Case Of Papilloma Research Articles

Endoscopic surgery for 89 cases of nasal inverted papilloma

To evaluate the effect of endoscopic surgery for nasal inverted papilloma. The clinical data of 89 patients treated with endoscopic surgery in our department from May 2003 to May 2008 were retrospectively analysed. The clinical classification was assessed by preoperative endoscopy and CT or MRI. All cases were routinely followed up from 1 to 5 years. The recurrence rates in group of endoscopic management and group of endoscopic plus Caldwell-Luc management were 12.5% and 11.8% respectively (chi(2) = 0.007, P > 0.05). The recurrence rates in group of grade I, grade II and group of grade III patients were 9.1% (5/55), 17.2% (5/29) and 20% (1/5) respectively (P > 0.05). The recurrence rate in the two times operation group (27.3%) was significantly higher than that in the one time group (7.5%, chi(2) = 4.311, P < 0.05). There were 70 lesions certified to be resected completely, six of these patients (8.6%) recurred. Nineteen lesions were certified to be resected uncompletely, five of these patients (26.3%) recurred. The difference was no significant (chi(2) = 2.860, P = 0.09). The endoscopic surgery in nasal inverted papillomas was an effective method with minimally invasiveness, but it still had a high recurrence. The pathological examine of surgical margin could partially judge the prognosis.

Genital Sanguineous Discharge in Prepuberty: A Case of Mullerian Papilloma of Vagina in a 9 Year-Old Girl

Vaginal bleeding in prepuberty is an alarming symptom that must be carefully investigated. Among quite common causes of genital sanguineous discharge, there are rarer conditions responsible for bleeding at this age like Mullerian papilloma of the genital tract. In this report, we describe a case of Mullerian papilloma of the vagina in a 9-year-old girl. We believe in the importance of a correct clinical setting and histological definition to avoid wrong diagnosis and consequent inadequate treatments. Mullerian papilloma, a benign tumor, can in fact be treated only with local excision.

A case of laryngeal papilloma treated by use of laryngeal microdebrider

A case of laryngeal papilloma treated by use of laryngeal microdebrider

Choroid Plexus Papilloma Originating in the Sella Turcica -Case Report-

A 51-year-old female presented with a rare case of choroid plexus papilloma originating in the sella turcica manifesting as headaches that was not readily distinguishable preoperatively from pituitary adenoma. Head magnetic resonance imaging revealed a tumor extending from the sella turcica to the suprasellar cistern. The tumor was removed via an endonasal transsphenoidal approach. Histological examination indicated a papillary structure covered with a layer of columnar epithelial cells that resembled normal choroid plexus. These findings, together with immunohistochemistry, led to a diagnosis of choroid plexus papilloma.

A Case of Bronchial Glandular Papilloma Preoperatively Diagnosed as a Lung Cancer by Biopsy

A Case of Bronchial Glandular Papilloma Preoperatively Diagnosed as a Lung Cancer by Biopsy

Choroid plexus tumors: An institutional series of 25 patients

Choroid plexus tumors (CPT) are rare neoplasms that pose considerable treatment challenges. This study reviews a single institute's experience with 25 patients of CPT and attempts to contribute to the general body of knowledge on CPT. A retrospective analysis of the case records of 25 patients operated for CPT since January 1998 and having a minimum of 1 year follow-up. The study group included 12 (48%) cases of choroid plexus papilloma (CPP), 09 (36%) cases of choroid plexus carcinoma (CPC) and 4 cases of atypical CPP. The mean age at presentation was 18.6 years (range, 6 months to 54 years; SD, 18.7) and a male preponderance was noted (17:8). Raised intracranial pressure was the commonest presenting symptom (72%). The tumors were distributed as follows: lateral ventricle (16; 64%), fourth ventricle (5; 20%), fourth ventricle with cerebellopontine angle extension (3; 12%), and third ventricle (1; 4%). A complete surgical excision was achieved in 11 cases of CPP and 8 cases of CPC. Operative complications include pneumocephalus (40%), focal deficits (36%), subdural effusion (32%), and persistent hydrocephalus requiring shunt (24%). All patients with CPP had a good outcome at the end of a mean follow-up of 5.4 years, whereas the median survival for patients with CPCs who underwent a subtotal resection with adjuvant therapy was 36 months. CPTs include a spectra ranging from CPP to CPC. Radiologic and histologic characterization of these tumors is difficult and newer immunohistochemical and genetic studies should be done to differentiate them from each other. Total excision offers a good prognosis and should be attempted for all forms of CPTs. CPPs carry a good prognosis, and adjuvant therapy is not indicated even after partial excision. CPCs and atypical CPCs carry a poor prognosis, and adjuvant therapy improves survival marginally after total excision. Spinal drop metastases are common for CPC and screening of the spine for possible metastasis should be part of the routine preoperative and postoperative investigation protocol.

Soft palate papilloma: A report of four cases with review of the literature

Papillomas appear as pedunculated or sessile, white or normal colored cauliflower-like projections that arise from the mucosal surface. The most common site is the palate/uvula area followed by the tongue and lips. Of all sites, the soft palate is the most common and accounted for 20% of the lesions. The etiology remains unknown. Viral origin has always been suspect but studies are still inconclusive. Conservative surgical excision is the treatment of choice with rare recurrence. There is no evidence that papillomas are premalignant. This is a report of four cases of soft palate papilloma in patients of different Asian nationalities. In conclusion soft palate papilloma is more common than it is thought to be.

Multiple intraductal papillomas of breast clinically masquerading as malignancy

Intraductal papilloma is characterized by proliferation of epithelial and myoepithelial cells overlying fibro-vascular stalks creating an arborescent structure within the lumen of duct. Some times multiple papillomas with florid proliferation of epithelium may be confused with malignancy. A case of multiple intraductal papillomas of breast with ulceration of overlying skin and large lump leading to clinical diagnosis of malignancy is documented here. A 45-year-old female presented with ulcerated mass of six months duration in the left breast. On examination, a firm, immobile lump of 8x 10 cm in size involving nipple with excoriation of surrounding skin and serosanguinous discharge from nipple was present. There was no axillary lymphadenopathy. No family history of carcinoma breast was present. Fine needle aspiration smears showed benign cellular changes with apocrine metaplasia. Biopsy from an area adjacent to nipple showed intraductal papilloma. Simple mastectomy showed lobulated dirty white mass with well circumscribed nodules below the nipple and areola. On histology with immunohistochemistry a diagnosis of multiple intraductal papillomas was made. Patient is on regular follow-up and doing well. The case highlights the problem in differentiating marked papillomatosis from a malignant lesion of breast and importance of biopsy with immunohistochemistry in such cases for proper management.

Consistent DNA Hypermethylation Patterns in Laryngeal Papillomas

INTRODUCTION: This study examined the contribution of promoter hypermethylation to the pathogenesis of respiratory papillomatosis (RP), including recurrences (RRP) and progression to squamous cell carcinoma (SSC). MATERIALS AND METHODS: A retrospective cohort of 25 laryngeal papilloma cases included 21 RRP, two of which progressed to SCC. Aberrant methylation status was determined using the multi-gene (22 tumor suppressor genes) methylation-specific multiplex ligation-dependent probe amplification assay and confirmed using methylation specific PCR. RESULTS: Twenty genes had altered DNA methylation in 22 of 25 cases. Aberrant methylation of CDKN2B and TIMP3 was most frequent. Promoter hypermethylation of BRCA2, APC, CDKN2A and CDKN2B was detected in 2 RRP cases with subsequent progression to SCC. Of the 25 cases, 22 were positive for HPV-6, 2 for HPV-11 and 1 for HPV-16 and 33. CONCLUSIONS: Consistent aberrant methylation of multiple tumor suppressor genes contributes to the pathogenesis of laryngeal papillomas. Persistent aberrant DNA methylation events in 2 RRP cases that progressed to cancer indicate an epigenetic monoclonal progression continuum to SCC.

Cystic choroid plexus papilloma in the cavum septum pellucidum

A choroid plexus papilloma is a rare CNS neoplasm arising from the neuroepithelial lining of the choroid plexus. A third ventricular location of a choroid plexus papilloma is rare compared with the more common sites in the lateral and fourth ventricles. Cystic choroid plexus papilloma represents an infrequent subtype that may present diagnostic ambiguity. The authors present a case of cystic choroid plexus papilloma within a cavum septum pellucidum that radiographically mimicked neurocysticercosis.

A rare case of oncocytic Schneiderian papilloma with intradural and intraorbital extension with notes of operative techniques

Epithelial cells of cylindrical cell papilloma are oncocytes, which arise from the sinonasal respiratory epithelium, hence the term Oncocytic Schneiderian papilloma.This is a rare and benign neoplasm of the nose and paranasal sinuses and it should be considered in the work-up of all unilateral nasal polypoid lesions. Clinically behaviour is comparable to inverted papillomas for local recurrence and malignancy coexistence. We report a case arisen from the nasoethmoidal space that extended to the anterior skull base through a bone dehiscence with intradural invasion and orbital space involvement. Surgical therapy is the treatment of choice, the endonasal endoscopic approach can be used in most of the cases and this surgical technique is safe and suitable also in presence of an extra nasal extension. We describe our experience for management of this kind of lesions and some notes on our operative technique.

Brodawczak odwrócony nosa i zatok przynosowych leczony endoskopowo w materiale Klinicznego Oddziału Otolaryngologicznego 4 Wojskowego Szpitala Klinicznego z Polikliniką we Wrocławiu w latach 2006–2008

The aim of presented work is analysis of the inverted papilloma cases treated by endoscopic surgery between years 2006 and 2008. Within this period there were 180 surgeries, out of which 11 patients were diagnosed with papilloma inversum in the histopatological test of irradiated tissue. Symptoms reported by the patients, tumor loci, scope of the surgery and its efficiency are described and analyzed. The arguments supporting endoscopic surgery as a treatment modality for inverted papilloma are presented.

Papilomas invertidos rinosinusales. Revisión de 61 casos

Introduction Inverted papillomas are benign sinonasal lesions that arise primarily from the lateral nasal wall which are characterized by their tendency to recur and propensity to be associated with malignancy. The aim of this work is to analyze our experience in the treatment of these lesions, especially through the endoscopic approach. Material and method We present 61 cases of sinonasal inverted papillomas that were treated at our hospital since 1983. The patients were studied by age, gender, site of presentation of the tumor, symptoms, radiologic studies, surgical treatment and evolution. The mean follow-up was 51 months (range 6–228 months). Results Thirty eight of the patients (62%) were males and 23 females (38%). The average age was 58 years (range 22–80). The most common symptom was unilateral nasal obstruction in 91% of the cases, followed by rhinorrhea in 46%. The most frequent location was the ethmoid region in 51% of cases, followed by the maxillary sinus in 28% and the lateral nasal wall in 21% of the cases. 78% of cases had associated sinusitis and the 43% polyposis. Tumours were classified with the Krouse staging system as follows: 35% stage I, 37% stage II, 18% stage III and 8% stage IV. 37% of the patients had bony erosion in the CT scan. Six of the 42 patients treated by endoscopic procedures presented recurrence (14%), compared with 6 of the 9 patients (67%) who were treated by open approaches. The average time to the recurrence was 41 months. 17% of the patients had malignant inverted papillomas, nine of them diagnosed from the beginning as malignant neoplasies and one which became malignant during follow up. Discussion and conclusions The endoscopic approach is the method of choice for the treatment of the majority of inverted papillomas. The close follow up of the patient for a large period of time is necessary for the early detection of recurrence and to allow for surgical salvage.

Papillomas of the External Ear Canal: Report of Ten cases in Chinese Patients with HPV In Situ Hybridization

Squamous papilloma is a benign exophytic proliferation which can occur occasionally in the external ear canal. It is widely assumed that the Human Papilloma Virus (HPV) is an etiologic factor of papillomas. Available techniques for detection of HPV genomes include immunohistochemistry, Southern blot hybridization, in situ hybridization (ISH), and polymerase chain reaction. To our knowledge, HPV typing has not been reported on tissue sections of papillomas in the external ear canal. We report HPV ISH analysis in ten cases of papillomas, involving the external ear canal in Chinese patients. These papilloma excrescences were less than 1 cm in diameter, and were benign morphologically. Automated HPV ISH analysis was performed for the hybridization of DNA probes, including both low-risk and high-risk HPV subtypes. HPV ISH results revealed that seven out of ten cases were positive for low-risk HPV (6, 11), three cases demonstrated no hybridization for low-risk HPV probe, and none of the cases revealed any detection of high-risk HPV (16, 18, 31, 33, 35, 39, 51, 52, 56, 58, and 66). On follow-up after 18-29 months (average 24.5 months), eight patients were doing well, with no local recurrence after excision. Two patients were lost to follow-up. Our results confirm that benign papillomas of the external ear canal are associated with low-risk HPV infection with benign behavior and neither recurrence nor high grade dysplasia.

Detection of human papillomavirus and adenovirus in benign and malignant lesions of the larynx

Objective To investigate the role of human papillomavirus (HPV) and adenovirus (AdV) infections in the oncogenesis of squamous cell carcinomas of the larynx and of laryngeal dysplasia. Study Design Cross-sectional study with planned data collection. Setting Department of Otorhinolaryngology G. Ferreri and Department of Experimental Medicine and Pathology-Section of Virology, Sapienza University of Rome. Subjects and Methods Biopsy samples were taken from 68 patients with benign and malignant lesions of the larynx. All tissue samples were analyzed by means of polymerase chain reaction with two groups of primers for HPV and with a pair of primers for AdV. Results All cases of carcinomas and dysplasia as well as all control cases were negative for both viruses. Four of the five cases of laryngeal papillomas were positive for only HPV, confirming the role of these viral types in the origin of papillomas. Conclusion The absence of viral genomes in laryngeal carcinomas as in the other cases studied suggests the existence of other factors that play a more important role than viral infection in the carcinogenesis of these lesions.

Primary Tracheal Tumors: Review of 37 Cases

Primary tracheal tumors are rare, and composed of various benign and malignant pathologies. Although nationwide epidemiologic studies were reported in western population, study about the oriental population is lacking. The aims of this study were to establish the clinical manifestations and treatment outcomes of primary tracheal tumors and explore the prognostic variables for malignant tracheal tumors. From January 1989 through December 2006, 37 patients (14 with benign tumors, 23 with malignant tumors) were treated in a tertiary referral center. Retrospective review of medical records was performed. Benign tumors comprised of various pathologies. Except the papilloma cases (n = 3), all of them were managed successfully without recurrence. Squamous cell carcinomas (n = 11) and adenoid cystic carcinomas (n = 9) comprised most of the malignant tumors. Clinical stage was a statistically significant prognostic variable (p = 0.016). Five-year overall survival rate was 41.1% for squamous cell carcinoma and 45.7% for adenoid cystic carcinoma and no statistically significant difference (p = 0.673) was observed. Papillomas were difficult to manage, however, other benign tumors were successfully treated. Among malignant tumors, surgery should be considered as the first choice of treatment, regardless of the histologic type, if the tumors are resectable.

Intraductal papilloma arising from sublingual minor salivary gland: Case report and immunohistochemical study

Intraductal papilloma is a rare benign salivary gland tumor. This lesion is commonly observed in the duct of the minor salivary gland, predominantly in lip and buccal mucosa, but the case in the sublingual region is quite rare. This report shows a first case of intraductal papilloma developed in minor salivary gland of sublingual region. A 47-year-old Japanese male was referred to our hospital with painless submucosal nodule in the right sublingual region beside Wharton's duct orifice. The excised specimen was histologically diagnosed as intraductal papilloma of minor salivary gland, according to the microscopic finding of the papillary growth of ductal epithelium into the ductal space with fibrovascular core. Immunohistochemical study showed the tumor cells originated from ductal luminal cells because of positive Cytokeratin 18 and 7 staining in both types of cells.

Excision is indicated for intraductal papilloma of the breast diagnosed on core needle biopsy

Although it has been accepted that intraductal papillomas with atypia or malignancy diagnosed on core needle biopsy require surgical excision, the management of pure intraductal papillomas has been controversial. Because some series reported a small but definite incidence of atypia or malignancy, whereas others claimed that radiologic follow-up was adequate, this study evaluated results of excision of all pure intraductal papillomas diagnosed on core needle biopsy at this institution. By using computerized pathology files from January of 2000 to December of 2004, 200 cases of intraductal papillomas on core needle biopsy were identified. Information regarding excision was available in 104 cases. All specimens were reviewed to confirm both the diagnoses as well as the presence of biopsy site changes in excision specimens, and the findings were correlated with radiologic data. The age of the patients ranged from 25 to 82 years (mean, 55.5). The diagnoses on excision were as follows: intraductal papillomas = 71 cases (68.3%), no residual intraductal papillomas = 16 (15.3%), atypical duct hyperplasia = 8 (7.7%), ductal carcinoma in situ = 6 (5.8%), and invasive carcinoma = 3 (2.9%). In cases with atypia or malignancy, these findings were adjacent to but not in the biopsy site. In cases with atypical duct hyperplasia or ductal carcinoma in situ, a spectrum of histologic changes ranging from florid to atypical duct hyperplasia (14 cases), to ductal carcinoma in situ (6 cases) were present, all involving intraductal papillomas. The upstage rate of pure intraductal papillomas on core needle biopsy to atypia or malignancy on excision was 16.4%. Because of sampling error and the close proximity of atypia or malignancy to the intraductal papillomas (suggesting precancerous potential), excision was recommended of these lesions diagnosed on core needle biopsy. Close radiologic-pathologic correlation was important in the evaluation of these lesions.

Laryngeal papillomas: classification and course

Seventy-one cases of laryngeal papillomas have been reviewed. Based on differences in age at presentation, female: male ratio and multiple versus solitary papillomas, the cases were classified into 4 groups: multiple juvenile papillomas, solitary juvenile papillomas, multiple and solitary adult papillomas. The clinical course in the groups is described. The authors do not support the common opinion that juvenile papillomas are influenced by puberty.

Intracystic papilloma of the breast forming a giant cyst

Intracystic tumors of the breast prove to benign more often than malignant, and most intracystic lesions are benign papillomas. Generally, the cyst with intracystic papilloma of the breast is small, and there are few cases of intracystic papilloma of the breast forming a giant cyst in the literature. We report the case had the intracystic papilloma of the breast with a giant cyst (diameter of 15.0 cm). Imaging examinations showed two intracystic components in the cyst, and suggested that they were malignancy. Cytological examinations revealed no malignant cell. In spite of many aspirations of the cyst fluid, the size was not changed finally. The surgical resection was performed, and histological examination revealed two intracystic papillomas. In review of the literatures, it is difficult to distinguish between intracystic papilloma and intracystic papillary carcinoma by imaging or cytologic examinations preoperatively. Surgery should be recommended to confirm diagnosis and treatment.