Case Of Papilloma Research Articles

CD163 Immunohistochemical "Circle Sign" Staining Pattern Differentiates Sinonasal Papillomas From Morphologically Similar Non-neoplastic Lesions.

Sinonasal papillomas are a diverse group of benign epithelial neoplasms of the sinonasal tract. Inverted papilloma, in particular, must be distinguished from other lesions with no malignant potential. The aim of this study was to distinguish sinonasal papillomas from morphologically similar lesions using CD163 immunostaining. Cases from a 19-year period were identified. These included 49 inverted, 10 exophytic, and 12 oncocytic papillomas, 21 chronic sinusitides with squamous metaplasia, 27 inflammatory polyps, 5 verrucae vulgares, 5 respiratory epithelial adenomatoid hamartomas, and 6 DEK::AFF2 carcinomas of the sinonasal tract. A subset of biopsy cases (8 inverted papillomas, 5 inflammatory polyps) was separately analyzed. CD163 immunohistochemistry (IHC) was performed. A unique "circle" staining pattern was identified in the surface epithelium. After locating a hotspot, circles were quantified in 10 consecutive high-power fields. Circles were present in 66/71 (93%) cases of sinonasal papilloma, with a mean of 35 circles/10HPF (range: 0 to 160/10HPF) and a median of 19 circles/10HPF. Circles were present in 20/58 (34%) non-neoplastic cases, with a mean of 2 circles/10HPF (range: 0 to 27/10HPF) and a median of 0. Considering all resection and biopsy cases, performance for distinguishing papillomas from non-neoplastic lesions was best at a cutoff of 10 circles/10HPF (2-tailed P <0.0001) with sensitivity, specificity, positive predictive value, and negative predictive value of 66.2%, 93.1%, 92.1%, and 69.2%, respectively. The results were similar in the biopsy subset. One other neoplastic entity, the DEK::AFF2 carcinomas, also showed prominent CD163 circle staining. In summary, sinonasal papillomas demonstrate extensive CD163 "circle" staining in the epithelium compared with the non-neoplastic lesions studied. As such, the "circle sign" on CD163 IHC may be helpful in distinguishing between diagnoses, particularly on small biopsies or equivocal specimens.

Analysis of lesion location and disease characteristics of pharyngeal and laryngeal papilloma in adult.

Papilloma is a common benign epithelial tumor of the respiratory tract in adults. Its histological structure and immune environment vary from site to site. This study investigated the disease characteristics and prognostic differences of papillomas at various primary locations. Clinical data was collected from patients with adult glossal root and hypopharyngeal papilloma admitted to our tertiary referral center between January 2010 and December 2020, and compared with patients with laryngeal papilloma. Differences in age, sex, smoking, alcohol consumption, single or multiple lesions, surgical methods, immunohistochemical indexes, Ki-67 and p16, were analyzed in patients with different primary papilloma sites. A total of 84 cases of glossal root papilloma, 51 cases of hypopharyngeal papilloma, and 51 cases of laryngeal papilloma were included. Differential analysis between groups showed that there were statistically significant differences in age, sex, smoking, single and multiple lesions, and surgical methods in the different primary sites. Ki-67 expression in laryngeal papilloma was higher than that in glossal root and hypopharyngeal papilloma. There was no significant difference in p16 expression in the three groups. In terms of prognosis, laryngeal papilloma is more likely to relapse than glossal root or hypopharyngeal papilloma, and the recurrence time is shorter. As the largest clinical study of papilloma in different primary locations, this study found that the clinical characteristics and postoperative recurrence of papilloma of the glossal root and hypopharynx differ from those of papilloma of the larynx. This finding supports the current clinical experience in treating papillomas in different locations and facilitates the development of clinical treatment plans.

Detection of Human Papillomavirus in Squamous Lesions of the Conjunctiva Using RNA and DNA In-Situ Hybridization.

In-situ hybridization provides a convenient and reliable method to detect human papillomavirus (HPV) infection in formalin-fixed paraffin-embedded tissue. Cases of conjunctival papillomas, conjunctival intraepithelial neoplasia (CIN), conjunctival carcinoma in situ (cCIS), and invasive squamous cell carcinoma (SCC), in which low-risk (LR) and/or high-risk (HR) HPV types were evaluated by RNA or DNA in-situ hybridization, were retrospectively identified. LR HPV types were frequently detected in conjunctival papillomas (25/30, 83%), including 17/18 (94%) with RNA probes, compared to 8/12 (75%) with DNA probes. None of the CIN/cCIS or SCC cases were positive for LR HPV by either method. HR HPV was detected by RNA in-situ hybridization in 1/16 (6%) of CIN/cCIS cases and 2/4 (50%) of SCC cases, while DNA in-situ hybridization failed to detect HPV infection in any of the CIN/cCIS lesions. Reactive atypia and dysplasia observed in papillomas was generally associated with the detection of LR HPV types. Collectively, our findings indicate RNA in-situ hybridization may provide a high-sensitivity approach for identifying HPV infection in squamous lesions of the conjunctiva and facilitate the distinction between reactive atypia and true dysplasia. There was no clear association between HPV infection and atopy in papillomas or dysplastic lesions.

A rare case of tracheal papilloma mimicking foreign body obstruction

A rare case of tracheal papilloma mimicking foreign body obstruction

Esophageal Grape-Like Lesion in a 41-Year-Old Man With a History of Gastroesophageal Junction Adenocarcinoma

Question: This 41-year-old Asian man received laparoscopic proximal gastrectomy and distal esophagectomy in March 2020 to remove a gastroesophageal junction adenocarcinoma of stage pT2N1. Adjuvant chemotherapy with tegafur/gimeracil/oteracil (TS-1) was administered. Follow-up computer tomography revealed no evidence of recurrence in February 2022. He had no epigastric discomfort, odynophagia, or dysphagia. However, an esophagogastroduodenoscopy revealed a grape-like polypoid lesion measuring 1 cm in dimension near the anastomotic site (38 cm level) in June 2022 (Figure A, white light image; Figure B, narrow band image). An esophageal polypectomy was performed, and representative photomicrographs of histologic sections were shown (Figure C; H&E; 10x objective). What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Esophageal squamous papilloma is a benign lesion with prevalence ranging from 0.01–0.45%.1Mosca S. Manes G. Monaco R. et al.Squamous papilloma of the esophagus: long-term follow up.J Gastroenterol Hepatol. 2001; 16: 857-861Crossref PubMed Scopus (71) Google Scholar, 2Sablich R. Benedetti G. Bignucolo S. et al.Squamous cell papilloma of the esophagus. Report on 35 endoscopic cases.Endoscopy. 1988; 20: 5-7Crossref PubMed Scopus (34) Google Scholar, 3Talamini G. Capelli P. Zamboni G. et al.Alcohol, smoking and papillomavirus infection as risk factors for esophageal squamous-cell papilloma and esophageal squamous-cell carcinoma in Italy.Int J Cancer. 2000; 86: 874-878Crossref PubMed Scopus (72) Google Scholar It is usually found incidentally as an asymptomatic lesion characterized endoscopically by wart-like, polypoid growth with surface vessel crossing under narrow-band imaging.4Wong M.W. Bair M.J. Shih S.C. et al.Using typical endoscopic features to diagnose esophageal squamous papilloma.World J Gastroenterol. 2016; 22: 2349-2356Crossref PubMed Scopus (11) Google Scholar The lesion is usually solitary and small (2 mm–8 mm), but cases of widespread esophageal squamous papilloma have been reported.4Wong M.W. Bair M.J. Shih S.C. et al.Using typical endoscopic features to diagnose esophageal squamous papilloma.World J Gastroenterol. 2016; 22: 2349-2356Crossref PubMed Scopus (11) Google Scholar, 5Shimamoto Y. Shichijo S. Ishihara R. Sudden appearance of widespread esophageal squamous papilloma with reflux esophagitis.Clin Gastroenterol Hepatol. 2021; 19: e27Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 6Franzin G. Musola R. Zamboni G. et al.Squamous papillomas of the esophagus.Gastrointest Endosc. 1983; 29: 104-106Abstract Full Text PDF PubMed Scopus (32) Google Scholar It is usually found in the distal esophagus in Western countries but in the middle esophagus in Asian countries.4Wong M.W. Bair M.J. Shih S.C. et al.Using typical endoscopic features to diagnose esophageal squamous papilloma.World J Gastroenterol. 2016; 22: 2349-2356Crossref PubMed Scopus (11) Google Scholar,7Ekin N. Bestas R. Cetin A. Clinicopathological characteristics of patients with oesophageal squamous papilloma in Turkey and comparison with the literature data: the largest case series ever reported from Turkey.Int J Clin Pract. 2021; 75e14420Crossref Scopus (1) Google Scholar,8d'Huart M.C. Chevaux J.B. Bressenot A.M. et al.Prevalence of esophageal squamous papilloma (ESP) and associated cancer in northeastern France.Endosc Int Open. 2015; 3: E101-E106Crossref PubMed Google Scholar Histologically, it is characterized by papillary fronds composed of fibrovascular cores covered by nondysplastic squamous epithelium.9Odze R. Antonioli D. Shocket D. et al.Esophageal squamous papillomas. A clinicopathologic study of 38 lesions and analysis for human papillomavirus by the polymerase chain reaction.Am J Surg Pathol. 1993; 17: 803-812Crossref PubMed Scopus (94) Google Scholar Although the etiology of esophageal squamous papilloma is uncertain, mucosal irritation and human papillomavirus infection have been proposed.4Wong M.W. Bair M.J. Shih S.C. et al.Using typical endoscopic features to diagnose esophageal squamous papilloma.World J Gastroenterol. 2016; 22: 2349-2356Crossref PubMed Scopus (11) Google Scholar,9Odze R. Antonioli D. Shocket D. et al.Esophageal squamous papillomas. A clinicopathologic study of 38 lesions and analysis for human papillomavirus by the polymerase chain reaction.Am J Surg Pathol. 1993; 17: 803-812Crossref PubMed Scopus (94) Google Scholar Differential diagnosis from squamous cell carcinoma, especially verrucous carcinoma, is important. It is generally treated with endoscopic resection, and recurrence after complete resection is uncommon.10Abeid M. Labib S. Neizamy E. Esophageal squamous papilloma.Gastrointest Endosc. 2011; 73: 1035Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar

Molecular detection of Papillomavirus and immunohistochemical investigation of p53 gene expressions in bovine papillomas and fibropapillomas

Papilloma and fibropapilloma cases are quite common in cattle breeding, which cause economic losses due to decrease in the production of milk, meat, and also impair the quality of hide. In this study, we aimed to determine viral etiology and investigate p53 expression levels with immunohistochemical methods from a total of 30 cases. The study material was collected between 2013 and 2021 in Kars, Turkey. Paraffin embedded tissues were used for earlier cases in which the freshly specimens could not be provided. Cases were investigated for papillomavirus etiology with polymerase chain reaction (PCR) using FAP59/FAP64 and MY09/MY11 primer pairs. In 20 of the 30 cases papillomaviruses were identified, and 10 cases were identified as Bovine papillomavirus-1 (BPV-1), 1 case as BPV-2, 1 case as BPV-12, and 1 case as equus caballus papillomavirus 2 (EcPV-2) after sequence analysis. p53 immunostaining was also performed, and the cases were graded according to the positively stained cells. In conclusion BPV-12 was detected for the first time in our country, EcPV-2 was detected first time in cattle indicating cross species infection and p53 was staining most evident in BPV-1 and BPV-2 cases and BPV-12 and EcPV-2 was not stained.

Rare and unusual benign tumors of the sinonasal tract and pharynx: Case series and literature review.

There are a number of benign tumors of the nose and pharynx that are seldomly reported in literature but that can sometimes prove difficult to treat and extremely important for differential diagnosis. The present study presents cases of rare benign tumors localized in the pharynx, nasal and sinus cavities, as well as reviews of literature and historical references for each type of tumor. Unilateral nasal hemangioma in a 72-year-old male which, although not a rare pathology, raised problems due to auto-resection of the tumor. The surgeon was able to pull it out with ease without bleeding; it is possible that the mass would have eventually fallen out. Pilomatrixoma is a relatively uncommon ectodermal benign tumor of the skin derived from hair matrix cells. Surgical resection is curative but recurrence is possible (≤5% risk). The presented case is of a 26-year-old female with a pilomatrixoma of the left cheek who, for aesthetic reasons, refused a classical external surgical approach. Trans-oral resection was performed, which proved feasible but laborious and prone to recurrence. Inverted Schneiderian papilloma is a rare benign tumor of the nasal and sinus cavities with increased potential for invasion, recurrence and malignant transformation compared with other types of papilloma and other benign tumors of the area. The tumor represents 0.5-4.0% of all nasal tumors and has been described under different names, such as villiform cancer and cylindrical/transitional papilloma. The present study reports a rare case of bilateral papilloma in a 68-year-old male. He presented with bilateral evolving nasal obstruction and hyposmia. Following surgery, the patient was treated by a multidisciplinary team and followed by a respiratory rehabilitation program.

Intraductal papilloma of the sublingual gland imitating a ranula

Ductal papillomas are rare benign lesions of the salivary glands with two distinctive types, intraductal and inverted. The rarest anatomical location where intraductal papillomas occur is the major salivary glands. In the present study, we report an intraductal papilloma of the left sublingual gland with the relevant clinical, imaging, and histopathological findings and postoperative follow-up. To our knowledge, this is the fourth case of an intraductal papilloma of a sublingual gland to be reported in the international literature. We present this rare case because of its clinical and radiological imitation of a ranula.

Clinical Review of 61 Cases of Laryngeal Papilloma Treated Surgically in Our Hospital

Clinical Review of 61 Cases of Laryngeal Papilloma Treated Surgically in Our Hospital

Our Experience of Posterior Fossa Tumors Surgeries

Objective: In Neurosurgery Unit III, Punjab Institute of Neurosciences, Lahore, we evaluated our posterior fossa tumor surgery results, complications, and surgical outcomes.&#x0D; Materials and Methods: Between January 2017 and September 2021, 80 patients with posterior fossa tumors who underwent surgical excision at the Neurosurgery Department-III of the Punjab Institute of Neurosciences in Lahore were studied retrospectively. For each patient, the diagnosis was made clinically and confirmed radiologically and histopathologically.&#x0D; Results: Males comprised 47 percent (37) of the 80 cases, while females made up 53 percent (43). The average age was 15 (with a range of 6 – 30 years). Medulloblastomas were the most frequent pathology in 25 patients (31%), followed by ependymomas in 21 patients (26%), pilocytic astrocytomas in 19 patients (24%), and hemangioblastomas in 7 individuals (8.8%). There were four cases of metastatic brain cancers (5%), two cases of choroid plexus papilloma (2.5%), one case of ganglioglioma (1.3%), and one case of Dermoid cyst (1.3%). In 90 percent of the cases (72 cases), gross total resection was obtained, while subtotal excision was performed in 10% of the cases (8 cases). The best results were seen in pilocytic astrocytoma surgery, followed by ependymoma surgery, whereas the worst results were seen in medulloblastoma surgery.&#x0D; Conclusion: The surgical treatment of posterior fossa tumors still poses a significant challenge to neurosurgeons. Our experience shows that accepted results, complications, and surgical outcomes can be obtained by meticulous surgical techniques from previous clinical studies.

Radiographic\u2013histopathologic correlation case report of a benign intraductal papilloma upstaged to invasive lobular carcinoma

BackgroundIntraductal papilloma is a common breast lesion that may be associated with malignancy. While there is general agreement regarding surgical excision of intraductal papilloma with atypia, the management of benign intraductal papilloma is variable, involving either excision or observation. Of the small number of benign intraductal papillomas that upstage to malignancy on subsequent surgical excision, a significant number of these demonstrate malignancy in peripheral tissues adjacent to the biopsy site.Case presentationThis report serves to illustrate two cases of benign intraductal papilloma upstaging to invasive lobular carcinoma and ductal carcinoma in situ.ConclusionGiven the low rate of malignancy in benign intraductal papillomas, close surveillance may be recommended over surgical excision, however, generous sampling of the adjacent tissue about the target lesion should be considered.

Clinico-radiological diagnosis of silent Choroid plexus papilloma in a child

Background: Choroid plexus papillomas (CPPs) are benign slow-growing tumors with the most common site as the choroid plexus of the lateral ventricle in children. These are highly vascular solid tumors which have classical diagnosis in contrast-enhanced computerized tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI). These require early management because of their secondary symptoms related to hydrocephalus and others due to tumoral compression. Case Report: We present a 10-month-old male child with abnormal eye movements and fever following head trauma seventeen days before. Ultrasound of the brain revealed the hyperechoic mass in the right lateral ventricle. CECT and CEMRI diagnosed as a case of choroid plexus papilloma with gross hydrocephalus. This was a silent CPP which came to limelight following head trauma. Ventriculoperitoneal shunt was placed for the decompression of the ventricular system and was advised for subsequent surgical management. Conclusion: Atypical presentations of CPP can confuse in making the diagnosis and this delay can be harmful to the patient. Early diagnosis of CPP is very important as these are slow-growing tumors which can lead to various complications if late diagnosis is made. Cross-sectional modalities such as CECT and CEMRI are the most valuable diagnostic modality tools for the early diagnosis

Inverted Papilloma of the Middle Ear: Two New Cases and Systematic Review.

Inverted papillomas of the middle ear are extremely rare tumors that carry an increased risk of recurrence and malignant transformation. There are currently 59 cases of middle ear inverted papillomas reported in the literature. The objective in this study was to systematically evaluate outcomes regarding middle ear inverted papillomas with respect to demographics, anatomical tumor sites, malignant transformation status, recurrence rate and HPV status. Retrospective case series and systematic review. A systematic review was completed on June 25, 2020 with a search strategy including PubMed, Embase, Scopus and Google Scholar. This revealed 181 articles. Full-text review was completed, and 66 articles were included. 115 articles were eliminated due to duplication of articles from databases, article titles not applicable to the aims of the systematic review and articles describing inverted papilloma of body sites other than middle ear. Thirty-one cases of primary inverted papillomas of the middle ear were found in the literature with an additional 26 cases of secondary tumors. Four case reports did not specify primary versus secondary. The malignant transformation rate was 34.4% with a 53.6% recurrence rate. Treatment of middle ear inverted papillomas is primarily surgical with adjuvant radiation therapy considered for patients with recurrence or malignant transformation. Frequent clinical follow up of these patients is critical due to the increased rate of recurrence and malignant transformation. Inverted papillomas of the middle ear are rare tumors that carry a high risk of recurrence and malignant transformation necessitating complete resection and frequent clinical follow up.

Excision of squamous papilloma of the nasal vestibule with high-frequency electrosurgery

Benign nasal tumors represent an uncommon pathology with various histopathological types. Squamous papilloma of the nasal vestibule, also called verruca vulgaris, is a benign epithelial tumor, sessile or pedunculated, small in size, unique or comprising multiple lesions, which can present with intermittent epistaxis or nasal obstruction. We chose to explore a case of squamous papilloma of nasal vestibule excision using high-frequency electrosurgery. A 38-year-old woman presented with one-month history of intermittent right nasal bleeding. The anterior rhinoscopy and the endoscopic examination revealed an 1x0.5 cm sized, unique, sessile and irregular shaped mass in the right nasal vestibule. An excisional biopsy was performed under local anesthesia, using high-frequency electrosurgery. The follow-up period consisted of two years, without any recurrence.

Irisin Association with Ki-67, MCM3 and MT-I/II in Squamous Cell Carcinomas of the Larynx.

Background: Current studies indicate irisin role in carcinogenesis. The aim of the study was to investigate the expression of irisin in LSCCs and to determine its association with clinicopathological factors, as well as recognized markers of proliferation, i.e., Ki-67 and MCM3,5,7 and MT-I/II proteins. Material and methods: The research material consisted of 140 cases of LSCCs, 57 cases of laryngeal papillomas (BLs) and 14 controls (benign hypertrophic changes). Tissue microarrays were used to perform IHC. Western blot and immunofluorescence were performed in laryngeal cancer cell lines and normal keratinocytes. Results: Irisin expression levels were significantly increased in LSCC compared to BLs (p < 0.0001) and controls (p = 0.001). We noted a positive moderate and weak correlation between irisin and Ki-67, MCM3 and MT-I/II. We observed an elevated level of irisin expression with increasing tumor size (T1–2 vs. T3–4; p = 0.0348). The levels of irisin were higher in N0 than in N1 and N2–3 (p = 0.0031 and p = 0.0457, respectively). Our in vitro study revealed a higher level of irisin in Larynx Epidermoid Carcinoma 2 (HEp-2) cells compared to the control Normal Human Keratinocyte (HaCat) cell line. Conclusions: Increased irisin expression levels in LSCC and its correlation with clinicopathological and proliferation factors may indicate the potential role of irisin as a biomarker in the diagnostic process of LSCC.

95 Long-term dual antiplatelet therapy after myocardial infarction in clinical practice: impact of nuisance bleeding on medication adherence

Abstract Aims Long-term treatment with ticagrelor 60 mg and low-dose aspirin are indicated after acute coronary syndrome (ACS) for the secondary prevention of atherothrombotic events in high-risk patients with a history of myocardial infarction of at least 1 year. Long-term dual antiplatelet therapy (DAPT) had a well tolerability and safety profile, but the risk of TIMI major bleeding was significantly increased. However even nonsignificant bleeding may be important because have an effect on quality of life and therefore may lead to treatment discontinuation. To understand the experiences of patients with long-term DAPT with ticagrelor 60 mg and low-dose aspirin and nuisance bleeding, and their impact of nuisance bleeding on medication adherence. Methods and results We retrospectively reviewed aggregate data of 187 patients (155 M e 38 F) (mean age 63.8 ± 9 years) in follow-up after ACS with at least one high risk condition (multivessel disease, diabetes, GFR &amp;lt; 60 mL/min, history of prior myocardial infarction, age &amp;gt; 65 years) treated with ticagrelor 60 mg twice daily (after 90 mg twice daily for 12 months). The high risk groups were represented as follows: multivessel disease 105 pts (82%), diabetes 63 pts (33%), GFR&amp;lt; 60 mL/min 27 pts (14%), history of prior MI 33 pts (17%), and &amp;gt;65 year aged 85 pts (45%). The outpatient follow-up programme after hospitalization provides visits at day 30 after discharge and subsequently after 3 months, then continuing with 6-monthly checks. The intensity of bleeding was assessed according to the TIMI score.1 Any overt bleeding event that did not meet the criteria of major and minor was defined ‘minimal’. Treatment was withdrawn in seven patients: three cases showed atrial fibrillation and were placed on oral anticoagulant drugs, one developed intracranial bleeding. In three patients, a temporary withdrawal was due to surgery (one colon polyposis and two cases of bladder papilloma). Minimal bleedings (nasal, gingival, conjunctival, subcutaneous/dermal, rectal and urinary) were present in 31 patients, but were not a cause for discontinuation of therapy. However, 22 (70%) subjects had asked opinion on stop the therapy at the telephone consultation. We found that: (i) participants adhered to treatment when they believed long-term DAPT was important to health outcomes; (ii) those who experienced nuisance bleeding reported symptoms to be mild and manageable; (iii) participants’ and their family’s understanding of long-term DAPT risks and benefits, and their ability to manage symptoms, influenced medication adherence. Factors influencing long-term DAPT knowledge included access to medication counselling, engaging with information communicated during medication counselling, and access to timely, relevant and expert information and advice after discharge from hospital. Conclusions All adverse events judged to be ‘not serious’ in trials may have an effect on quality of life and therefore may lead to treatment discontinuation. The need to educate the patient in order to improve adherence should therefore be emphasized. The authors underline the importance of careful outpatient follow-up and constant counselling in order to check out compliance and possible adverse effect of long term DAPT risks treatment.

A case report of exophytic nasal papilloma with acute dacryocystitis as the first symptom

BackgroundThis study aims to explore a case of exophytic nasal papilloma with acute dacryocystitis as the first symptom.Case presentationA 72-year-old male patient complaining of “a 10-year history of tearing and purulent discharge from the right eye, with subsequent redness and pain in the inner canthus for three days” was initially diagnosed with acute dacryocystitis of the right eye. The patient was treated with anti-inflammatory therapy. However, the redness and swelling of the inner canthus continued to increase. An endoscopic dacryocystorhinostomy of the right eye was performed under general anesthesia. A large amount of purulent secretion was drained during the operation. As a result, the swelling of the inner canthus was significantly reduced. A routine intra-operative biopsy of the wall of the lacrimal sac revealed an exophytic nasal papilloma. A second biopsy, 1 week after the surgery, revealed the same result. The patient was advised to undergo a dacryocystectomy once the swelling had subsided. However, the patient was reluctant to undergo this surgery and remains under clinical observation.ConclusionIt is rare for an exophytic nasal papilloma, which is a benign tumor in the lacrimal sac, which has the potential for recurrence and malignant transformation, to manifest with acute dacryocystitis as the first symptom. Therefore, this case report could provide a reference for the future clinical diagnosis of this disease.

Oro- and Nasopharyngeal Papillomas with Squamous and Respiratory Features: A Case Series of Schneiderian-Like Papillomas of the Pharynx.

There is limited literature detailing the histology of pharyngeal papillomas. Herein, we report our experience with papillomas occurring in the oro-and nasopharynx that have both squamous and respiratory features akin to the sinonasal Schneiderian papilloma. We retrospectively reviewed pharyngeal papillomas that were composed of both squamous and respiratory epithelium received at our institution between 2010 and 2020. Cases of sinonasal papillomas directly extending into the pharynx were excluded. Immunohistochemistry for p16 as well as RNA in situ hybridization to evaluate for 6 low-risk and 18 high-risk HPV genotypes were performed on all cases. Thirteen cases were included. Mean age was 61 with 12 males and 1 female. While often incidentally found, presenting symptoms included globus sensation, hemoptysis, and hoarseness of voice. Histologically, all tumors consisted of squamous and respiratory epithelium with neutrophilic infiltrates arranged in an exophytic/papillary architecture that was reminiscent of the exophytic type of Schneiderian papilloma. Immunohistochemistry for p16 was negative in all papillomas. 85% were positive for low-risk human papillomavirus (HPV) subtypes and all were negative for high-risk HPV subtypes. A well-differentiated, invasive squamous cell carcinoma was associated with two of the cases. Papillomas with squamous and respiratory features similar to the sinonasal exophytic Schneiderian papilloma can arise in the oro- and nasopharynx and like their sinonasal counterparts show an association with HPV. While many in this series were benign, they can be harbingers for invasive squamous cell carcinoma.

Long term dual antiplatelet therapy after myocardial infarction: retrospective analysis in an outpatient population.

Long term treatment with ticagrelor 60 mg and low-dose aspirin are indicated after acute coronary syndrome (ACS). We retrospectively reviewed aggregate data of 187 patients (155 M and 38 F) (mean age 63.8±9 years) in follow up after ACS with at least one high risk condition (Multivessel disease, diabetes, GFR<60 mL/min, history of prior myocardial infarction, age >65 years) treated with ticagrelor 60 mg twice daily (after 90 mg twice daily for 12 months). The results were compared with findings (characteristics of the patients at baseline, outcomes, bleeding) of PEGASUS-TIMI 54 trial and Eu Label. The highrisk groups were represented as follows: multivessel disease 105 pts (82%), diabetes 63 pts (33%), GFR< 60 mL/min 27 pts (14%), history of prior MI 33 pts (17%), >65 year aged 85 pts (45%). Treatment was withdrawn in 7 patients: 3 cases showed atrial fibrillation and were placed on oral anticoagulant drugs, one developed intracranial bleeding, in three patients a temporary withdrawal was due to surgery (1 colon polyposis and 2 cases of bladder papilloma). Chest pain without myocardial infarction occurred in 16 patients (revascularization was required in 9 patients). Dyspnea was present in 15 patients, but was not a cause for discontinuation of therapy. Long term treatment with ticagrelor 60 mg twice daily plus aspirin 100 mg/day showed a favourable benefit/risk profile after ACS. In this study all patients had been given ticagrelor 90 mg twice daily for 12 months and the 60 mg twice daily dosage was started immediately thereafter, unlike PEGASUS-TIMI 54 trial in which it was prescribed within a period ranging from 1 day to 1 year after discontinuation of the 90 mg dose. This makes our results more consistent with current clinical practice. However, a careful outpatient follow-up and constant counseling are mandatory to check out compliance to therapy and adverse side effects.

Conjunctival Exophytic Schneiderian-type Papillomas: A Rare Occurrence.

Conjunctival papillomas are common tumors that exhibit an exophytic growth pattern, comprised of multiple filiform fronds of squamous epithelium that contain fibrovascular cores. The inverted (endophytic) variety of papilloma, often termed "Schneiderian," rarely occurs on the conjunctiva, with only 15 cases reported to date. Endophytic and exophytic papillomas are well described arising in the sinonasal Schneiderian epithelium where a low rate of malignant transformation may occur in the endophytic type; malignant transformation in exophytic sinonasal papillomas is exceedingly rare. The authors describe 2 cases of exophytic conjunctival papillomas with the morphology of a sinonasal or Schneiderian-type papilloma. Both were pink, sessile acquired growths in women in the sixth decade of life involving the inferior conjunctival fornix or nasal limbus. Nonkeratinizing squamous epithelium along with numerous goblet cells, intraepithelial mucinous cysts, and microabscesses were present. Immunohistochemistry showed reactivity for cytokeratin 7 and wild-type staining for p16 and p53, paralleling the findings in common conjunctival papillomas; both were also driven by low-risk human papillomavirus.