Sinonasal inverted papilloma: rate of recurrence and malignant transformation in 44 operated patients / Papiloma invertido nasossinusal: taxa de recorrência e transformação maligna em 44 pacientes operados

Abstract Introduction: Although sinonasal inverted papillomas are benign lesions, they are locally aggressive and have a potential malignant transformation ranging from 5% to 15%, with a high recurrence rate. Objective: The aim of this article is to describe the rate of recurrence and malignant transformation in patients with a diagnosis of inverted papilloma who underwent surgery in a tertiary hospital in São Paulo. Methods: We performed a retrospective analysis of patients diagnosed with sinonasal papilloma who had undergone surgery in a tertiary hospital in São Paulo, between August 1998 and August 2017. A patient chart review was conducted to assess data of patients' demographics, tumors characteristics, follow-up appointments, recurrence and malignancy. Inverted papillomas were analyzed and classified under the Krouse staging system. Results: A total of 69 surgeries were performed in patients with diagnosis of sinonasal papilloma. Inverted papilloma was the most prevalent subtype (49 cases ‒ 80.33%), followed by exophytic papilloma (6 cases ‒ 9.84%) and by oncocytic papilloma (6 cases - 9.84%). The recurrence rate was 34.09% for inverted papilloma (15/44) and the mean time of recurrence was 24.6 months. Malignant transformation occurred in 6 patients (13.64%). Three of these patients presented carcinoma in the first surgery and three patients developed carcinoma during the follow-up. Conclusion: The high recurrence rate and malignancy potential allow us to consider inverted papillomas as aggressive tumors. In a tertiary hospital in São Paulo the recurrence rate the mean time to recurrence is 24.6 months. The recurrence after 10 years implies was 34.09% and the need for long-term follow up. It is possible that the high recurrence rate and the high malignant transformation rate we found are due to the large number of tumors discovered at an advanced stage (most of them staged T3 and T4), secondary to poor access to health system, in developing countries.

Resumo Introdução: Embora os papilomas invertidos nasossinusais sejam lesões benignas, eles são localmente agressivos e apresentam uma potencial transformação maligna que varia de 5% a 15%, com alta taxa de recorrência. Objetivo: Descrever a taxa de recorrência e transformação maligna em pacientes com diagnóstico de papiloma invertido submetidos à cirurgia em um hospital terciário em São Paulo. Método: Análise retrospectiva dos pacientes diagnosticados com papiloma nasossinusal submetidos a cirurgia em um hospital terciário em São Paulo, entre agosto de 1998 e agosto de 2017. Uma revisão de prontuários dos pacientes foi realizada para avaliar dados demográficos, características dos tumores, consultas de seguimento, recorrência e malignidade. Os papilomas invertidos foram analisados e classificados de acordo com o sistema de estadiamento de Krouse. Resultados: Foram realizadas 69 cirurgias em pacientes com diagnóstico de papiloma nasossinusal. O papiloma invertido foi o subtipo mais prevalente (49 casos - 80,33%), seguido pelo papiloma exofítico (6 casos - 9,84%) e pelo papiloma oncocítico (6 casos - 9,84%). A taxa de recidiva foi de 34,09% para o papiloma invertido (15/44) e o tempo médio de recorrência foi de 24,6 meses. Transformação maligna ocorreu em seis pacientes (13,64%); três desses pacientes apresentaram carcinoma na primeira cirurgia e três pacientes desenvolveram carcinoma durante o seguimento. Conclusão: A alta taxa de recorrência e o potencial de malignidade nos permitem considerar os papilomas invertidos como tumores agressivos. Em um hospital terciário de São Paulo, a taxa de recorrência foi de 34,09% e o tempo médio de recorrência de 24,6 meses. A recorrência após 10 anos implica na necessidade de acompanhamento a longo prazo. É possível que a alta taxa de recorrência e a alta taxa de transformação maligna que encontramos sejam devidas à grande extensão dos tumores (a maioria deles nos estágios T3 e T4), decorrente do acesso precário ao sistema de saúde nos países em desenvolvimento.

Chemosensory Dysfunction in COVID-19: Prevalences, Recovery Rates, and Clinical Associations on a Large Brazilian Sample.

OBJECTIVE: Our study aimed to measure the percentage of reported olfactory or taste losses and their severity, recovery time, and association with other features in a large cohort of patients with COVID-19. STUDY DESIGN: Prospective survey. SETTING: Quaternary medical center and online survey. METHODS: The perceived chemosensory capacities of 655 patients with confirmed COVID-19 were assessed with 11-point category rating scales (0, no function; 10, normal function). Patients were contacted in hospital, by phone calls, or by internet regarding their ability to smell or taste, and 143 were interviewed by phone 1 to 4 months later to assess the recovery of their chemosensory abilities. RESULTS: The prevalence of self-reported olfactory, general taste, and taste quality-specific disturbances (sweet, sour, bitter, and salty) in the patients with COVID-19 were 82.4% (95% CI, 79.5%-85.3%), 76.2% (95% CI, 72.9%-79.4%), and 52.2% (95% CI, 48.3%-56.1%), respectively. The majority reported anosmia (42.9%). The presence of chemosensory symptoms was not associated with COVID-19 severity. At a median time >2 months after the onset of symptoms, rates of total and partial olfaction recovery were 53.8% and 44.7%, while complete or partial return to previous taste function was 68.3% and 27.6%. Less than 5% of the patients reported no chemosensory function improvement at all. CONCLUSION: The prevalence of self-reported chemosensory dysfunction is high among patients with COVID-19. Almost all patients seem to recover a significant part of their smell and taste abilities in the first 4 months after the onset of symptoms.

Mucocele: Clinical Characteristics and Outcomes in 46 Operated Patients

Abstract Introduction Paranasal sinus mucocele is a benign, expansive lesion associated with paranasal sinus obstruction. It affectsmostly adults, and ismost common in the frontal and ethmoidal sinuses. Objective To evaluate outcomes in patients undergoing surgical treatment for paranasal sinus mucocele. Methods Retrospective review of medical records of patients treated for paranasal sinus mucocele at the ENT department of a tertiary care hospital between 2005 and 2016. Results Forty-six patients underwent surgical treatment of paranasal sinusmucocele. Themean age was 50.1 years, and 56.5% were male. The most prevalent symptom was pain, and the frontal sinus was most commonly affected. The vast majority of patients (89.1%) underwent endoscopic sinusmarsupialization; 10.9% required combined open and endoscopic access. Seven recurrences occurred. Conclusion Sinus mucocele is an expansive disease that primarily affects the frontal sinus of adult patients. In most cases, endoscopic surgery is an effective treatment modality. (AU)