Tratamiento del papiloma oncocítico nasosinusal avanzado sin malignización asociada, con resección endoscópica y radioterapia en arcos de volumen modulado (RAVM). Reporte de un caso / Management of advanced sinonasal non-malignant oncocytic papilloma with endoscopic resection and volumetric modulated arc radiotherapy (VMAR). Case report / Gestão do Papiloma Oncocítico Nasossinusal avançado sem malignidade associada, com ressecção endoscópica e Radioterapia em Volume de Arcos de Modulado. Relato de caso

RESUMEN El papiloma oncocítico (PO) es una neoplasia rara de la cavidad nasal y los senos paranasales y es el subtipo histológico menos frecuente del papiloma rinosinusal. Al igual que el papiloma invertido (PI), se lo considera un tumor benigno, pero su comportamiento biológico no lo es tanto por su crecimiento local agresivo, su tasa alta de recurrencia y el riesgo de transformación maligna con asociación a carcinoma. El tratamiento de elección es la resección endoscópica. Se ha usado exitosamente la radioterapia para el tratamiento de los PI extensos, pero no se conocen informes documentados de su uso en pacientes con PO avanzado o con extensión extrasinusal y sin malignización asociada. Se presenta un caso de PO unilateral izquierdo con enfermedad extensa que comprometía la pared nasal lateral y los senos maxilar, etmoidal y frontal del mismo lado, tratado con radioterapia en arcos de volumen modulado.

SUMMARY Oncocytic papiloma (OP) is a rare neoplasm of the nasal cavity and paranasal sinuses. It is the least common histological subtype of sinonasal papilloma. OP is regarded as a benign tumor like inverted papilloma (IP), but its biological behavior is not so benign due to its aggressive local growth, the high rate of recurrences and the risk of malignant transformation with associated carcinoma. Endoscopic resection is the treatment of choice for OP. No relevant reports on the use of radiotherapy are known in patients with OP with advanced disease or extrasinonasal extension without associated malignancy, although its application in advanced IP has been successfull. We report a case of unilateral left OP with advanced disease that involved lateral nasal wall, maxillary, ethmoidal and frontal sinus on the same side, treated with volumetric modulated arc radiotherapy.

RESUMO O Papiloma Oncocítico (PO) é uma neoplasia rara da cavidade nasal e os Seios Parinasais menos comum e representa o subtipo histológicos menos frequente dos Papilomas Nasossinusais (PNS). Assim como o Papiloma Invertido (PI), o PO é considerado um tumor benigno, mas o seu comportamento biológico não é tão benigno devido a seu crescimento local agressivo, a sua elevada taxa de recorrência e o risco potencial de transformação maligna com carcinoma associado. A ressecção endoscópica é o tratamento de preferência do PO. Em pacientes com doença avançada ou extensão extrassinusal sem malignidade associada, não há relatórios relevantes do uso de radioterapia (RT), embora a sua aplicação no caso dos PI avançados, em que tem sido utilizado com sucesso. Um caso de PO unilateral é apresentado com doença extensa que comprometeu a parede lateral nasal e os seios maxilar, etmoidal e frontal do mesmo lado, que foi tratado com sucesso com cirurgia endoscópica e radioterapia em arco volumetricamente modulada (RAVM).

Papilomas rinosinusales en un centro de referencia otorrinolaringológico privado: revisión de 22 años de experiencia / Sinonasal papillomas in a private referral otorhinolaryngology centre: Review of 22 years experience

Objetivos: Evaluar la presentación clínica, los resultados al tratamiento y el seguimiento de los pacientes con papilomas rinosinusales (PRS), en un centro de atención terciaria otorrinolaringológica en Caracas (Venezuela). Material y métodos: Se realizó una revisión de 94 pacientes con PRS que fueron diagnosticados en nuestro centro otorrinolaringológico desde el 1de julio de 1993 hasta el 31 de junio de 2015. Se evaluaron los datos demográficos, las características clínicas, los hallazgos radiológicos, el origen anatómico, la extensión de la enfermedad hacia estructuras adyacentes, los procedimientos quirúrgicos realizados, la histopatología, el riesgo de recurrencia y la tasa de transformación maligna, y las terapias coadyuvantes. Resultados: Sesenta y cinco pacientes (69,1%) eran varones y 29 (30,9%) mujeres, con una edad promedio de 44,5 años (rango 9-80 años). Todos los pacientes fueron sometidos a cirugía endoscópica de senos paranasales. Los subtipos histológicos más comunes de PRS fueron el papiloma invertido (58 pacientes; 61,7%), el papiloma fungiforme o exofítico (35 pacientes; 37,2%) y el papiloma oncocítico (un paciente; 1,1%). El papiloma invertido se asoció en 2 pacientes con carcinoma indiferenciado de células escamosas. Doce pacientes (12,8%) presentaron enfermedad de extensión extrasinusal. Todos estos pacientes recibieron tratamiento adyuvante con técnicas avanzadas de radioterapia. El promedio de duración del seguimiento fue de 9 años y 2 meses. Dieciocho pacientes (19,1%) presentaron enfermedad recurrente durante todo ese periodo de seguimiento. Conclusiones: La resección endoscópica completa de los PRS es el tratamiento de elección. En lesiones menos accesibles endoscópicamente, con extensión periférica o tumores resecados de forma incompleta, las técnicas de radioterapia avanzadas como la radioterapia de intensidad modulada y la radioterapia en arcos de volumen modulado pueden estar indicadas con éxito. El control endoscópico postoperatorio oportuno con biopsias de lesiones sospechosas son importantes para la detección precoz de recidivas y malignización asociada (AU)

Objectives: To evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela). Material and methods: We reviewed 94 patients with SP that were treated at our otolaryngology center, from July 1st 1993 to June 31st 2015. The demographic data, clinical features, radiological findings, anatomical origin, disease extension into the adjacent structures, surgical approaches performed, histopathology outcomes, recurrent risk, malignant transformation rate and coadjuvant therapies were assessed. Results: Sixty-five patients (69.1%) were male and 29 (30.9%) female with an average age of 44.5 years (range 9-80 years). All patients underwent endoscopic sinus surgery. The most commont histologic subtypes of SP were inverted papilloma (58 patients; 61.7%), fungiform papilloma (35 patients; 37.2%) and oncocytic papilloma (one patient; 1.1%). SP was associated in 2 patients with undifferentiated squamous cell carcinoma. Twelve patients (12.8%) had disease with extension beyond the sinus without associated malignancy. All these patients received adjuvant treatment with advanced techniques of radiotherapy. The mean duration of the follow-up period was 9 years and 2 months. Eighteen patients (19.1%) had recurrent disease during the entire course of follow-up.Conclusions: Complete endoscopic surgical removal of SP is the treatment of choice. In less endoscopically accessible tumours, with peripheral extension or incompletely resected, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy may be indicated. Timely post-operative endoscopic follow-up with biopsy of suspected lesions is important for early detection of recurrences and associated malignancy (AU)

Sinonasal papillomas in a private referral otorhinolaryngology centre: Review of 22 years experience. / Papilomas rinosinusales en un centro de referencia otorrinolaringológico privado: revisión de 22 años de experiencia.

OBJECTIVES: To evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela). MATERIAL AND METHODS: We reviewed 94 patients with SP that were treated at our otolaryngology center, from July 1st 1993 to June 31st 2015. The demographic data, clinical features, radiological findings, anatomical origin, disease extension into the adjacent structures, surgical approaches performed, histopathology outcomes, recurrent risk, malignant transformation rate and coadjuvant therapies were assessed. RESULTS: Sixty-five patients (69.1%) were male and 29 (30.9%) female with an average age of 44.5 years (range 9-80 years). All patients underwent endoscopic sinus surgery. The most commont histologic subtypes of SP were inverted papilloma (58 patients; 61.7%), fungiform papilloma (35 patients; 37.2%) and oncocytic papilloma (one patient; 1.1%). SP was associated in 2 patients with undifferentiated squamous cell carcinoma. Twelve patients (12.8%) had disease with extension beyond the sinus without associated malignancy. All these patients received adjuvant treatment with advanced techniques of radiotherapy. The mean duration of the follow-up period was 9 years and 2 months. Eighteen patients (19.1%) had recurrent disease during the entire course of follow-up. CONCLUSIONS: Complete endoscopic surgical removal of SP is the treatment of choice. In less endoscopically accessible tumours, with peripheral extension or incompletely resected, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy may be indicated. Timely post-operative endoscopic follow-up with biopsy of suspected lesions is important for early detection of recurrences and associated malignancy.