Inverted Papilloma: A Clinico-Pathological Dilemma with Special Reference to Recurrence and Malignant Transformation

Abstract

To study the clinicopathological profile, recurrence and malignant potential of the inverted papilloma of nose and paranasal sinuses in relation to the definitive diagnosis and the management undertaken. A total number of 52 cases of histologically proven inverted papilloma managed in our department of otolaryngology over a 10-year period (May 1998-April 2008) were followed up (until October 2009) and the results were analyzed retrospectively to find out any incidence of recurrence of these tumours. A total of 52 inverted papilloma cases were managed with different surgical interventions. Male:female ratio was found to be 10:1. The mean follow up period was 74 months (range 16 months-11 years). Recurrence was observed in 20 (38%) cases. 23% had recurrence without any specific histological pattern, 12% had recurrence with focal dysplasia and 4% had recurrence with malignant transformation into squamous cell carcinoma (SCC). Post-operative radiotherapy was given to 8% (four cases) with malignant transformation. The management of inverted papilloma depends on its size and extension. Recurrence can be minimized by an appropriate surgical planning. Careful endoscopic assessment is essential to detect early recurrence. Recurrent inverted papilloma should be treated more aggressively. Malignant transformation in inverted papilloma should be managed like any aggressive sino-nasal malignancy.

Sinonasal Inverted Papilloma and the Dilemma of Treatments

“…6 First the ability of the tumor to recur is highly variable and was reported to be 0 to 86% 1,5-7,10 even after free period up to 7 years 7 or more in some studies. 3 Second is its destructive expansion and third is the tendency for malignant transformation reaching to 21% mostly SCC. 1,5,7 The introduction of endoscopes and their wide use in nasal surgery has changed the view of management of inverted papilloma and their technological advancements, including improved optics, angled endoscopes and computer-aided navigation has led many surgeons practicing them nowadays instead of the traditional open technique.…”

“…This is related primarily to the poorly understood pathogenesis and aggressive clinical behavior of this lesion. 3 Inverted papilloma or Schneiderian papilloma inverted type is the most frequent variant, representing almost 70% of all sinonasal papillomas. 4 Inverted papillomas were first described in 1854 by Ward and Billroth and later characterized histologically by Ringertz in 1938.…”

Sinonasal Mass - A Diverse Clinicopathological Entity – An Experience in a Tertiary Care Centre in the North Eastern India

“…Saha et al found a recurrence rate of 38% of cases. 27 Barnes quotes a recurrence rate of 0-30% within 2-3 years following lateral rhinotomy and medial maxillectomy. 28 Few cases were lost to followup and as such the final outcome of all the cases in the study are not known.…”

Advances in recurrence and malignant transformation of sinonasal inverted papillomas

“…Currently, the majority of surgeons prefer endoscopic methods to traditional external approaches, due to similar success rates, less trauma and no facial scars. However, the common view is that SIP recurrence is due to inadequate removal during the first surgery (2)(3)(4). Therefore, preoperative evaluation as well as postoperative follow up is very important.…”