Clinical evidence based review and systematic scientific review in the identification of malignant transformation of inverted papilloma

Abstract

Background: Inverted papilloma (IP) is an unusual type of benign tumor that has high recurrence rates and the potential to transform into squamous cell carcinomas (SCC). The mechanism of the transformation process from IP to IP-SCC is uncertain and there is no consensus regarding the best practice for IP-SCC detection. The goal of this study is to identify the best clinical methods to detect for IP-SCC. Methods: An evidence-based review was performed using Medline and Ovid to obtain all articles up to October 10th, 2019 pertaining to identification of IP malignant transformation. All manuscripts discussing clinical methods or biomarkers were included. Results: Based on clinical research studies, convoluted cerebriform pattern and apparent diffusion coefficient values on Magnetic Resonance Imaging (MRI) can help differentiate benign IP from SCC and increased SUVmax on PET/CT is associated with higher probability of malignancy although not as specific. No consensus about the best biomarker for IP-SCC has been reached among researchers and continues to be exploratory. Conclusion: Endoscopy with biopsy is the gold standard practice to identify IP-SCC; however, MRI is the preferred imaging modality to recognize malignant transformation in cases where biopsy is difficult. Multiple biomarkers have shown positive results, but no single indicator with clinical significance for monitoring malignant transformation process has been found.

Sinonasal Squamous Cell Carcinoma, a Narrative Reappraisal of the Current Evidence

“…SNSCC may occasionally arise from an inverted papilloma, posing an additional issue of differential diagnosis. In this respect, MRI plays a central role in differentiating benign inverted papillomas from SCC; convoluted cerebriform pattern and apparent diffusion coefficient (ADC) value [ 50 ], particularly when associated with increased maximum standardized uptake values (SUV) on 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT, are associated with higher probability of malignancy [ 51 , 52 ]. However, this result was not confirmed in other studies [ 53 , 54 ].…”

Bilateral Sinonasal Inverted Papilloma: Report of an Uncommon Case Involving Sinuses of the Face and Orbital Cavity

“…Orbital involvement occurs in about 9% of cases of advanced SIP [ 8 ]. However, there are no reports of cases of benign tumors that invaded the adjacent soft tissues [ 10 , 11 ].…”

“…In these areas, it is not feasible to use endoscopy alone [ 8 ]. Due to this limitation, many authors describe a combination of techniques as the better option for treatment [ 1 , 9 , 11 ].…”

“…Sinonasal inverted papilloma (SIP) usually affects men, with a male-to-female ratio of 4: 1, and normally occurs between the ages of 40 and 70 years; it is rarely observed during childhood and adolescence [ 9 – 11 ]. In descending order, the most commonly affected paranasal sinuses are the maxillary, ethmoidal, frontal, and sphenoidal; extension to the base of the skull is rare [ 12 , 13 ].…”

“…Clinically, the most common symptom that makes the patient seek medical treatment from an otolaryngologist is unilateral nasal obstruction [ 14 , 15 ]. Other frequently reported symptoms include epistaxis, rhinorrhoea, and epiphora [ 4 , 6 , 11 ]. Bilateral extension of the tumor is rare, and when it occurs, it is associated with destruction of the adjacent structures and a tendency for recurrence.…”