To assess the suggested etiological role of human papillomavirus (HPV), biopsies from 14 patients operated on for an inverted papilloma (11 cases) and squamous cell carcinoma (3 cases) of the nasal cavity and paranasal sinuses were analysed for light microscopical evidence of HPV, by indirect immunoperoxidase (IP-PAP) to demonstrate HPV structural proteins, and using in situ DNA-hybridization to disclose the DNA of HPV types 6, 11 and 16. The majority of the inverted papillomas contained areas of metaplastic squamous cells, including koilocytes as well as dysplastic changes consistent with intra-epithelial neoplasia as described in uterine cervix. In 3 patients, frankly invasive squamous cell carcinomas were found, originating from dysplastic squamous epithelium. Of the 14 lesions, 7 (50%) expressed HPV antigens, usually confined to only a few cells close to the surface of the epithelium. None of the malignant lesions expressed HPV antigens. In situ DNA-hybridization disclosed HPV 11 DNA alone in 5 lesions, but none of the lesions contained HPV 6 DNA. HPV 16 DNA was found in 2 lesions as a single HPV type, and in 3 other lesions concomitant with HPV 11. All three carcinomas contained HPV 16 DNA. The HPV DNA distribution proved to be different from that found in the genital tract HPV lesions; HPV DNA was less abundant in the nasal papillomas, and it was also found in the basal and suprabasal cells.(ABSTRACT TRUNCATED AT 250 WORDS)

The nuclear DNA content of 19 transitional papillomas of the sinonasal region and 9 maxillary squamous cell carcinomas was studied by flow cytometry; the presence of human papillomavirus (HPV) DNA types 11 and 16 was determined by the in situ hybridization technique from paraffin-embedded tissue. Thirteen (68%) of the papillomas and none of the carcinomas contained HPV genome. Six (32%) of the papillomas and 4 (44%) of the carcinomas had an aneuploid DNA content. The relative DNA content (DNA index) of the aneuploid maxillary carcinomas was larger than that of aneuploid papillomas (p = 0.004). Three of the papillomas underwent malignant transformation, all three of which contained HPV type 16 DNA; two were also aneuploid. Data indicate that papillomas containing HPV type 16 DNA have a tendency (p = 0.06) to undergo malignant transformation, and that this tendency is greater if DNA aneuploidy or HPV type 11 DNA is also present (p = 0.02).

Sex steroid hormone receptors (SSHR) were determined in 14 cases of sinonasal papillomas, 17 cases of nasal polyps and in the normal nasal mucosa of 13 patients. The determination of SSHR was done by the dextran-coated charcoal assay from cytosol protein. All the cases of sinonasal papilloma were SSHR negative, while some specimens of normal nasal mucosa contained small amounts of SSHR. In addition, some cases of nasal polyps were found to contain low concentrations of the receptors, but concentrations were lower than those found in normal mucosa. Although nasal papillomas are more common in men than in women, this study shows that SSHR do not play any role in the development of these tumors.

Transitional papilloma is a rare but not uncommon tumor with an overall incidence varying between 0.5 and 4 % of all primary nasal tumors. The probability of recurrence is high, between 20 and 62 %, even after adequate therapy. Malignancies are associated with transitional papilloma in 2–13% of cases. A series of 21 patients with transitional papilloma of the nose and/or paranasal sinuses is presented. Human papillomavirus (HPV) structural proteins and DNA types were found in 13 cases (62 %) of transitional papillomas studied. None of the 9 nasal polyps and none of the 9 squamous cell carcinomas of paranasal sinuses studied as control material contained HPV DNA. We found 4 recurrent papillomas (19 %) during the 2-year observation time. All recurrences were HPV-positive. The incidence of malignant transformation was 14 % in this series. Treatment of transitional papilloma is always surgical. In our opinion medial maxillectomy and ethmoidectomy via sublabial rhinotomy is the surgery of choice in the treatment of transitional papilloma.