Case Of Papilloma Research Articles

Bilateral Inverted Papilloma of the Paranasal Sinus: Literature Review

ABSTRACT Objective We describe an unusual case of bilateral nasal inverted papilloma. Case report Inverted papilloma is a benign epithelial tumor that frequently occurs unilaterally. We report a 65-year-old male patient with a bilateral inverted papilloma located in the ethmoid and maxillary sinus. Functional endoscopic sinus surgery was performed in order to completely remove both tumors. Conclusion We present a rare entity of bilateral independent sinonasal papilloma treated successfully with endoscopic sinus approach.

Malignant sinonasal papilloma with neck metastasis: a rare report and literature review

Sinonasal papillomas are relatively rare, benign epithelial tumours of the nasal cavity. These lesions generate considerable interest because they are locally aggressive, have a tendency to recur and are associated with malignancy. The authors present a unique case of malignant sinonasal papilloma with neck metastasis. In the English literature only one case of such a presentation has been reported.

Clinicopathologic and immunohistochemical study of 187 cases of intraductal papillary neoplasm of breast

To evaluate the diagnostic approach and criteria for intraductal papillary neoplasms of breast. According to the criteria of 2003 WHO classification, 187 cases of intraductal papillary neoplasm of breast were identified and enrolled into the study. The clinical and histologic features were reviewed and immunohistochemical study for CD10, p63, CK14, CK5/6, CK7, MGB1 and p53 were carried out on 53 cases. Amongst the 187 cases studied, there were 128 cases of intraductal papilloma, 16 cases of atypical intraductal papilloma and 43 cases of intraductal papillary carcinoma. They showed a spectrum of morphologic features including epithelial and stromal hyperplasia and secondary changes. The expression of myoepithelial markers, including CD10 and p63, significantly decreased in ascending order from intraductal papillomas, atypical intraductal papillomas and intraductal papillary carcinomas (P < 0.001). The expression of basal cell markers, including CK5/6 and CK14, showed a mosaic pattern in benign lesions and significantly decreased or was absent in atypical and carcinomatous lesions (P < 0.001). In contrast, the luminal cell marker CK7 expressed in the three groups with no statistically significant difference (P = 0.06). On the other hand, the expression of MGB1 in intraductal papillary carcinomas was much lower than that in the other two groups (P = 0.002 and P = 0.007). The staining for p53 was negative in all of the three groups. Intraductal papillary neoplasms of breast represent a heterogeneous group of lesions with various morphologic appearances. Correlation with immunostaining results for myoepithelial markers, basal-type cytokeratins and luminal epithelial markers are helpful in arriving at a definitive diagnosis.

A case of choroid plexus papilloma with stromal sclerosis and indistinct papillary structures

We present a case of choroid plexus papilloma with unusual histopathological findings. A 41-year-old Japanese man presented with dizziness. Brain magnetic resonance imaging scan showed a distinct mass in the fourth ventricle. Histopathological examination showed proliferation of cuboidal cells forming irregular trabeculae, small nests, and pseudoglandular and indistinct papillary structures, accompanied by a variable degree of stromal sclerosis. The tissue sections also showed rare mitotic activity, no hypercellularity, cellular pleomorphism, or necrosis. The immunohistochemical findings were tumor cells positive for cytokeratin 7, vimentin, S-100 protein, and transthyretin but negative for cytokeratin 20, BerEP4 and carcinoembryonic antigen. These findings were consistent with choroid plexus papilloma. The combination of these immunohistochemical markers was helpful in establishing the diagnosis, although the morphological finding of stromal sclerosis is rare for choroid plexus papilloma.

Combined Staged Endoscopic and Microsurgical Approach of a Third Ventricular Choroid Plexus Papilloma in an Infant

Choroid plexus papillomas of the third ventricle in newborn infants are quite rare and present a significant surgical challenge. This case report illustrates the utility of endoscopy in facilitating tumor resection. A 6-week-old boy, born prematurely at a gestational age of 35 weeks, presented with hydrocephalus secondary to a choroid plexus papilloma in the third ventricle, extending to the aqueduct of Sylvius and into the fourth ventricle. On admission, he was found to have clinical signs of raised intracranial pressure. MRI revealed a homogeneously enhancing mass primarily in the third ventricle. The initial surgical procedure was insertion of a ventriculo-peritoneal shunt, followed by an endoscopic biopsy, which allowed the surgeons to mobilize the tumor into the right lateral ventricle. This facilitated a subsequent transcortical approach to completely remove the tumour. The authors present a case of choroid plexus papilloma in an uncommon location with a unique surgical approach and a successful outcome with no neurological deficits. We detail our surgical approach and the complexity of approaching a tumor located in the third ventricle of an infant.

Abstract A115: Natural history of HPV in cervical tumors: Identification of genotypes from formalin-fixed cervical tissues

Abstract Background: Since the identification of HPV as the necessary cause of cervical cancer, knowledge of its natural history for cervical infection; genotypes, load and form, is essential to prevent and predict cervical carcinoma. A cross sectional study was conducted to see the natural history and genotypes of HPV in cervical neoplastic lesions. Materials and Methods: Two diagnostic modalities, IHC and PCR, were performed on 102 diagnosed cases of cervical premalignant and malignant lesions (Cervical Neoplastic Lesions: CNL) and lesions by histopathology. Results: Out of the102 cases there were 12, 44,40 and 6 cases of Squamous cell Papilloma(SCP), Squamous Cell Dysplasia(CD), Squamous Cell Carcinoma(SCC) and Adenocarcinoma(ADC) respectively. There were 82 CNL, which showed positive HPV reaction on IHC while 88 CNL showed presence of HPV (56/88:64% HPV-18 and 32/88:36% HPV-18) on PCR. There was significant association between the presence of HPV and p53 mutation among different CNL. There was no statistical difference in lesions with respect to positivity of HPV and P53 suggesting that the expression of this suppressor gene was affected by the presence of the HPV genome, p-value&amp;gt;0.05.IHC scoring of CNL was not significantly affected with HPV infection (p-value&amp;gt;0.05). The overall sensitivity, Specificity and accuracy of IHC against PCR was 93%,70,89% merits and demerits of each modality has also been given in detailed. The major mode of infection of HPV-16 was host nuclear integration (p:0.000) with different variant with predominant E-350G genotype(p:0.000). High Viral load was seen in infected cervical tissues. Conclusion: HPV-18&amp;16 were detected;E-350 G genotype was most common form while predominant way of infection was host nuclear integration of HPV. The etiological involvement of HPV in the development of CNL was found because of high viral load and significant association with p53 protein expression with HPV infection. Citation Information: Cancer Prev Res 2011;4(10 Suppl):A115.

Benign Inverted Papilloma with Intracranial Extension: Prognostic Factors and Outcomes

We describe a case of benign inverted papilloma with intracranial extension treated with endoscopic resection combined with craniotomy. Intracranial involvement of inverted papilloma, in the absence of malignancy, is uncommon. We present an analysis of the literature identifying the characteristics and outcomes of benign intracranial inverted papilloma. PubMed database was searched using keywords intracranial, inverted or inverting, and papilloma. There are 17 reports of benign inverted papilloma with intracranial extension reported with a mean age of 49.2 years (range, 23 to 92 years), a female predominance, 22% of cases with an associated mucocele, and 60% recurrent disease. The most common sites of invasion are the frontal sinus or cribriform plate. The prognosis for benign intracranial inverted papilloma is dependent on the presence of dural invasion and the achievement of total resection. There are no reported recurrences after craniofacial resection with a mean follow-up of 7.9 years. Adjuvant radiation therapy has demonstrated benefit in cases of residual disease after resection. We expect that endoscopic resection, the standard treatment for sinonasal inverted papilloma, will be increasingly used in the presence of intracranial extension.

Clinicopathologic features of endolymphatic sac tumor at cerebellopontine angle

To study the clinicopathologic features and immunophenotype of endolymphatic sac tumor (ELST) and normal endolymphatic sac. The clinical and histologic features were evaluated in 5 cases of ELST. Eight cases of choroid plexus papilloma at cerebellopontine angle and 2 cases of normal endolymphatic sac were used as controls. Immunohistochemical study for vimentin, AE1/AE3, CK8/18, CK5/6, EMA, GFAP, synaptophysin, S-100 protein, CEA, TTF-1, VEGF, D2-40, calponin, calretinin and Ki-67 was carried out. The age of onset of ELST ranged from 23 to 35 years (median = 24 years). The male-to-female ratio was 2:3. The clinical presentation was tinnitus, otalgia, hearing loss, otorrhagia with effusion and headache. The duration of symptoms ranged from 6 months to 10 years. Local recurrences were noted in 3 cases. Radiologically, the tumors were located at cerebellopontine angle and demonstrated petrous bone destruction. Histologic examination showed that the tumors had a papillary-glandular pattern. The papillae were covered by a single layer of low cuboidal cells. The tumor cells had distinct cell borders and contained eosinophilic to clear cytoplasm. The nuclei were slightly atypical and sometimes apically located. Focal dilated glandular structures with colloid-like material were also identified. The surrounding stroma was vascularized. All of the 5 cases had dural or petrous bone infiltration. Immunohistochemical study showed that all of the 5 cases were positive for AE1/AE3, CK8/18, CK5/6 and VEGF, 4 cases for EMA, 3 cases for calponin (focal), 2 cases for vimentin, 2 cases for S-100 protein, 1 case for GFAP and 1 case for synaptophysin (focal and weak). The Ki-67 index measured less than 1%. The staining for D2-40, calretinin, CEA and TTF-1 was negative. The 2 cases of the normal endolymphatic sac were positive for AE1/AE3 and CK8/18, and negative for CK5/6, EMA, S-100 protein, GFAP and synaptophysin. The 8 cases of choroid plexus papilloma were positive for synaptophysin. Seven cases were also positive for S-100 protein, 2 cases for GFAP and 1 case for D2-40. All of the 8 cases were negative for EMA, CK5/6 and calponin. ELST is a rare slow-growing and potentially malignant tumor with a tendency of bone invasion and local recurrence. Distant metastasis is not observed. It must be distinguished from choroid plexus papilloma occurring at cerebellopontine angle. Correlation with clinical, radiologic and immunohistochemical findings would also be helpful.

Inverting Papilloma of the Temporal Bone

To review the literature on inverting papilloma of the middle ear and mastoid with a focus on familiarizing clinicians with its presentation and cause and to discuss its epidemiologic, diagnostic, and therapeutic issues. Search of the English literature for cases of inverted papilloma of temporal bone in conjunction with 1 new case presenting at the UCSD Medical Center. Academic, tertiary referral hospital. The patient underwent radical mastoidectomy with adjuvant therapy, revealing substantial tumor growth filling the external ear canal and middle ear space and obliterating much of the mastoid air cells. Histopathology confirmed inverted papilloma of the middle ear and mastoid. The patient underwent postoperative radiation and has been free of the disease at 6 months of follow-up. A total of 25 inverted papillomas of the temporal bone cases from the English literature between 1987 and 2010 were reviewed. This tumor commonly presents with hearing loss and otorrhea. Although rare, temporal inverted papillomas display a higher incidence of malignancy (40%) compared with sinonasal papillomas. Secondary and recurrent temporal disease was frequently associated with carcinomatous changes. Although recurrence rate is higher in temporal inverted papillomas than that in sinonasal disease, this difference becomes magnified in cases with more aggressive surgical approaches. We present a case of multicentric inverted papillomas in the middle ear and the sinonasal cavities. Efforts to define the cause of middle ear papilloma have been challenging because of its exceeding rarity. Although published literature shows that middle ear papillomas differ from their sinonasal counterparts pathologically and epidemiologically, these papillomas parallel in the unique characteristics of local aggressiveness, tendency to recur, association with malignancy, and multicentricity. Surgical resection with adjuvant radiation therapy and long-term follow-up with magnetic resonance imaging is advocated in the successful management of middle ear inverted papillomas.

Anterior segment OCT and histopathologic data in conjunctival, limbal and subconjunctival tumors

AbstractPurpose To show the use of anterior segment optical coherence tomography (AS‐OCT) in conjunctival, limbal, subconjunctival tumors and to compare the data with histopathologic specimens.Methods 15 patients (15 eyes) with conjunctival, limbal and subconjunctival lesions were examined using AS‐OCT (Visante OCT 2.0, Carl Zeiss Meditec, Dublin, CA). Eyes were scanned using Anterior Segment Single, High Resolution Corneal and Raw Image modes. Gray‐scale, OCT Color and Rainbow Color images were analyzed using built‐in software. All tumors were excised and histopathologicaly examined.Results In all small tumor cases AS‐OCT allowed to see the deeper lesion structure with complete penetration. In conjunctival melanoma, papilloma, subepithelial naevus and pterygia cases AS‐OCT showed tumor structure, layers and extension clearly. Underlying cornea was also visible. In larger and solid tumors (squamous cell carcinoma, fibroma and lipoma) anterior surfaces were hyper‐reflective, but the deeper structures of the lesions were incompletely penetrated. However, in all cases it was possible to differentiate cystic lesions from solid lesions. Histopathologic examination revealed the diagnosis and in small tumors confirmed the AS‐OCT data showing tumor epithelium and underling layers.Conclusion AS‐OCT may be a useful non‐invasive diagnostic tool for the evaluation of ocular surface tumors in selective cases. AS‐OCT may give useful information before planning the surgery.

Intraductal papillomas of the breast: Diagnosis and management of 151 patients

Introduction The assessment of papillary lesions continues to be a challenging area in breast radiology and pathology. The management of intraductal papillomas without atypia of the breast remains controversial. The purpose of the present study was to determine diagnostic accuracy of radiographical diagnosis, core biopsy, and surgical excision in papillary breast lesions. Material and methods By using files from 1995 to 2010, 151 cases of intraductal papilloma with or without atypia were identified. Patients were stratified as follows: core biopsy followed by surgical excision ( n = 61), core biopsy alone ( n = 19), and surgical excision alone ( n = 71). Results The upstage rate of intraductal papillomas without atypia on core biopsy to atypia or malignancy on excision was 8.9%. Excision specimens revealed intraductal papillomas without atypia in 68 out of 71 cases, and atypical papillomas in 3 cases. Conclusion Our findings suggest that radiographic and histopathological diagnosis of intraductal papillomas show high accuracy and good concordance. In cases where the radiographic diagnosis reveals suspicious lesions core biopsy represents the first choice.

Sinonasal inverted papilloma: 84 patients treated by endoscopy and proposal for a new classification

To suggest a new classification system for sinonasal papilloma based on a critical analysis of surgical indications and results obtained. We analysed surgical data from 84 cases of sinonasal papilloma treated endoscopically. In 58 males and 26 females, between 25 and 85 years, the ethmoid sinus (63 cases), the maxillary sinus (43), and the nasal fossa (22) were mostly involved. No case of endocranial extension or carcinoma was reported. Complications were reported in 15.4% of patients, as well as 5 recurrences (5.9%). Median follow up was 39,5 months. To categorise the tumour for the most appropriate surgical treatment, we propose a classification based on 6 main categories that depend on the location, origin and extension of the tumour. The classification that we propose presents advantages for prognosis and surgical indication in comparison with other classifications.

Coblation treatment for laryngeal papilloma in adult

To evaluate the effect and feasibility of coblation treatment for laryngeal papilloma in adult. A total of 18 patients with laryngeal papilloma treated by coblation from April 2008 to June 2010 was retrospectively analysed. There were 4 cases of multiple laryngeal papilloma and 14 cases of single laryngeal papilloma. All of these patients were treated with CoblatorTM Reflex #7070 under general anesthesia without tracheotomy. The volumes of blood loss during surgery varied from 1 ml to 10 ml, 2 ml on average. There was no postoperative bleeding or other complications. Follow-ups ranged from 6 months to 33 months after surgery, median 18 months. Recurrence occurred 4 months and 8 months after surgery in two patients. They were treated with coblation for the second time and followed up for 4 months and 12 months respectively. Recurrence occurred again in one patient. Coblation under suspension laryngoscope for laryngeal papilloma in adult was an ideal way due to less bleeding and less damage.

Mixed squamous cell and glandular papilloma of the lung: A case study and literature review

Mixed squamous cell and glandular papilloma (mixed papilloma) of the lung is an extremely rare neoplasm, with only 10 cases reported so far in the English literature. We present a case study of endobronchial mixed papilloma with immunohistochemical and etiological investigations. A 49-year-old male with a smoking history complained of hemoptysis, presented with a lung mass closely adjacent to large vessels in the computed tomography findings, and underwent lobectomy. The 3.0-cm sized polypoid tumor was histologically diagnosed as endobronchial mixed papilloma. Immunohistochemically, intracellular mucin was positive for MUC5AC, which is expressed in tracheobronchial goblet cells. CAM5.2 and CK19 were diffusely positive, indicating that the tumor originated from the columnar epithelium by squamous metaplasia. CEA and CA19-9 were focally positive. A human papillomavirus (HPV) investigation with in situ hybridization using a wide spectrum probe and a newly-developed PCR system did not detect any HPV infection. Including this case with a detailed HPV investigation, all of the reported cases of mixed papilloma were HPV-negative, and a literature review including newly-reported cases indicated a high frequency of smoking in such cases. Endobronchial mixed papillomas might have a smoking-related etiology.

Inverted Papilloma with Intracranial Extension

Background: Inverted papilloma is a benign yet locally aggressive neoplasm of the paranasal sinuses with a propensity for recurrence and potential for malignant transformation. Inverted papilloma with intracranial extension represents a rare clinical presentation of this tumor. Here we describe a case of nonrecurrent inverted papilloma with intracranial extension and present a comprehensive review and analysis of cases published in the literature identifying the characteristics of intracranial disease and the efficacy of surgical and adjuvant treatment.

A Case of Multiple Squamous Cell Papillomas of the Trachea

We report a case of 68-year-old woman suffering from breathlessness on exertion with stridor. A chest computed tomography showed a tumor arising from the posterior wall of the trachea. The diagnosis was squamous cell papilloma of the surgically removed tumor, which had caused the asphyxiation. After removal of the tumor, the patient received radical therapy: semiconductor laser transpiration. Polymerase chain reaction (PCR) detected human papilloma virus (HPV) type 6, thought to be the cause of the respiratory papilloma.

Clinical study of 62 surgical cases of sinonasal papillomas

今回われわれは2000年から10年間に当科で入院，手術を行った鼻副鼻腔乳頭腫62 例について検討を行った。年齢は平均56歳，男性47人，女性15人，主訴は一側性の鼻閉，発症部位は上顎洞内側壁，病理組織診断はinverted papillomaが最も多かった。Krouseの分類ではT1 4例，T2 27例，T3 28例，T4 3例であった。治療は全例手術（Denker 29例，ESS 34例（うちEMM 6例））を施行した。再発は11例にみられた。鼻副鼻腔乳頭腫は完全摘出が必要な腫瘍だが，その手術方法は，近年内視鏡手術を中心とした低侵襲な手術法が選択されるようになってきている。しかし再発する例もみられ，適切な手術法の選択と術後の厳重な経過観察が必要と考えられた。

Synchronous Choroid Plexus Papilloma of the Fourth Ventricle and Ependymoma of the Filum Terminale: Case Report

We report the first case of synchronous choroid plexus papilloma of the fourth ventricle and myxopapillary ependymoma of the filum terminale. Both are papillary World Health Organization grade I tumors known to disseminate via cerebrospinal fluid pathways. A 65-year-old man presented with an incidental mass in the fourth ventricle found on a computed tomography scan of the head after a motor vehicle collision and an intradural mass of the filum terminale. The patient underwent resection of the fourth ventricle mass. After pathological diagnosis of a choroid plexus papilloma, the patient underwent resection of the spinal cord tumor. This case underscores the need for separate pathological diagnosis in a patient with an intradural spine lesion in the context of a benign intracranial lesion. We detail a panel of immunohistochemical markers essential for distinguishing the 2 papillary neuroectodermal tumors recovered in this case.

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

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 74months (range 16months-11years). 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.

Primary temporal inverted papilloma with premalignant change

To explore the pathology, diagnosis, therapeutic strategies and prognosis of primary temporal inverted papilloma. We present one of the first reported cases of primary temporal inverted papilloma with premalignant change. The available data are reviewed. To the best of our knowledge, only 10 evaluable cases of this tumour have been reported. The recurrence rate is higher for this tumour than for sinonasal inverted papilloma. Primary temporal inverted papilloma is extremely rare, and its diagnosis should be made only following clinical exclusion of sinonasal papilloma. Therapy mainly comprises radical resection of the lesion, and long-term post-operative follow up is mandatory.