Inverted papilloma is associated with greater radiographic inflammatory disease than other sinonasal malignancy

Abstract

Background The pathogenesis of inverted papilloma (IP) has not been fully elucidated. However, chronic paranasal sinus inflammation has been anecdotally observed in sites distant from tumor obstruction in IP patients, suggesting an association between inflammation and IP tumorigenesis. This study assesses the association between sinonasal inflammation found in IP and compares this to the level of inflammation observed in other sinonasal tumors. Methods A retrospective chart review was performed identifying patients with unilateral IP. Pertinent clinical data was obtained and comparative analysis of preoperative computed tomography (CT) imaging and histopathology was performed. A sample of unilateral, sinonasal, non‐IP and non–squamous cell tumors was used as the control. The Lund‐Mackay scoring system was used to assess radiologic sinonasal inflammation both ipsilateral and contralateral to the tumor. Results Seventy‐one patients were included; 58.9% of patients with IP had evidence of contralateral sinusitis at the time of presentation. In the control group, 26.7% had evidence of contralateral inflammation. When comparing contralateral sinus inflammation between the 2 study groups, the IP patients had significantly higher Lund‐Mackay scores than the control group (1.9 vs 0.26, p < 0.001). When comparing ipsilateral sinus inflammation, no significant difference was found in Lund‐Mackay scores (5.44 vs 4.00, p < 0.184). Conclusion In this study, unilateral IPs were associated with a higher level of contralateral sinonasal inflammation when compared to control. This suggests that IP may be associated with inflammation that is independent of obstruction by the tumor. Further studies are needed to better understand the temporal relationship between chronic inflammation and tumorigenesis.

Etiology of sinonasal inverted papilloma: An update

“…The data show an association between IPs and contralateral sinusitis (58.9% vs. 26.7%), 31 while case–control studies reveal that organic solvents may be risk factors in IP development (OR 2.11). 32 The evidence around industrial exposures is contradictory.…”

“…They cited the Orlandi study as a possible role of inflammation in the development of IP, but also emphasized there was limited evidence to support the theory. An updated, 2020 retrospective cohort study by Papagiannopoulous et al 31 replicated these results, comparing CT scans to determine contralateral sinus inflammation in patient with unilateral IP. They found that IP patients had a higher prevalence of contralateral sinusitis than the control group (58.9% vs. 26.7%) with higher Lund‐McKay scores in IP patients than controls (1.9 vs. 0.26).…”

Evaluation of paranasal sinus variations among patients with a diagnosis of sinonasal inverted papilloma

“…[20] Nazal mukozadaki bu neoplastik büyümeyi ve metaplaziyi açıklayacak sigara kullanımı, mesleksel ve endüstriyel maruziyetler, HPV, kronik enf lamasyon gibi çeşitli faktörler İP etiyolojisinde araştırılmıştır. [5,[21][22][23] Tüm bu etiyolojik faktörler her iki nazal kaviteyi aynı anda etkilemektedir. İnverted papillomun %96-98 oranlarında tek taraflı görüldüğü bilinmektedir.…”

Comprehensive Analysis of Sinonasal Inverted Papilloma Expression Profiles Identifies Long Non-Coding RNA AKTIP as a Potential Biomarker

“…Human papillomavirus (HPV) is considered to be closely related to the pathogenesis of SNIP. The other considered risk factors for SNIP development include inflammatory infiltration, welding fumes and organic solvents (Zydroń et al, 2018;Fulla et al, 2020;Papagiannopoulos et al, 2020). However, little is known about the underlying molecular genetic alterations, specific pathologic mechanism and diagnostic biomarkers of this clinical entity.…”