Cylindrical Cell Papilloma Research Articles

Exophytic Papilloma

Schneiderian papillomas are papillomas arising in the sinonasal tract, which is lined with Schneiderian epithelium, ectodermally derived respiratory mucosa [1,2]. This distinctive epithelium can give rise to three histologically unique types of papillomas: exophytic (fungiform, septal, and squamous), inverted (inverting), and oncocytic (cylindrical cell and columnar) papillomas. Exophytic papillomas almost exclusively arise from the nasal septum with rare cases arising from the vestibule or middle turbinate. In this paper a case of Exophytic papilloma in 52 year old male is presented.

Detection of human papillomavirus in sinonasal papillomas: Systematic review and meta‐analysis

To perform a systematic review and formal meta-analysis of the literature reporting on HPV detection in sinonasal papillomas. Since first reported in 1983, the etiological role for human papillomavirus (HPV) in sinonasal papillomas has been subject to increasing interest. A systematic review, with meta-analysis and formal meta-regression. Literature was searched through April 2012. The effect size was calculated as event rates (95% confidence interval [CI]), with homogeneity testing using Cochran's Q and I(2) statistics. Meta-regression was used to test the impact of study-level covariates (HPV detection method, geographic origin, papilloma type) on effect size, and potential publication bias was estimated using funnel plot symmetry. Seventy-six studies were eligible covering 1,956 sinonasal papillomas from different geographic regions. Altogether, 760 (38.8%) cases tested HPV-positive; effect size 0.421 (95% CI 0.359-0.485, random effects model). The summary HPV prevalence was highest (65.3%) in exophytic papillomas (EP), followed by inverted papillomas (37.8%) and cylindrical cell papillomas (22.5%). In meta-analysis stratified by 1) HPV detection technique, 2) geographic study origin, and 3) papilloma type, the between-study heterogeneity was significant only for the papilloma types (P = .001). In meta-regression, HPV detection method (P = .102), geographic origin (P = .149), or histological type (P = .240) were not significant study-level covariates. Some evidence for publication bias was found only for studies on EP. In sensitivity analysis, all meta-analytic results were robust to all one-by-one study removals. Variability in HPV detection rates in sinonasal papillomas is explained by their histological types (not by HPV detection method or geographic origin of study), but none of the three were significant study-level covariates in formal meta-regression.

Cylindrical Cell Papilloma (Oncocytic Schneiderian Papilloma): Clinicopathological Study of Five Cases.

To study the clinicopathological findings of cylindrical cell papilloma (oncocytic schneiderian papilloma) diagnosed among patients at Bahrain Defense Force Hospital with review of literature. All cases of cylindrical cell papilloma were retrieved from the pathology register from 2006-2010. The medical records of the cases were studied for age, sex, clinical presentation, and imaging reports along with the histopathological findings. Five cases were found and showed male to female ratio 4:1. Their ages were between 36-71 years with average age of 55 years. The main symptom found was unilateral nasal obstruction mainly involving the left side. All papillomas were removed by endoscopic sinus surgery. Four patients had regular followup with complete recovery, while only one case was lost for followup. Cylindrical cell papilloma is a variant of sinonasal schneiderian papilloma. Although most are benign complete excision is the treatment of choice to prevent tumour recurrence as a proportion exhibit unpredictable biological behavior. This study is an important reminder for both clinicians and pathologists to recognize this tumor and to differentiate it from other tumours and rhinosporidiosis. Regular followup is an important strategy for complete recovery and tumour-free surveillance.

Nasopharyngeal cylindrical cell papilloma

Cylindrical cell papillomas are rare tumours which usually arise in the sinonasal region. We report a case of a nasopharyngeal cylindrical cell papilloma in a 56-year-old man who presented with a four-month history of right-sided hearing loss, otalgia, vertigo and tinnitus. Investigation revealed a soft, nodular lesion obstructing the pharyngeal opening of the right eustachian tube; this was treated by wide endoscopic excision. Cylindrical cell papilloma is a possible cause of eustachian tube obstruction in adults. Effective treatment of these lesions usually requires wide endoscopic excision, in order not to miss coexistent carcinoma.

Hamartomas, papillomas and adenocarcinomas of the sinonasal tract and nasopharynx

Lesions of the sinonasal tract are uncommon, with most of the specimens seen by surgical pathologists consisting primarily of fragments of inflamed sinonasal mucosa or inflammatory polyps from patients with...

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.

Cell proliferation and p27Kip1 expression in endophytic schneiderian papillomas.

To clarify epithelial cell proliferation and p27Kip1 expression along the stepwise histological changes from endophytic schneiderian papillomas to associated carcinomas. Retrospective investigation involved surgical specimens from 58 patients. Immunohistochemical assessment involved the nuclear Ki67 antigen expressed in proliferating cells. Further, the cyclin-dependent kinase (cdk) inhibitor p27Kip1 was assessed. Binding of p27Kip1 to the cyclin E-cdk2 complex inhibits this kinase, which results in cell cycle arrest. The expression rates of both proteins were compared between nonpapillomatous nasal mucosa, endophytic schneiderian papillomas, carcinoma in situ, and invasive squamous cell carcinomas. Statistics involved the Wilcoxon and Mann-Whitney u tests. Significance was set at P <.05. Comparable cell proliferation rates were observed between non-papillomatous nasal mucosa and cylindrical cell papillomas. Significant increases in cell proliferation were found along the stepwise series of histological changes involving non-papillomatous nasal mucosa, columnar epithelium in inverted papillomas, transitional and squamous metaplasia in inverted papillomas, and dysplastic inverted papillomas (P <.05, respectively). A tendency toward increased cell proliferation in carcinoma in situ compared with dysplastic inverted papillomas was present; however, this was not statistically significant. The expression rates of p27Kip1 were comparable between non-papillomatous nasal mucosa and all histological subtypes within nondysplastic endophytic schneiderian papillomas. Significantly reduced p27Kip1 expression was found in surface cells in dysplastic compared with non-dysplastic inverted papillomas, as well as in the total number of cells in carcinoma in situ compared with dysplastic inverted papillomas (P <.05, respectively). Inverted papillomas but not cylindrical cell papillomas show increased cell proliferation compared with nonpapillomatous nasal mucosa. Stepwise increases in cell proliferation accompany the consecutive histological changes within inverted papillomas. Among them, increased cell proliferation along with the development of dysplasia and carcinoma in situ is associated with reduced p27Kip1 expression.

Papilloma of the nasal and paranasal sinuses : A clinical study of 36 cases

Clinical studies of 36 patients with papilloma of the nasal and sinonasal sinuses were performed. We treated 25 men and 11 women with an average age of 55.1 years. Chief complaints were nasal obstruction. Histology showed 11 cases of squamous cell papilloma and 25 cases of sinonasal papilloma. Sinonasal papilloma were classified into three histopathological types : exophitic papilloma, inverted papilloma and cylindrical cell papilloma. In this study, inverted papilloma was the most common type. Inverted papilloma occurred primarily in the internal wall of the maxillary sinus. The recurrence rate was 9.7% (3 cases), one case was squamous cell papilloma with sinonasal papilloma, and two cases were inverted papilloma. Four cases (11.1 % ) showed malignant transformation.

Patterns of p21(waf1/cip1) expression in non-papillomatous nasal mucosa, endophytic sinonasal papillomas, and associated carcinomas.

To clarify p21(waf1/cip1) expression in sinonasal lesions. Archived surgical specimens from 38 patients were investigated by means of immunohistochemistry. p21(waf1/cip1) staining was evaluated in the different layers of the epithelium. In addition, human papillomavirus (HPV) infection and p53 protein overexpression were assessed and correlated with p21(waf1/cip1) expression. p21(waf1/cip1) staining was negative in non-papillomatous nasal mucosa. HPV infection and p53 protein overexpression were not seen. Sixteen of 20 inverted papillomas showed p21(waf1/cip1) expression. HPV infection was found in 16 cases and p53 protein overexpression was present in 13 specimens. Expression of p21(waf1/cip1) was restricted to surface cells in five cases, but involved basal/parabasal cells in 11 specimens. Immunoreactivity for p21(waf1/cip1) in basal/parabasal cells colocalised with p53 protein overexpression. Enhanced expression rates for p21(waf1/cip1) were seen in transitional and squamous epithelium compared with columnar epithelium. p21(waf1/cip1) expression involved only surface cells in cylindrical cell papillomas. HPV infection and p53 protein overexpression were detected in all specimens. One of five squamous cell carcinomas showed p21(waf1/cip1) expression. HPV infection was seen in two cases, and all carcinomas showed p53 protein overexpression. Expression of p21(waf1/cip1) is associated with terminal differentiation in surface cells in inverted papillomas and cylindrical cell papillomas, but not in non-papillomatous nasal mucosa. Overexpression of p53 protein colocalises with p21(waf1/cip1) expression in basal/parabasal cells in inverted papillomas but not in cylindrical cell papillomas. Expression of p21(waf1/cip1) in squamous cell carcinomas involves a subset of tumours with p53 protein overexpression.

Radiation therapy in inverted papillomas of the nasal cavity and paranasal sinuses

Between December 1969 and September 1989, a total of 10 patients with advanced and/or recurrent inverted or cylindrical cell papillomas were treated with irradiation at the University of Florida in Gainesville. Nine of 10 patients had 1 or more recurrences before they received radiation therapy. Three patients were treated with irradiation alone, and 7 patients received surgery and irradiation (preoperatively in 1 patient and postoperatively in 6 patients). Eight patients had inverted papillomas (3 with concomitant squamous cell carcinoma), and 2 patients had cylindrical cell papillomas. Local recurrence developed in 4 patients at 1.5, 6.5, 12, and 13 years after treatment. No evidence of recurrence was observed in 6 patients at 7, 8.5, 8.5, 9, 9, and 20.5 years after treatment. Four patients died of intercurrent disease. No patient developed a malignant transformation. Significant complications of treatment included, in 1 patient, an area of bone exposure in the orbit that necessitated debridement. Surgery is the primary treatment of this entity. Radiation therapy should be considered in patients with incompletely resectable lesions, multiply recurrent tumors, and tumors associated with malignancy.

Head and neck computed tomography virtual endoscopy: evaluation of a new imaging technique.

To evaluate a new radiographic imaging technique: computed tomography virtual endoscopy (CTVE) for head and neck tumors. Twenty-one patients presenting with head and neck masses who underwent axial computed tomography (CT) scan with contrast were evaluated by CTVE. Comparisons were made with video-recorded images and operative records to evaluate the potential utility of this new imaging technique. Twenty-one patients with aerodigestive head and neck tumors were evaluated by CTVE. One patient had a nasal cylindrical cell papilloma; the remainder, squamous cell carcinomas distributed throughout the upper aerodigestive tract. Patients underwent complete head and neck examination, flexible laryngoscopy, axial CT with contrast, CTVE, and in most cases, operative endoscopy. Available clinical and radiographic evaluations were compared and correlated to CTVE findings. CTVE accurately demonstrated abnormalities caused by intraluminal tumor, but where there was apposition of normal tissue against tumor, inaccurate depictions of surface contour occurred. Contour resolution was limited, and mucosal irregularity could not be defined. There was very good overall correlation between virtual images, flexible laryngoscopic findings, rigid endoscopy, and operative evaluation in cases where oncological resections were performed. CTVE appears to be most accurate in evaluation of subglottic and nasopharyngeal anatomy in our series of patients. CTVE is a new radiographic technique that provides surface-contour details. The technique is undergoing rapid technical evolution, and although the image quality is limited in situations where there is apposition of tissue folds, there are a number of potential applications for this new imaging technique.

Benefits of stereolithography in orbital reconstruction

Objective To describe the benefits of the stereolithography (SLA) modeling system in the evaluation and surgical planning of selected bony orbital pathology. Design Two case reports. Participants One patient presented with a displaced left orbital roof fracture into his orbit causing globe compression and binocular vertical diplopia. A second patient underwent removal of his right orbital floor, medial wall, and inferior portion of his lateral wall during excision of a cylindrical cell papilloma of the paranasal sinuses. Postoperatively, he suffered from globe ptosis and binocular oblique diplopia. Intervention Stereolithographic models of the patients’ orbits were obtained from computed tomography data to better assess the bony orbital pathology. In the second patient, the model was used as a template to create a temporary custom fit prosthesis to repair the defect of his orbital walls. Results The SLA models were useful in evaluating the dimensions of the bony defects and in preoperative surgical planning. Intraoperatively, the SLA models facilitated orbital surgical rehabilitation. Postoperatively, both patients noted resolution of their diplopia after reconstruction of more normal bony anatomy. Conclusions In selected cases, SLA offers highly accurate models of the bony orbit for preoperative evaluation, surgical planning, and teaching and can act as a template for custom prosthesis manufacturing. This technology increases the orbital surgeon’s options in managing complex orbital pathology.

鼻副鼻腔原発乳頭腫の臨床的検討

Clinical studies of twenty-four patients with sinonasal papillomas were performed. The cases were classified into three histopathological types: 1) exophytic (fungiform), 2) inverted, and 3) cylindrical cell (columnar cell) papillomas. In this study, inverted papilloma was the most common type. All types of sinonasal papillomas had male predominance. The mean age of patients with inverted papillomas was higher than that of patients with exophytic papillomas. The most common major symptom of exophytic papillomas was a nasal mass and that of inverted papillomas was nasal obstruction. The exophytic papillomas occurred in the nasal septum or the nasal vestibules, whereas the inverted papillomas occurred primarily in the lateral nasal wall and/or in the paranasal sinuses. Exophytic papillomas had a lower recurrence rate than inverted papillomas even though only intranasal tumor resection was undertaken in the former, whereas medial maxillectomy was performed in the latter. The resection range of inverted papillomas should be decided on the basis of the location and the degree of invasion to avoid inadequate excision. This is especially important when the inverted papilloma is located in the ethmoid sinus or on the middle turbinate. In such cases wider excision is needed to prevent recurrences. In our cases, there was no association of malignancy with sinonasal papillomas.

Inverted papilloma associated with squamous cell carcinoma and adenocarcinoma: Case report and review of the literature

Nasal papillomas were first described by Ward1 in 1854. Subsequently, several classifications of nasal papillomas have been proposed.2 Hyams3 divided these lesions into inverted papillomas, fungiform papillomas, and cylindrical cell papillomas. This categorization was based on different histological appearances, anatomic sites, and clinical behavior. Fungiform papillomas, which primarily arise on the septum, have also been referred to as septal papillomas. Cylindrical cell papillomas are also classified as oncocytic papillomas. Some institutions suggest that the histological differences are not significant enough to warrant separate classifications and describe all nasal papillomas as inverted papillomas.2 CASE REPORT

Cylindrical Cell Papilloma of the Nasal Septum

Papillomas of the sinonasal tract are uncommon tumors. They can be subdivided into different histopathological entities including inverting papilloma, fungiform papilloma and cylindrical cell papilloma. Cylindrical cell papilloma is one of the rarest with only twenty-three cases reported. This rare histologically distinct variant of papillomas of the sinonasal tract behaves clinically like inverting papillomas. We present what we believe to be the first reported case of a cylindrical cell papilloma isolated to the nasal septum. The patient's pathology and a literature review of cylindrical cell papillomas of the sinonasal tract are presented.

Carcinoma ex oncocytic Schneiderian (cylindrical cell) papilloma

Introduction: This study reviews the clinicopathologic features of carcinoma presenting in oncocytic Schneiderian papilloma (OSP; cylindrical cell papilloma), a rare histologically distinctive papilloma sharing features with inverted papilloma. Materials and Methods: Nine cases of carcinoma ex OSP (1970–1990), six from the files of the Armed Forces Institute of Pathology (Washington, DC) and three from the surgical pathology files, Presbyterian-University Hospital and Eye and Ear Institute (Pittsburgh, PA), were studied. One case was previously reported. Clinical data were obtained from the patients' medical records. All available histologic slides were reviewed. Results: The patients (eight men, one woman) ranged in age from 48 to 83 years (mean age, 74 years). The carcinoma and OSP were synchronous in eight patients. In one case, the carcinoma occurred 8 years after OSP was diagnosed on biopsy. The presenting manifestations included nasal obstruction, “polyps,” epistaxis, and proptosis. Radio-graphically, a sinonasal mass was present, often with extension to adjacent sites and bone destruction. Most patients received postoperative irradiation. Of six patients with follow-up, four died of carcinoma and two were alive without disease at 1.5 and 7 years, respectively. The types of carcinoma were: squamous cell (n = 6), high-grade mucoepidermoid (n = 2), and sinonasal undifferentiated (n = 1). Histologic transition was observed between carcinoma and dysplastic/benign OSP in eight cases. Conclusion: Demonstration of histologic continuity between carcinoma and dysplastic OSP epithelium in eight of our nine cases indicates origin of carcinoma from the OSP, rather than a coincidence of the two neoplasms. Although histologically benign, OSP should be totally excised at diagnosis because of a potential for malignant transformation.

Cylindrical Cell Papilloma of the Nasal Cavity and Paranasal Sinuses: A Histochemical and Cytochemical Study

A cylindrical cell papilloma occurring in the sino-nasal mucosa of a 61-year-old woman was studied histochemically at both light and electron microscopic levels. The cylindrical cells demonstrated distended intracytoplasmic microcysts with numerous microvillous projections on the apical cell membrane. The retained mucosubstance in the cystic spaces stained intensely with HID-TCH-SP sequence and showed no apparent communication with the extracellular space. These findings indicate that the cylindrical cells may be of mucous-secreting cell derivation, being derived from cells possessing abnormal and/or failed secretory function. The property of sulfated mucin in the 'cylindric' intracytoplasmic cysts is suggested to be the result of endodermal displacement or metaplasia of the Schneiderian epithelium.

Sinonasal papillomas and human papillomavirus: Human papillomavirus 11 detected in fungiform schneiderian papillomas by in situ hybridization and the polymerase chain reaction

A series of 19 paraffin-embedded sinonasal papillomas (four squamous papillomas, three fungiform papillomas, nine inverted papillomas, and three cylindrical cell papillomas) were investigated for evidence of human papillomavirus (HPV) infection using immunohistochemistry (polyclonal antibody to HPV capsid antigen), in situ hybridization (DNA probes for HPV 6 11 , 16 18 , and 31/33/35), and the polymerase chain reaction (primers and probes for HPV 6, 11, 18, and 33). All three fungiform papillomas were positive by all three techniques: immunohistochemistry, in situ hybridization for HPV 6 11 , and the polymerase chain reaction for HPV 11. None of the other lesions contained detectable HPV using the specific probes included in this study. These results support the continued classification of fungiform papilloma as a distinctive variant of schneiderian papilloma characterized by a predominantly exophytic growth pattern and an association with HPV 11.

The role of radiation therapy in inverted papilloma of the nasal cavity and paranasal sinuses

Between December 1969 and March 1985, seven patients with advanced biologically aggressive inverted or cylindrical cell papillomas were treated with irradiation at the University of Florida. Three patients were treated with radiation therapy alone, and four patients were irradiated either before (one patient) or after (three patients) resection. No recurrences were observed in six patients at 4.5, 7, 8, 8, 9, and 20 years following treatment (including two who died of intercurrent disease at 7 and 9 years after radiation therapy without evidence of recurrent tumor). One patient treated with irradiation alone for an advanced recurrent papilloma developed a local recurrence extending into the frontal lobe of the brain and died 17 months after radiation therapy. None of the patients experienced a significant complication of irradiation. Although surgery is generally the primary treatment modality for this disease, radiation therapy should be considered for patients with advanced, incompletely resected, or unresectable lesions.

Cylindrical Cell Papilloma of the Maxillary Sinus

The cylindrical cell papilloma is considered to be a form of Schneiderian nasal papilloma. This form of papilloma is rare. There are clinical and histologic differences between an ordinary inverting papilloma and a cylindrical cell papilloma. Both forms of papillomas present as ragged or papillary growths in the maxillary sinus or in conjunction with lesions of the adjacent lateral nasal wall or ethmoid sinus. An unusual case of cylindrical cell papilloma and a review of the literature concerning this lesion is presented. Magnetic resonance imaging (MRI) scan is advantageous in evaluating this lesion, especially in distinguishing these lesions from cysts and in defining the extent of the problem. Medial maxillectomy via lateral rhinotomy or a facial degloving approach partial maxillectomy is usually curative for this problem, although more aggressive lesions require more extensive maxillectomy.