sinuses: a report of 41 cases

Forty-two cases of inverting papilloma of the nose and paranasal sinuses were reviewed from 1972 to 1989. Forty-one patients underwent surgical excision. Of those patients followed up for at least 6 months, lateral rhinotomy was performed in 14 patients and midfacial degloving in 9 patients. The recurrence rates were 29% and 22%, respectively. The other 10 patients underwent excision through an external ethmoidectomy, Caldwell-Luc operation, or intranasal approach. There were five patients (12%) diagnosed with squamous cell carcinoma associated with inverting papilloma. The correlation of malignancy with proptosis, visual changes, infraorbital hypesthesia, and skull base involvement on presenting symptomatology is noted. Inverting papilloma is a benign neoplastic lesion that shows variable aggressiveness. A computed tomography (CT) scan evaluation is very important for the work-up. An aggressive wide surgical excision is best performed through an open approach. The approach for surgical removal should be based on the location and extension of the lesion. A graduating approach from a lesser to a more major excision is advocated even though a risk exists of having to reoperate in about one fifth of the patients who experience a recurrence. A secondary surgical excision, even with craniofacial resection, is essential to eradicate disease in cases of recurrence. Close follow-up is necessary. Further surgery may be indicated. Post-operative radiation therapy is recommended if malignancy is indeed present.

[A case report of inverted papilloma of the posterior urethra]

A case of inverted papilloma of the posterior urethra is reported. A 59-year-old male was admitted with the chief complaint of hematuria. Urethrogram revealed a small defect in the neck of the bladder. Endoscopic examination revealed a polypoid tumor on the stalk arising from prostatic urethra, and transurethral resection was performed. The patient has been subsequently followed up and there has been no evidence of recurrence. Although 141 cases of inverted papilloma have been reported in many anatomical sites of the urinary tract, only 19 cases involving the posterior urethra have been described in Japan. This is the 20th case of a posterior urethra.

Tracheal papilloma presenting as asthma in a child

This report describes a child with a tracheal papilloma who was initially diagnosed and treated as having asthma. The case illustrates that all wheezing in children should not be attributed to asthma.

[Inverted papilloma of the ureter]

We report a case of inverted urothelial papilloma localized to the ureter in a patient with solitary kidney. Treatment was by segmental resection and end-to-end anastomosis. In spite of the benign nature of this tumor type and because treatment is conservative, patients should be closely followed owing to the possibility of recurrence and because progression to malignancy has been reported in the literature.

[Doppler ultrasound differentiation of benign and malignant breast tumors]

Before surgery we studied the blood flow in and around 59 breast tumours (35 malignant and 24 benign) and investigated a correlation with the histology. The most decisive factors were the maximum end-diastolic frequency B (probability greater than magnitude of z = 0.0009) and the mean frequency F mean (probability greater than magnitude of z = 0.0017). The maximum systolic frequency A, the resistance index Ri, the diastolic angle W and the pulsatility index Pi showed less significant differences between malignant and benign histological types. In a retrospective survey, we tried to confirm the definitive histology by our Doppler results. In this, we failed in 17.14%--of malignant cases and in 33.33% in the cases of benign tumours.

Benign papillary neoplasms of the breast: mammographic findings

The clinical presentation, pathologic characteristics, and mammographic/ductographic (also known as galactographic) findings were reviewed in 77 patients with histologically proved benign papillary neoplasms of the breast. Patients were classified as having either solitary or multiple papillomas. Patients with multiple papillomas were further subclassified as having either central or peripheral papillomas. Fifty-one patients (66%) had solitary papillomas. Thirty-seven of these patients were symptomatic; 36 had spontaneous nipple discharge, and one had a palpable mass. Ductography was positive in 32 of the 35 patients who underwent the procedure. In the 14 asymptomatic patients, subareolar (n = 10) and peripheral (n = 4) mammographic abnormalities prompted biopsy. Fourteen patients (18%) had multiple peripheral papillomas, and one patient also had bilateral central solitary papillomas. Eleven of these patients were asymptomatic, while two presented with palpable abnormalities and one with spontaneous bilateral discharge. Mammographic findings included microcalcifications (n = 5) and clustering nodules (n = 2). Associated atypical ductal hyperplasia was found in six (43%) of the 14 patients with multiple peripheral papillomas. Some of these patients also had lobular carcinoma in situ and radical scars. Twelve patients had multiple central papillomas; all presented with spontaneous nipple discharge and had positive ductograms.

[Diagnosis and treatment of benign tumors of the gallbladder]

The article generalizes experience in the treatment of 226 patients with benign tumors and preneoplastic diseases of the gallbladder, who underwent cholecystectomy. The increased number of patients with the disease is noted, they accounted for 12.77% of all patients who were operated on for gallbladder diseases. Females 40 to 60 years of age have the disease most frequently. In most cases (n = 190) it is seen with calculi. In the absence of concomitant pathological conditions it is generally asymptomatic. The diagnosis is based on instrumental examination. Ultrasonic examination in combination with cholecystography is preferable. Operation is the recommended method of treatment.

[Solitary intraductal papilloma of the breast. An echographic study of 12 cases]

Solitary intraductal papillomas (SIP) of the breast are relatively common lesions (incidence: 2-3%) originating from proximal ducts or from retroareolar lactiferous ducts. This work was aimed at evaluating the diagnostic reliability of US in the diagnosis of this condition and at discussing the differential diagnosis with similar focal lesions. Twelve cases of SIP were diagnosed with US among 31 selected female patients (aged 16-35 years) who had been referred for serohematic discharging breast and/or palpable nodules. All cases had surgical confirmation. US patterns typical of SIP were: 1) solid hypoechoic nodules with peripheral anechoic areas (7 cases); 2) small papillary excrescences within a cystic cavity, corresponding to papillary cystadenocarcinoma (4 cases); 3) periareolar overdistended ducts filled with dense material (1 case). Surgery was performed directly in 8 patients with positive cytology while mammography, ductography and fine-needle biopsy were performed in the extant 4 patients with negative or questionable cytologic findings. US combined with cytologic samples allowed the correct diagnosis to be made in 8 of 12 cases (66%): this is noteworthy when considering the low reliability of mammography in young patients and the poor tolerance to ductography in general. US allows the differential diagnosis with other focal lesions and subsequently helps shorten the diagnostic route.

Simulated aggressive skull base erosion in response to benign sinonasal disease

Benign sinonasal masses and slow-growing neoplasms tend to remodel the nasal vault and facial bones, and this is particularly true of nasal polyps and inverted papillomas. However, when such benign masses press against the floor of the anterior cranial fossa and the walls of the sphenoid sinuses, simulated aggressive bone destruction rather than bone remodeling usually occurs. This type of bone destruction implies to the radiologist that a carcinoma may also be present, and this information could dissuade a surgeon from operating with an attempt at cure. In fact, about 90% of the time with inverted papillomas and in virtually all cases of nasal polyposis, no carcinoma is present. The computed tomographic (CT) scans and magnetic resonance images of 14 patients are used to demonstrate these changes. In addition, the CT scans of three patients with malignancies are shown to illustrate the similarity in the bony skull base changes.

[Proliferative pathology of the mammary ducts. Diagnostic value of ductogalactography and cytologic correlations]

Three hundred and thirty-six patients with nipple discharge and neither physical signs at breast examination nor pathological findings at mammography, were observed from 1984 to 1988 and studied by means of ductogalactography and cytology of discharge. Of this group, 76 patients (22.6%) underwent surgery and histology. In 65/76 cases proliferative pathologic conditions were demonstrated: 51 single/multiple papillomas and 14 carcinomas. Ductogalactography suggested proliferative pathologic conditions in 59 cases and cytology of discharge showed blood in 44 patients, papillary clusters in 23, and atypical cells in 15 (both as single occurrences and in association). In cancer patients discharge appeared to be mostly spontaneous, monoductal and blood-stained. In papillomas, induced discharge was almost as frequent as spontaneous discharge, serous discharge was almost as frequent as blood-stained discharge, and milky discharge was also present. Ductogalactography confirmed its value in the diagnosis of proliferative pathologic conditions of the mammary ducts, being especially useful to detect carcinomas without palpable tumors. Cytology of discharge had poorer diagnostic significance.

Inverted squamous papilloma with neuro-ophthalmic features

The schneiderian or inverted papilloma is an infrequent and usually benign tumor of the paranasal sinuses. It most commonly manifests as unilateral nasal obstruction. This is a case of an inverted papilloma in a 92-year-old woman who presented with severe proptosis, loss of vision in the left eye, and rhinorrhea. The mass was visible in her left nostril; neuroimaging studies showed that the lesion extended from the left paranasal sinus into the frontal sinuses. In addition, there was secondary spread into the cranial cavity and brain substance.

Tumors of the lateral ventricles

Tumors are only rarely found in the lateral ventricles. Although various oncotypes of these tumors differ in growth rate and invasiveness they present the same clinical pattern with the same diagnostic and surgical problems. Thus we can consider them as a group. This series comprises 51 primary tumors arising strictly from the structures of the lateral ventricles, the majority from the trigone, operated on between 1952 and 1988: 20 meningiomas, 19 ependymomas, 9 papillomas of the choroid plexuses, and 3 subependymomas. As most of these tumors were benign, the response to surgical treatment was, as other authors have found, good with permanent cure or long survival in the majority of cases. Advances in neuroradiological techniques have greatly facilitated the work-up and differential diagnosis of these tumors. Of the various surgical approaches, the parieto-occipital is preferred by our department, even for tumors of the dominant hemisphere. Our operative mortality of 10.6% tallies with that of other workers.

Solitary bronchial papilloma presenting with recurrent dyspnea attacks: case report with computed tomography findings

A case of solitary bronchial papilloma is reported which, because of its unusual location near the carina and marked mobility, presented with attacks of dyspnea that were misdiagnosed as asthma for many years. It caused no abnormality on a plain chest X-ray, but could be visualized on linear and computed tomograms. The computed tomograms further demonstrated the absence of extraluminal extension of the tumor or mediastinal lymphadenopathy which could not be excluded by linear tomography or bronchoscopy. Transbronchial resection resulted in complete relief of symptoms.

[Importance of early diagnosis in the improvement of prognosis in breast carcinoma: non-palpable lesions. Preliminary results]

There are still marked differences in the current indications for breast screening proposed by the various international school of oncology. Epidemiological data to the effect that breast screening in asymptomatic women aged over 50 reduces the death rate due to breast cancer now appears to be widely accepted, but an analogous finding for women aged between 40-49 has not yet been confirmed. Following a brief analysis of the most important breast screening programmes carried out to date, the Authors report the preliminary results regarding the identification and biopsy of non-palpable breast lesions during the course of a screening programme in 1986 by the Dept. of Cancer Surgery. Of a total of 1128 breast scans in asymptomatic patients aged between 40 and 73, 24 suspect (1.9%) non-palpable lesions were found of which 5 (20.8%) proved to be carcinomas.

Bilateral ureteral inverted papillomas in association with bladder carcinoma: a case report and review of the literature

A case of multiple inverted papillomas of both ureters, in association with a bladder carcinoma, is presented. Inverted papilloma is a rare benign urothelial tumor. Because of its curability by conservative surgery, it should be considered in the differential diagnosis of a ureteral filling defect and ureteral obstruction. Inverted papilloma may be associated with carcinomas of the urinary tract.

Lateral ventricular neoplasms of the brain: differential diagnosis based on clinical, CT, and MR findings

The differential diagnosis of lateral ventricular tumors was explored by retrospective analysis of 47 pathologically proved cases identified by CT and/or MR imaging. Third ventricular tumors adjacent to the foramen of Monro (e.g., colloid cysts) were excluded. Forty-six patients underwent CT, and eight had MR imaging. The most common neoplasms were choroid plexus papilloma (10 cases) and meningioma (nine cases). Other common neoplasms included subependymoma (six cases), subependymal giant cell astrocytoma (five cases), and metastasis/lymphoma (four cases). Important features for differential diagnosis included age of the patient, the tumor's location within the lateral ventricle, and density on CT before IV administration of contrast material. Fifty percent of the tumors were in the ventricular atrium. All intraventricular tumor types (except subependymoma) showed contrast enhancement. MR was most useful in evaluating tumor location, size, and extent, but it did not help in eliminating alternative diagnoses. On the basis of patients' ages, specific tumor location, and the appearance on CT scans or MR images, an algorithm for differential diagnosis of lateral ventricular tumors was developed.

Recurrent conjunctival papilloma causing nasolacrimal duct obstruction

We treated two patients who had recurrent conjunctival papillomas that invaded the nasolacrimal sac and caused complete canalicular and nasolacrimal duct obstruction. The ophthalmologist should be aware of the possibility of a conjunctival papilloma invading the lacrimal sac when treating patients with conjunctival papillomas. Excision should be complete, and adjunctive therapy such as cryotherapy should be considered to reduce the chance of tumor recurrence.