Inverted papilloma of the sphenoid sinus: clinical presentation, management, and systematic review of the literature

Endoscopic transsphenoidal approach to a sphenoid sinus inverted papilloma combined with pituitary adenoma: a case report

Sphenoid sinus inverted papilloma (IP) is a very infrequent tumor, and the combination of sphenoidal IP with pituitary tumor is extremely rare. In this report, the authors describe the case of a 63-year-old male with oculomotor nerve palsy in the left eye due to sellar region tumor. After endoscopic transsphenoidal surgery, the postoperative pathological examination confirmed the co-occurrence of an sphenoidal IP and pituitary adenoma. To our knowledge, the present case is the second reported case of an IP with a pituitary adenoma.

Extended sphenoidotomy combined with transpterygoid approach for sphenoidal sinus inverted papilloma

PURPOSE

Inverted papilloma of the sphenoid sinus (IPSS) is a rare tumor with debated surgical management due to its proximity to vital structures. The aim of this manuscript is to highlight the role of a transpterygoid approach (TPA) and pedicle-orientated strategy in case of involvement of critical structures in IPSS and compare it with data from the literature.

METHODS

Patients with primary IPSS between January 2000 and June 2021 were included. Pre-operative CT/MRI were analyzed to classify the pneumatization of the SS and predict the insertion point of the inverted papilloma. All patients were treated with a trans-sphenoidal approach which was combined with a TPA in case of lateral insertion point. A systematic search was also performed to summarize the available literature.

RESULTS

Twenty-two patients were treated for IPSS. By CT, the SS was categorized with type III pneumatization in 72.8% of cases. Eleven patients (50%) were treated with a TPA with a statistical association with the insertion point on the SS lateral wall (p = 0.01), rather than a SS pneumatization (p = 0.63). The overall success was 95.5% after a mean follow-up of 35.9 months. For the literature, 26 publications were included on 97 patients and described a trans-sphenoidal approach with a success rate of 84.6% after a mean follow-up of 24.5 months.

CONCLUSION

IPSS is generally treated with a sphenoidotomy approach, although in selected cases, a TPA should be preferred to expose the whole SS lateral wall though allowing a complete pedicled oriented resection of the tumor.

Simultaneous Resection of Pituitary Macroadenoma and Sphenoid Sinus Inverted Papilloma: The Challenge of Operating Sinonasal and Skull Base Pathologies Through a Single-Stage Endoscopic Endonasal Approach

BACKGROUND

Coexistence of sinonasal and skull base tumors is uncommon but possible, and the endonasal route seems to be the best option to manage both lesions simultaneously. We report the first case in the English literature of concomitant sphenoid sinus inverted papilloma and pituitary macroadenoma treated through an endoscopic endonasal approach.

CASE DESCRIPTION

A 68-year-old man presented with a history of progressive visual loss and nasal obstruction. Clinical examination disclosed bitemporal hemianopsia. Computed tomography scan and magnetic resonance imaging obtained on admission showed a large sellar/suprasellar enhancing lesion with a marked mass effect on the optic chiasm. Imaging also showed a second mass extending from the sphenoid sinus to the left nasal cavity with obstruction of the maxillary sinus ostium and development of maxillary sinus mucocele. Both tumors were entirely resected by an endoscopic endonasal approach. Additionally, middle meatal antrostomy and marsupialization with drainage of the maxillary mucocele was performed. Biopsy confirmed the coexistence of a pituitary macroadenoma and sphenoid sinus inverted papilloma.

CONCLUSIONS

This case and the literature suggest that patients with concomitant nasal and skull base pathologies can be simultaneously managed. The otolaryngologist plays an essential role in removing the sinonasal lesion to ensure a safe surgical corridor before entering the intracranial cavity and for planning for the skull base reconstruction.

Role of the Akt/mTOR signaling pathway in human papillomavirus-associated nasal and sinonasal inverted papilloma

Nasal and sinonasal inverted papilloma (NSIP) is a benign tumor in which surface epithelial cells grow downward into the underlying supportive tissue with varying degrees of metaplasia. Human papillomavirus (HPV) has been proposed as the causal agent in the pathogenesis of this disease. Many studies have shown that HPV can activate the Akt/mechanistic target of rapamycin (mTOR) signaling pathway, but the role of this pathway in HPV-associated NSIP is largely unknown. In this study, we enrolled 40 control tissue samples and 80 NSIP tissue samples. HPV genotyping showed that 47 of the 80 examined cases of NSIP were HPV-positive (58.8%), and the most common subtype was HPV11 (20/53, 37.7%). The immunohistochemistry showed statistically significant differences in phosphorylated Akt and phosphorylated S6 ribosomal protein staining among control samples, HPV-positive NSIP and HPV-negative NSIP. The HPV11 L1-L2 plasmid increased the proliferation of normal human nasopharyngeal epithelial NP69-SV40T cells and human nasopharyngeal cancer CNE1 cells. Meanwhile, rapamycin, an mTOR inhibitor, reversed the increased cell proliferation induced by the HPV11 L1-L2 plasmid. Western blot analysis showed that Akt/mTOR/S6 were overexpressed in NP69-SV40T cells and CNE1 cells infected with the HPV11 L1-L2 plasmid. These data demonstrate that HPV promotes cell proliferation through the Akt/mTOR signaling pathway in NSIP.

Atypical presentations of sinonasal inverted papilloma: Surgical management and influence on the recurrence rate

BACKGROUND

Sinonasal inverted papilloma (SNIP), classically, is a unilateral benign tumor of the nasal lateral wall. Numerous variations have been observed, depending on location, bilateral presentation, or association with nasal polyposis.

OBJECTIVE

The aim of this work was to describe atypical presentations of SNIPs with their management specificities and to assess their influence on the recurrence rate in a large case series.

METHODS

A retrospective single center study of 110 patients treated for SNIP. Atypical inverted papillomas were identified according to the following criteria: (1) unusual location (frontal, posterior, anterior), (2) bilateral involvement, and (3) association with nasal polyposis. Surgical management was detailed, and the influence of each atypical group on recurrence was assessed by using Kaplan-Meier survival curves and the log-rank test.

RESULTS

Distribution of atypical presentations was as follows: frontal sinus localization (10.9%); posterior localization, including sphenoid sinus (9%); nasal anterior localization (3.6%); bilateral involvement (3.6%); and nasal polyposis association (10%). The surgical approach was endoscopic (74.5%), external (5.5%), or combined endoscopic and external (20%). Except for nasal anterior localization, all the groups were associated with a higher recurrence rate, without reaching statistical significance.

CONCLUSION

Recurrence rates for these atypical presentations arise from their specific surgical challenges. The choice of the surgical technique is guided by tumor location and extension, and by the surgeon's experience; the main objective is a complete resection. The endoscopic endonasal approach is the most frequent procedure.

Inverted papilloma of the sphenoid sinus: risk factors for disease recurrence

OBJECTIVES/HYPOTHESIS

Surgical treatment of inverted papilloma (IP) of the sphenoid sinus is complicated by close proximity to vital structures of the skull base. Identifying the site of tumor attachment and achieving complete removal can be challenging compared to IP at other sites. The objective of this study is to illustrate the clinical presentation, management, and risk factors for tumor recurrence for sphenoid IP.

STUDY DESIGN

Retrospective study.

METHODS

A multi-institutional, retrospective review of endoscopic resections of IP based within the sphenoid sinus was performed from 1996 to 2014. Demographic and tumor data, operative notes, complications, and recurrence rates were collected. Statistical analysis was performed to identify risk factors for tumor recurrence.

RESULTS

Forty-eight patients (31 males, 17 females) were identified. Mean age was 57 years, with a median follow-up of 13.6 months (range 6.8-36). Rate of tumor recurrence was 14.6%, with median time to recurrence of 13.1 months. Patients with dysplasia/carcinoma in situ (CIS) had a 3.6 greater rate of recurrence (RR) compared to patients with no dysplasia, approaching significance (RR = 3.6; P = 0.08). Patients with IP attachment sites overlying the optic nerve or carotid artery had a 4.76 greater rate of recurrence compared to other sites (RR = 4.76; P = 0.073).

CONCLUSION

Sphenoid sinus IP is associated with a 14.6% rate of recurrence after surgery. Potential risk factors for tumor recurrence identified in this study include attachment sites over the optic nerve and carotid artery or evidence of dysplasia or CIS. Close follow-up in the postoperative period is essential for these patients to monitor for tumor recurrence.

Sphenoid sinus inverted papilloma: a case report and literature review

Introduction Inverted papilloma is a rare benign tumor of the nasal fossa, which usually originates from its lateral wall. Only 5% of cases demonstrate exclusive sinus involvement. Primary sphenoid sinus involvement is even rarer. Although considered a benign lesion, the tumor has a potentially invasive nature and has also been found to have an associated malignancy rate of 7 to 15%.

Objectives To report a case of inverted nasal papilloma originating in a rare location: the sphenoid sinus.

Resumed Report a 56-year-old woman, presented to our outpatient clinic complaining of frontal headache, occasional otalgia and recent forgetfulness. She was initially evaluated by a neurologist and then submitted to a head magnetic resonance imaging. A lesion was found to be filling both sphenoid sinuses. Sinus computed tomography showed an opacified sphenoid sinus with apparent bony integrity. The patient underwent sphenoidotomy through a transnasal endoscopic approach. A bleeding papillomatous lesion was identified. A biopsy was performed and histopathologic study suggested inverted papilloma. The lesion was then completely resected. The patient has been followed for 60 days after surgery; no signs of recurrence were found upon flexible nasofibroscope examination.

Conclusion Inverted Papilloma exclusively involving the sphenoid sinus is a rare entity. Non specific symptomatology and Clinical presentation make this kind of tumor a diagnostic and therapeutic challenge. The Endoscopic Sphenoidotomy has been the treatment of choice. Close follow-up is required in order to detect possible recurrences and malignant transformation.

Isolated inverting papilloma of the sphenoid sinus: clinical presentations, imaging manifestations, and therapeutic strategies

BACKGROUND

Isolated inverting papilloma (IP) of the sphenoid sinus is rare, with about 50 patients reported in the English-language literature. With its rarity, scientists have paid less attention to the clinical and radiographic characteristics of isolated IPs arising from the sphenoid sinus.

METHODS

We describe the clinical presentation, imaging manifestations, and surgical methods of isolated IPs from the sphenoid sinus in 3 patients and review the English-language literature from 1970 to 2011.

RESULTS

In total, 59 cases of isolated sphenoid sinus IPs (including our cases) have been reported, 40 patients with computed tomography or magnetic resonance imaging details. The most common presentation is headache. Lesions were found in the sphenoethmoidal recess in 26 cases. In 8 patients who underwent enhanced magnetic resonance imaging, the tumor was obviously intensified. We found 26 patients with bony destruction, and 8 lesions revealed the correct tumor origin.

CONCLUSIONS

A polyp-like mass in the sphenoethmoidal recess strongly implied the diagnosis of an IP in the sphenoid sinus. Bony destruction on computed tomography is a common characteristic of this disease and had a close relationship with the original tumor site in our study. Malignant transformation of IPs in the sphenoid sinus is much scarcer.

Surgical management of inverted papilloma: approaching a new standard for surgery

BACKGROUND

Inverted papilloma surgery is currently performed primarily with an endoscopic approach, a technique that has a recurrence rate of 12%. However, a recent study reported a recurrence rate of 5% with a strategy based on subperiosteal dissection of the tumor, with limited indications for using an external approach. The aim of this work was to evaluate whether different teams using the same surgical concepts could reproduce the excellent results that were recently reported.

METHODS

This study is a retrospective chart review of 71 consecutive patients with inverted papilloma who were treated during the last 10 years.

RESULTS

In all, 80% of the patients were treated using a purely endoscopic approach. The mean follow-up period was 31.6 months. The recurrence rate was 3.3% for cases with at least a 12-month follow-up.

CONCLUSIONS

This work confirms the results described in recent literature and further supports transnasal endoscopic surgery to manage inverted papilloma.

Role of endoscopic approach in the management of inverted papilloma

PURPOSE OF REVIEW

The aim of this work, based on a recent review of the literature concerning sinonasal inverted papilloma, is to describe the diagnostic strategy for inverted papilloma and to propose an algorithm for the choice of surgical techniques, based on recent results of clinical series.

RECENT FINDINGS

Traditionally, inverted papilloma was managed through an open approach. Endoscopic techniques have been developed, first combined with an open approach, and then exclusively endoscopic with the advent of medial maxillectomy and median drainage or Draf procedures. Numerous case series strongly support that they now represent the treatment modality of choice.

SUMMARY

This is a review concerning recent findings about inverted papilloma, based on recent literature revision.Diagnosis of inverted papilloma has to be made before surgery, and planning of the surgical strategy is based on the comparison of computed tomography and MRI, with the aim of targeting the insertion of the tumor. With the help of expanded surgical procedures, endoscopic surgery has become the gold standard for the treatment of the vast majority of inverted papilloma. In case of massive frontal or supraorbital extensions, the frontal osteoplastic flap is the complementary approach of choice.

Isolated inverted papilloma of the sphenoid sinus

Primary inverted papilloma of the sphenoid sinus is rare. Such a case, of a 42-year-old female, is reported here, discussing the clinical presentation, diagnostic clues, radiographic features, histological findings and management. In contrast to the vast majority of cases that present with nasal complaints because of lateral nasal wall involvement, the clinical presentation of inverted papillomas confined to the sphenoid sinus is often nonspecific and insidious. Nasal endoscopy and radiologic imaging are key to an accurate diagnosis. Preoperative imaging with computed tomography and the surgeon's experience will dictate the appropriate surgical approach. In our opinion, transnasal endoscopic large sphenoidotomy remains an effective modality for management of patients with this lesion when the sphenoid sinus is the only sinus requiring investigation. A more anatomically directed approach to the sphenoid sinus with less violation of other sinuses can be achieved.