Inverted papilloma with multifocal attachment is associated with increased recurrence

Abstract

Background: Inverted papilloma (IP) is a benign sinonasal tumor with a well-known propensity to recur, especially at its bony a achment site. Anecdotal evidence suggests lower rate of recurrence in primary resection. We also aimed to evaluate the effect of multifocal vs single focus of a achment in disease control. Methods:This work is a retrospective review of 535 IP resections performed during the period from 2006 to 2016 at a tertiary-care center. Demographic data, tumor location and a achment sites, and follow-up duration data were obtained. Results:Two hundred ten patients were eligible for analysis. The mean age was 57 years, with an average postoperative surveillance of 36.4 months. Patients who had a previous procedure at an outside institution have a recurrence rate of 22.3%, compared with 12.4% for patients who had primary surgery at our institution. The most common site of a achment was maxillary sinus (47.6%), followed by ethmoid sinus (39%). Individual tumor review showed 50% of the patients to have multifocal a achment disease, of which there is a higher prevalence in secondary cases when compared with primary cases (53.7% vs 44.9%). Multiple tumor a achment sites had a significant effect on recurrence (odds ratio, 3.5; 95% confidence interval, 1.6-7.6; p = 0.002). Conclusion:Primary resection and single-focus a achment of inverted papilloma are associated with lower recurrence rates at 3-year follow-up. C 2019 ARS-AAOA, LLC. How to Cite thisArticle: Tong CCL, Patel NN, Maina IW, et al. Inverted papilloma with multifocal a achment is associated with increased recurrence. Int Forum Allergy Rhinol. 2019;9:865-869.S inonasal inverted papilloma (IP) is a benign tumor with a locally aggressive nature, a propensity to recur, and potential for malignant transformation to squamous cell carcinoma. Recurrence rates from the most recent metaanalysis reports 14-21% among all IPs, contingent on surgical approach. 1 Although the etiology of tumor remains

Imaging of sino-nasal inverted papilloma: How can we emphasize the usefulness of the “striated pattern” sign?

“…The literature included reported cases of multiple bony attachments with higher post-operative recurrences. However, our retrospective survey revealed only single attachments [31].…”

Targeted gene expression profiling of inverted papilloma and squamous cell carcinoma

“…The incidence of this tumor was low in our overall study cohort, and only five specimen blocks met the criteria for transcriptome analysis 26 . Also, an ideal study design would include patients with multiple recurrences and metachronous lesions, but our treatment approach has resulted in excellent recurrence‐free outcomes, and patients with malignancies most often presented with synchronous squamous cell carcinoma 27 . Lastly, the findings of a targeted transcriptome approach are recognizably narrow, but despite the methodological limitations, novel discoveries were made and more comprehensive and prospective genomic studies are underway.…”

Frequent Recurrence of Sinonasal Inverted Papilloma With Carcinoma In Situ in a Multifocal Attachment Pattern: A Case Report and Review of the Literature

“…5 Studies by Minni et al 6 showed that SIP recurrence could be affected by several risk factors, such as surgical approaches, incomplete surgical resection, tumor anatomic location, tumor staging, and malignant degree. A retrospective review by Tong et al 7 noted that SIP with multifocal attachment had a higher prevalence in secondary cases as compared with primary cases (53.7% vs 44.9%), which plays a significant role in tumor recurrence. The malignant transformation of SIP may occur synchronously with the first resection, or it may happen metachronously as the disease progresses.…”