Rate of recurrence and malignant transformation in 88 cases with inverted papilloma between 1998–2008

Abstract

Conclusions The recurrence rate of IP in the current study is comparable to international and national studies. When the primary tumour was located in the frontal or the sphenoid sinus, the tumour seemed more likely to recur. Some recurrences were more than 2 years after primary surgery, suggesting continued need for long-term follow-up. The rate of malignant transformation in inverted papilloma cases has not changed in Denmark. Objectives Inverted papillomas are benign tumours located in the nasal cavity and paranasal sinuses. They are known for their tendency to recur after surgery and show invasive growth, causing bone remodulation and the association with malignant transformation. The introduction of endoscopic sinus surgery and computer aided sinus surgery over the last decades has made this tumour more approachable with less cosmetic and functional damage. The objective of this study is to establish whether the recurrence rate and the rate of malignant transformation of IP have changed with the application of these new techniques. Method A retrospective study between 1998-2008 including 88 cases with inverted papilloma. Results In total, 25.3% had recurrence. Combined surgical approach with endoscope/open approach had the lowest rate of recurrence. A malignant transformation in the postoperative histological examination was found in 8.9%.

Morphologic, intraoperative, and histologic risk factors for sinonasal inverted papilloma recurrence

“…Although benign, IPs may be associated with epithelial atypia, dysplasia, carcinoma in situ, and invasive carcinoma . They have a 7% to 11% overall malignancy rate, which can be synchronous (discovered at the same time as primary IP but not necessarily in the same lesion) or metachronous (at a site of previous IP resection, indicating malignant transformation) …”

“…Sinonasal IP also has a high propensity for local recurrence, with cited rates of 14% to 33%, most of which are due to residual disease at the original resection site . Many risk factors for recurrence are reported; however, controversy remains regarding which is most clinically important .…”

A sinonasal inverted papilloma: an evaluation of 38 cases at a single center

“…Ortalama nüks oranı %25.3 olmakla birlikte, en yüksek nüks oranı (%50) non-endoskopik endonazal yaklaşım uygulanan olgularda görülürken en düşük nüks (%10) endoskopik ve açık cerrahinin kombine uygulandığı olgularda görülmektedir. [15] Hastalarımızın yedisinde (%18.4) nüks vardı. Bu hastalarda endoskopik sinüs cerrahisi ile eksizyon uygulanmıştı.…”

“…[16] Ayrıca frontal ve sfenoid sinüs yerleşimli tümörlerde nüks oranı-nın daha yüksek olduğu bildirilmiştir. [15] Bunun cerrahi tekniğin uygulama zorluğu nedeniyle olması muhtemeldir. Nüksü öngörmede patognomonik histolojik bulgu yoktur.…”

“…[6,17] İnverted papillomda kanser üç şekilde karşımıza çıkabilir: (i) papillom içerisinde invaziv tümör adası, (ii) papilloma ile aynı anda senkron karsinom bulunması ve (iii) inverted papilloma eksizyon yerinde metakron karsinom gelişmesi. [15] Literatürün gözden geçirildiği bir çalışmada malignite, olguların %7.1'inde senkron, %3.6'sında metakron olarak bildirilmiştir. [6] Malignite bizim hastalarımızın tamamında senkron Şekil 1.…”