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Mohsin SF, Al-Drobie B. Human papillomavirus expression in relation to biological behavior, Ki-67 proliferative marker, and P53 prognostic marker in Schneiderian papilloma. J Med Life 2023; 16:1022-1027. [PMID: 37900071 PMCID: PMC10600675 DOI: 10.25122/jml-2022-0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/03/2023] [Indexed: 10/31/2023] Open
Abstract
Various malignant and benign tumors can arise in the sinonasal cavity, including inverted papilloma (IP), a benign neoplasm with unique clinical characteristics. However, the mechanisms involved in the recurrence, occurrence, and malignant transformation of IP remain debatable. This study aimed to investigate the impact of human papillomavirus (HPV) infections on IP by comparing the number of infections in cases with epithelial tissue dysplasia and explore the predictive role of proliferative and prognostic markers in dysplasia. Tissue blocks from 35 cases of sinonasal papilloma, collected between 2015 and 2021 from the laboratory archives of the Medical City of Ghazi Al-Hererri Hospital in Baghdad, Iraq, were immunohistochemically stained with monoclonal antibodies (mAbs) to detect Ki-67 and p53. A quantitative immunohistochemical analysis was conducted to analyze the results. Polymerase chain reaction (PCR) was performed to detect HPV genotypes 16/18 and 6/11 in the tissues. There was an insignificant increase in Ki-67 and p53 expression in inverted papillomas with dysplasia. HPV11 was the most prevalent genotype in 34.3% of the patients, followed by HPV16 and HPV18 in 31.4% of the patients for each virus. The least common virus detected was human papillomavirus 6 (8.6%), which did not show any significant association with the degree of dysplasia. Viral detection proliferation and apoptosis had no impact on tumor dysplasia amongst all the patients, showing no relationship with the evaluated cases.
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Affiliation(s)
- Shaymaa Fadhl Mohsin
- Department of Oral and Maxillofacial Pathology, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Ban Al-Drobie
- Department of Oral and Maxillofacial Pathology, College of Dentistry, University of Baghdad, Baghdad, Iraq
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Yu S, Grose E, Lee DJ, Wu V, Pellarin M, Lee JM. Evaluation of inverted papilloma recurrence rates and factors associated recurrence after endoscopic surgical resection: a retrospective review. J Otolaryngol Head Neck Surg 2023; 52:34. [PMID: 37106391 PMCID: PMC10134596 DOI: 10.1186/s40463-023-00638-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Sinonasal inverted papillomas (IP) are benign tumours arising from the mucosal lining of the nasal cavity and paranasal sinuses with a high propensity for recurrence and malignant transformation. Advances in endoscopic surgery and improved radiologic navigation have increased the role of endoscopic surgical resection in the treatment of IPs. The current study aims to evaluate the rate of IP recurrence after endoscopic endonasal resection and to evaluate factors which impact recurrence. METHODS This was a single-centre retrospective chart review of all patients who underwent endoscopic sinus surgery for management of IP between January 2009 and February 2022. Primary outcomes were the rate of IP recurrence and time to IP recurrence. Secondary outcome measures were patient and tumour factors that contributed to IP recurrence. RESULTS Eighty-five patients were included. The mean age was 55.7 and 36.5% of patients were female. The mean follow-up time was 39.5 months. Of the 85 cases, 13 cases (15.3%) had recurrence of their IP and the median time to recurrence was 22.0 months. All recurrent tumours recurred at the attachment site of the primary tumour. The univariate analysis did not identify any significant demographic, clinical, or surgical predictors of IP recurrence. There were no significant changes in sinonasal symptoms at the time IP recurrence was detected. CONCLUSION Endoscopic endonasal resection of IPs represents an effective surgical approach, however, the relatively high rate of recurrence and lack of symptomatic changes at the time of recurrence necessitates long term follow up. Better delineation of risk factors for recurrence can help identify high-risk patients and inform postoperative follow up strategies.
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Affiliation(s)
- Sheila Yu
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, 8 Cardinal Carter Wing, Toronto, ON, M5B 1W8, Canada
| | - Elysia Grose
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, 8 Cardinal Carter Wing, Toronto, ON, M5B 1W8, Canada
| | - Daniel J Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vincent Wu
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, 8 Cardinal Carter Wing, Toronto, ON, M5B 1W8, Canada
| | - Mitchell Pellarin
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, 30 Bond Street, 8 Cardinal Carter Wing, Toronto, ON, M5B 1W8, Canada.
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Inverted papilloma presenting as unilateral proptosis: A case report with review of literature. Saudi J Ophthalmol 2019; 33:413-416. [PMID: 31920456 PMCID: PMC6950950 DOI: 10.1016/j.sjopt.2019.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/13/2019] [Accepted: 01/28/2019] [Indexed: 11/23/2022] Open
Abstract
Inverted papilloma is an interesting benign tumour arising from lining epithelium of paranasal sinuses which most commonly involves nasal cavity and paranasal sinuses. However, involvement of orbit and intracranial extension without malignant transformation is very rare. We report a case of extensive inverted papilloma of frontal sinus which primarily presented with proptosis, an uncommon presentation. Ophthalmologic symptoms are rare manifestations of paranasal sinus inverted papilloma without malignant transformation and signify extensive disease with possible intracranial extension.
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Wu V, Siu J, Yip J, Lee JM. Endoscopic management of maxillary sinus inverted papilloma attachment sites to minimize disease recurrence. J Otolaryngol Head Neck Surg 2018; 47:24. [PMID: 29618385 PMCID: PMC5885307 DOI: 10.1186/s40463-018-0271-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/27/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Inverted papillomas (IPs) are benign neoplasms, most commonly arising from the mucosal lining of the maxillary sinus. IPs can have single or multifocal sites of attachment. Although pedicle location is an important factor to consider in surgical planning, it is less clear whether the location or number of IP attachment sites hold any prognostic value. Herein, we aimed to determine the prognostic significance of the number and location of attachment sites of IPs originating from the maxillary sinus when managed by a pure endoscopic approach. METHODS This was a single-center, single-surgeon retrospective chart review. Patients with maxillary sinus IPs who were managed by endoscopic approaches only, from January 1, 2010 to June 30, 2016, were identified. Demographic data, operative technique, number and location of IP attachment sites, follow-up duration, recurrence, and presence of malignant transformation were captured. RESULTS Twenty-eight maxillary IP patients (61% males) were included, with a mean age of 54.9 (standard deviation (SD): 16.5) years. Approximately 36% of patients were referred from other institutions for management of recurrent IPs after failing previous surgical treatment. All patients were managed with an endoscopic approach, and all required an endoscopic medial maxillectomy to facilitate access to the maxillary sinus. At a mean follow-up of 31.1 (SD: 22.6) months, there were no recurrences identified. IPs with single (46%) and multifocal (54%) attachments were predominately to the medial and lateral walls. Maxillary IPs with multifocal attachments most frequently involved 2-3 walls of the sinus. Osteitis (36%) was commonly seen. CONCLUSION IPs originating from the maxillary sinus frequently had multifocal attachments, but this did not impact disease recurrence. Despite the surgical challenges of accessing all of the maxillary sinus walls, IPs originating from the maxillary sinus can be effectively managed via a pure endoscopic approach.
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Affiliation(s)
- Vincent Wu
- School of Medicine, Faculty of Health Sciences, Queen’s University, Kingston, Ontario Canada
| | - Jennifer Siu
- Division of Rhinology, Department of Otolaryngology – Head and Neck Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario Canada
| | - Jonathan Yip
- Division of Rhinology, Department of Otolaryngology – Head and Neck Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario Canada
| | - John M. Lee
- Division of Rhinology, Department of Otolaryngology – Head and Neck Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
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Di Pietrantonio A, Asmus H, Ingratta C, Brennan W, Schulz J, Carballo L. [Invasive sinonasal papilloma with intracranial invasion: Case report and bibliographic review]. Surg Neurol Int 2018; 9:S29-S35. [PMID: 29430328 PMCID: PMC5799940 DOI: 10.4103/sni.sni_370_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/30/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Inverted papilloma is a locally-aggressive benign neoplasm of the paranasal sinuses with a high potential for recurrence and malignancy. Intracranial extension is infrequent, and dural penetration even more so, typically associated with recurrence of the disease or its degeneration into squamous cell carcinoma. CLINICAL CASE A 32-year-old female patient consulted us for an exophytic lesion in her right nostril and exophthalmos, associated with headache, anosmia and dysgeusia. Craniofacial and brain CT and brain MRI demonstrated a lesion in the right nostril, extending into the aerial sinuses, orbital lateral wall and anterior fossa, with osteolysis and intracranial invasion towards the right frontal region. A mass effect and brain compression were noted. A histological diagnosis of inverted papilloma was made initially. Upon later resection of the lesion by double access, with reconstruction of the anterior cranial fossa, a definitive diagnosis was made of inverted papilloma of the Schneiderian type, with areas of atypical transformation in situ. Post-operatively, the patient has had a favorable course, with full upper airway patency and neither complications nor signs of recurrence after four years of follow-up. CONCLUSIONS Intracranial invasion of this pathology is extremely uncommon. When it exists, the tumor has a high potential for local recurrence. Consequently, complete excision of the lesion determines the patient's prognosis.
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Affiliation(s)
- Andrés Di Pietrantonio
- Servicio de Neurocirugía, Hospital de Trauma y Emergencias Dr. Federico Abete, Malvinas Argentinas, Provincia de Buenos Aires, Argentina
| | - Humberto Asmus
- Servicio de Neurocirugía, Hospital de Trauma y Emergencias Dr. Federico Abete, Malvinas Argentinas, Provincia de Buenos Aires, Argentina
| | - Christian Ingratta
- Servicio de ORL, Hospital de Trauma y Emergencias Dr. Federico Abete, Malvinas Argentinas, Provincia de Buenos Aires, Argentina
| | - Walter Brennan
- Servicio de Neurocirugía, Hospital de Trauma y Emergencias Dr. Federico Abete, Malvinas Argentinas, Provincia de Buenos Aires, Argentina
| | - Javier Schulz
- Servicio de Neurocirugía, Hospital de Trauma y Emergencias Dr. Federico Abete, Malvinas Argentinas, Provincia de Buenos Aires, Argentina
| | - Leandro Carballo
- Servicio de Neurocirugía, Hospital de Trauma y Emergencias Dr. Federico Abete, Malvinas Argentinas, Provincia de Buenos Aires, Argentina
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Yildirim V, Pausch NC, Halama D, Lübbers HT, Yildirim A. Is radical surgery of an inverted papilloma of the maxillary sinus obsolete? a case report. J Med Case Rep 2016; 10:341. [PMID: 27906054 PMCID: PMC5134116 DOI: 10.1186/s13256-016-1114-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 10/23/2016] [Indexed: 11/18/2022] Open
Abstract
Background Sinonasal inverted papilloma is a locally aggressive tumor arising from the Schneiderian membrane which lines the nasal cavity and paranasal sinuses. Aggressive surgical approaches, such as lateral rhinotomy, were used until recently for complete removal of the inverted papilloma. Currently, endoscopic resection is the gold standard in the treatment of inverted papilloma. However, there are situations that justify an open approach. For example there are studies that report a higher postoperative recurrence rate after endonasal endoscopic resection, particularly in the treatment of recurrent diseases. While endoscopic resection performed by an experienced surgeon is definitely a minimally invasive therapy, an open approach is not necessarily associated with functional and aesthetic disadvantages. This case report describes the treatment of inverted papilloma by an open approach. This has been described before but the new gold standard of endoscopic resection has to be taken into account before any treatment decision is made nowadays. Case presentation Contrast-enhanced magnetic resonance imaging of the head and neck area was indicated in a 72-year-old white German man who presented with suspected squamous cell carcinoma of his lower lip. Magnetic resonance imaging additionally revealed a 3×2 cm2 polycyclic arranged mucosal thickening with cystic and solid contrast affine shares at the antral laterocaudal area of his right maxillary sinus, extending from his right lateral nasal wall to his maxillary sinus floor. He received antral polypectomy with medial maxillectomy via a unilateral LeFort I osteotomy approach. His pterygoid plate was preserved. A histological examination demonstrated a tumor composed of hyperplastic squamous epithelium protruding into the stroma (surface epithelial cells grew downward into the underlying supportive tissue), thus producing a grossly convoluted cerebriform appearance. Two weeks later, the patient regained a well-formed maxilla without any restrictions. He has remained disease-free for 25 months following the surgery and surveillance was continued in our tumor clinic. Conclusions Endoscopic resection of an inverted papilloma continues to be the gold standard. However, some cases require a radical approach. This does not necessarily increase patient morbidity.
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Affiliation(s)
- Vedat Yildirim
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, University Hospital of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Niels Christian Pausch
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, University Hospital of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Dirk Halama
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, University Hospital of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Heinz-Theo Lübbers
- Private Practice for Oral and Maxillofacial Surgery, Archstr. 12, 8400, Winterthur, Switzerland. .,Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Frauenklinikstr. 24, 8091, Zurich, Switzerland.
| | - Ayhan Yildirim
- Clinic for Cranio-Maxillofacial Surgery, University Hospital of Zurich, Frauenklinikstr. 24, 8091, Zurich, Switzerland
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Prasad H, Sruthi R, Anuthama K, Perumal M, Parthasarathy R. Inverted Sinonasal Papilloma Masquerading as a Malignancy - Report of an Unusual Case. Cureus 2016; 8:e526. [PMID: 27081587 PMCID: PMC4829412 DOI: 10.7759/cureus.526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Inverted sinonasal papilloma (ISP) is a benign epithelial neoplasm arising from the Schneiderian membrane. We report a case of ISP in a 50-year-old male that clinically presented as a polypoid mass in the nasal cavity. Imaging studies revealed it to be an aggressive lesion showing intracranial extension. On histopathological examination of the excised specimen, a diagnosis of ISP was arrived at. However, an extensive sampling of the tissue revealed no evidence of any malignant transformation. Taking into account the suggested viral aetiology for such lesions and the aggressiveness observed in this case, human papillomavirus (HPV) profiling was done but it turned out to be negative. Only one other case of inverted sinonasal papilloma arising from the nasal cavity and involving the brain has been reported in the literature to date. Considering the alarming clinical course in spite of its benign nature, it is important for the pathologist and surgeon to be well informed about this lesion.
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Affiliation(s)
- Harikrishnan Prasad
- Oral and Maxillofacial Pathology and Microbiology, KSR Institute of Dental Science and Research
| | | | | | - Mahendra Perumal
- Oral and Maxillofacial Surgery, KSR Institute of Dental Science and Research
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