Sinonasal inverted papilloma associated with malignancy: the role of human papillomavirus infection and its implications for radiotherapy.

Sinonasal inverted papilloma (IP) is a benign but destructive tumor originating from the ciliated respiratory mucosa of the sinonasal tract. It can be associated with malignancy (squamous cell histology, in particular) and human papillomavirus infection has been investigated as a potential etiological factor linked to malignant alterations of IP. Surgery is the treatment of choice for IP, however, radiotherapy as an adjunct to surgery is indicated for IP with associated malignancy.

Inverted papilloma of the middle ear: a case report and review of the literature.

Papilloma of the middle ear is extremely rare; to our knowledge there have been only 9 reports (13 cases) in the literature. Aggressive surgical excision is the only curative treatment and radiation therapy is necessary if there is evidence of focal squamous cell carcinoma. We describe a case of a 65-year-old male with inverted papilloma of the middle ear. The tumor was surgically resected by radical tympanomastoidectomy, and we provided postoperative radiation therapy. There has been no evidence of recurrence to date. We discuss the clinical presentation, diagnosis, and treatment of this case and present a review of the literature.

[Sinonasal basaloid squamous cell carcinoma in biopsies of inverted papilloma]. / Das sinonasale basaloid-squamöse Karzinom in Biopsien eines invertierten Papilloms.

Basaloid squamous cell carcinoma (BSCC) is a rare tumor representing an aggressive variant of squamous cell carcinoma (SCC) and arising from a common precursor cell. BSCC rarely originates from the sinonasal tract. We report on an 83-year-old woman with BSCC after multiple resections of an inverted papilloma (IP) of the left sinonasal tract. The tumor filled the nasal cavity completely and was infiltrating the ipsilateral frontal skull base and periorbita. Because of the tumor's expansion, the patient's age, and comorbidity, surgery was not performed, but primary radiotherapy was initiated. A possible association between sinonasal BSCC and IP, as implicated by the current case, must be further investigated. In any case, IP requires consequent endoscopic and, if necessary, radiological follow-up in order to detect recurrent disease or malignant transformation.

Inverted papilloma involving the temporal bone and its association with squamous cell carcinoma: critical analysis of the literature.

Inverted papilloma is a rare, benign neoplasm, which usually originates from the lateral nasal wall and can be locally aggressive, extending into surrounding structures. Unusually, this disease involves temporal bone. There have been only 18 reported cases in the literature. The available data regarding inverted papilloma of the temporal bone are reviewed, and its etiopathogenesis, recurrence rate and association with squamous cell carcinoma are discussed.

Radiation therapy in inverted papillomas of the nasal cavity and paranasal sinuses.

PURPOSE: Between December 1969 and September 1989, a total of 10 patients with advanced and/or recurrent inverted or cylindrical cell papillomas were treated with irradiation at the University of Florida in Gainesville. MATERIALS AND METHODS: Nine of 10 patients had 1 or more recurrences before they received radiation therapy. Three patients were treated with irradiation alone, and 7 patients received surgery and irradiation (preoperatively in 1 patient and postoperatively in 6 patients). Eight patients had inverted papillomas (3 with concomitant squamous cell carcinoma), and 2 patients had cylindrical cell papillomas. RESULTS: Local recurrence developed in 4 patients at 1.5, 6.5, 12, and 13 years after treatment. No evidence of recurrence was observed in 6 patients at 7, 8.5, 8.5, 9, 9, and 20.5 years after treatment. Four patients died of intercurrent disease. No patient developed a malignant transformation. Significant complications of treatment included, in 1 patient, an area of bone exposure in the orbit that necessitated debridement. CONCLUSION: Surgery is the primary treatment of this entity. Radiation therapy should be considered in patients with incompletely resectable lesions, multiply recurrent tumors, and tumors associated with malignancy.

Degloving mediofacial: experiencia clínica / Mediofacial degloving: clinical experience

Se analiza nuestra experiencia desde el año 1992 a 1996, con esta versátil y útil vía de abordaje, publicada por primera vez por Casson en 1974, revisando las publicaciones más relevantes hasta la fecha. Esta cirugía se realizó en 11 pacientes con tumores benignos de cavidades perinasales y rinofarinx, siendo el papiloma invertido la lesión más frecuente. Otros diagnóstico fueron: angiofibroma del rinofarinx, hemangiopericitoma del rinofarinx, adenocarcinoma tubolopapilar maxiloetmoidal y melanoma maligno mucoso maxilar. Se analiza las indicaciones, detalles técnicos, ventajas, desventajas, complicaciones y alternativas para asociarlas a otras vías de abordaje. Finalmente se propone como una técnica fácial, rápida, con pocas complicaciones, que puede estar al alcance del otorrino general que conozca las técnicas de rinoplastía, microcirugía y/o endoscopía de cavidades perinasales

Intracranial inverting papilloma.

BACKGROUND: Inverting papillomas usually originate from the lateral wall of the nose and sporadically from the ethmoid, maxillary, sphenoid, or frontal sinuses. Intracranial extension and dural penetration is rare and often associated with recurrent disease that has degenerated into squamous cell carcinoma. A case of inverting papilloma with dural penetration in the absence of malignant degeneration has prompted an investigation into the incidence and treatment of dural invasion by benign inverting papilloma. METHODS: A literature search revealed 1468 cases of inverting papilloma. A detailed analysis was performed to obtain data on the incidence of intracranial invasion. RESULTS: Of the 1468 cases, 5 were noted to be associated with intracranial extension without histologic evidence of malignancy (0.34%). Treatment consisted of surgery alone in 3, radiotherapy in 1, and combined therapy in the last patient. Dural invasion was documented histopathologically in one case. CONCLUSION: Intracranial extension and dural penetration of benign inverting papilloma is extremely rare, and a uniform treatment plan has not been established. Further investigation is necessary in the pathophysiology and management of intracranial inverting papilloma.

The inverted Schneiderian papilloma: a 25-year study.

Inverted papillomas arising from the lateral nasal wall are controversial lesions which have been reported in the medical literature under a variety of titles. The designation "inverted Schneiderian papilloma" is recommended as an appropriate title to best convey the tumor's qualities of inversion, location, and distinctiveness of character. The etiology is uncertain. In the absence of a better explanation of its origin, the tumor should be considered a true epithelial neoplasm. Clinical features in 101 cases seen at the Geisinger Medical Center during the past 25 years are presented. The most frequent presenting complaint was nasal obstruction. The site of origin was the lateral nasal wall in the region of the middle meatus. The most characteristic attributes of the tumor were its tendency to recur, its destructive capacity, and its propensity to be associated with malignancy. To illustrate the pernicious nature of the lesion, a detailed description is given of the extent of bone erosion, the extraordinary sites of tumor extension, and the perioperative complications encountered. A philosophy of management has evolved based on the experiences gained from these 101 patients combined with a review of the experiences of others and study of the regional anatomy. A bold surgical approach is detailed using a lateral rhinotomy incision or a modified Weber-Ferguson incision to expose the tumor adequately and remove it completely. The recurrence rate using this approach was 2%. An associated malignancy was present in 8 patients. Four died of widespread metastases within a year of the diagnosis. The remaining 4 patients are long-term survivors free of disease.