Endoscopic approach of sinonasal inverted papilloma – our 15 years’ experience on 162 cases

Abstract

BACKGROUND. Inverted papilloma is a benign tumor of the nose and sinuses, with a high risk of recurrence and malignant degeneration. The inverted papilloma is a slow growing tumor that can be approached through an endoscopic or external approach, depending on its stage.OBJECTIVE. The aims of the study are to identify the particularities of diagnosis of the inverted papilloma, to establish the correct steps in surgical treatment of this tumor and to open the access for other steps of treatment.MATERIAL AND METHODS. The authors present their experience in managing the sinonasal inverted papilloma in a 15-year retrospective clinical study, which included 162 patients. The preoperative protocol consisted in clinical examination, nasal endoscopy, radiologic imaging (CT scan) and biopsy with histopathology results and immunohistochemistry findings. Surgical removal of the inverted papilloma was performed by endoscopic techniques, according to the stage of the tumor. We were interested in the recurrence rate of the tumor and its malignancy after a long-term follow-up.RESULTS. In our series, we included 162 patients and we had 26 (16.04%) recurrences and 12 (7.40%) malignant degenerations. All our patients were diagnosed in Krouse stages I, II and III and underwent endoscopic resection of the tumor.CONCLUSION. In order not to have any leftover tumor (the most important factor of recurrence and malignant transformation), it is mandatory to have a complete diagnosis of the inverted papilloma, a precise surgical technique and a rigorous followup. In some cases, the surgical treatment is associated with other type of treatment (antiviral, antiangiogenetic).

Orbital decompression for inverted papilloma – Case report

“…This case emphasizes the importance of HPV genotyping in the inverted papilloma diagnostic algorithm 9 . The question remains as to what is the next therapeutic attitude for an inverted papilloma with macroscopically complete resection, but with type 16 HPV determination.…”

Inverted Sinonasal Papilloma: Update and Literature Review

“…Inverted papilloma can arise from the entire Schneiderian membrane (as described above) and molecular genetics have confirmed that inverted papilloma is an actual neoplasm developing from a single progenitor cell [1,13]. However, the exact etiology still remains unclear [14]. Some investigators have associated the development of inverted sino-nasal papilloma with cigarette smoking, persistent chronic inflammation, Human Papilloma Virus (HPV) infection, Epstein-Barr virus (EBV) infection, occupational and environmental exposures, while some have associated it with mutations in cell cycle proteins and angiogenic factors [12,14].…”

“…However, the exact etiology still remains unclear [14]. Some investigators have associated the development of inverted sino-nasal papilloma with cigarette smoking, persistent chronic inflammation, Human Papilloma Virus (HPV) infection, Epstein-Barr virus (EBV) infection, occupational and environmental exposures, while some have associated it with mutations in cell cycle proteins and angiogenic factors [12,14]. A higher rate of recurrence and malignant transformation has been associated with the presence of some HPV DNA subtypes including; HPV 6, 11, 16, and 18 [15].…”