Inverted Papilloma Research Articles

Epithelial Tight Junction Anomalies in Nasal Inverted Papilloma.

As a critical component of the epithelial barrier, tight junctions (TJs) are essential in nasal mucosa against pathogen invasion. However, the function of TJs has rarely been reported in nasal inverted papilloma (NIP). This study aims to investigate the potential factors of TJs' abnormality in NIP. We assessed the expression of ZO-1, occludin, claudin-1, claudin-3, and claudin-7 in healthy controls and NIP by real-time quantitative polymerase chain reaction and immunofluorescent staining. The correlation between TJs expression and neutrophil count, TH 1/TH 2/TH 17 and regulatory T cell biomarkers, and the proportion of nasal epithelial cells was investigated. Upregulation of ZO-1, occludin, claudin-1, and claudin-7, along with downregulation of claudin-3, was found in NIP compared to control (all p < 0.05). An abnormal proportion with a lower number of ciliated cells (control vs. NIP: 37.60 vs. 8.67) and goblet cells (12.52 vs. 0.33) together with a higher number of basal cells (45.58 vs. 124.00) in NIP. Meanwhile, claudin-3 was positively correlated with ciliated and goblet cells (all p < 0.01). Additionally, neutrophils were excessively infiltrated in NIP, negatively correlated with ZO-1, but positively with claudin-3 (all p < 0.05). Furthermore, FOXP3, IL-10, TGF-β1, IL-5, IL-13, and IL-22 levels were induced in NIP (all p < 0.01). Occludin level was negatively correlated with IL-10, IL-5, IL-13, and IL-22, whereas ZO-1 was positively with TGF-β1 (all p < 0.05). Nasal epithelial barrier dysfunction with TJs anomalies is commonly associated with abnormal proliferation and differentiation of epithelial cells and imbalance of immune and inflammatory patterns in NIP. NA Laryngoscope, 134:552-561, 2024.

Inverted Papilloma in a 61-year-old Man: A Case Report

Introduction: Inverted papilloma is a benign epithelial tumor of cavum nasi and paranasal sinuses that originates on the mucosal surface of the sinonasal tract. The etiology of this tumor remains unknown although chronic sinusitis, allergy, and viral infections are suspected. Although it is a benign tumor, it has a tendency toward malignancy. We aim to present the report as a case of sinonasal inverted papilloma with clinical manifestations, and radiological and histopathological features in a 61-year-old male patient. Case Presentation: A 61-year-old man presented to the Department of Ear, Nose, and Throat (ENT), Bali Royal Hospital on 17 January 2023 with left nasal obstruction 5 years ago, and getting worse over 3 months. Due to the obstruction, he felt his sense of smell diminished. He also often sneezed had headaches and felt his left nose was bigger than his right. On examination, a grey-white mass with an irregular, slippery surface, and soft consistency were found. The mass did not bleed easily, was not painful when touched, and filled almost the entire cavum nasi sinistra. CT scan revealed rhinosinusitis of maxillary dextra et sinistra, ethmoidal dextra et sinistra, and frontalis sinistra with polyp shape and concha nasi sinistra protruding posteriorly. Functional Endoscopic Sinus Surgery (FESS) and extirpation under general anesthesia (GA) were planned. An excisional biopsy was sent for histopathological examination. Based on clinicohistopathologic, it suggests of final diagnosis of inverted papilloma. Conclusion: Due to the signs and symptoms of inverted papilloma are not specific, a CT scan and biopsy are needed to confirm the diagnosis. To reduce the recurrence of these tumors, complete tumor removal with an endoscopic approach is recommended. Long-term follow-up is also necessary to prevent the recurrence

Application experience of prelacrimal recess combined with septotomy in resection of recurrent inverted papilloma

Objective:To investigate the effectiveness of nasal endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum in resecting recurrent nasal inverted papilloma. Methods:Patients with recurrent nasal inverted papilloma who underwent reoperation in our hospital during the past 2 years were included . The nasal septum may hinder full access to and effective treatment of the lesions at the anterior and medial wall of the maxillary sinus by endoscope, aspirator and surgical instrument in the narrow aperture of the prelacrimal recess, although these lesions could be observed by 70° nasal endoscope. Results:The nasal septum is temporarily opened on the basis of the prelacrimal recess approach, and the nasal endoscope and instrument was introduced through trans-septal window, so as to provide a better view of the operative field and the angular range of the instrument's movement. Conclusion:The recurrent nasal inverted papilloma could be successfully managed by re-endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum, and no recurrence was observed during the 2-year follow-up. This surgical approach is recommended for the inverted papilla which originates from the anterior medial wall of the maxillary sinus, as the tumor can be removed completely using this surgical approach.

Predictive Value of Magnetic Resonance Imaging Multi-parametric Analysis for Malignant Transformation of Sinonasal Inverted Papilloma: A Comprehensive Prediction Model.

Accurate preoperative prediction of sinonasal inverted papilloma (SNIP) malignant transformation is essential and challenging. In this study, 3.0T magnetic resonance was used for qualitative, quantitative, and multi-parametric analysis to evaluate the predictive value of magnetic resonance imaging (MRI) in malignant transformation. The data of patients with SNIP (n=83) or SNIP-transformed squamous cell carcinoma (SNIP-SCC) (n=21) were analysed retrospectively. Univariate analysis and multivariate logistic regression were used to establish models to predict the risk factors for the malignant transformation of SNIP. Receiver operating characteristic (ROC) curves were used to evaluate the ability of independent risk factors and related combination models to predict the malignant transformation of SNIP. Convoluted cerebriform pattern (CCP) mutation, apparent diffusion coefficient ratio (ADCr), and wash-in index (WII) 2 and 3 were independent risk factors for predicting malignant transformation of SNIP, with area under the ROC curve (AUC) values of 0.845, 0.862, 0.727, and 0.704, respectively. The AUC of the quantitative parameter model combined with ADCr and WII 2 and 3 was 0.910 for diagnosing malignant transformation. The AUC of the comprehensive model comprising all independent risk factors was 0.937, with a sensitivity, specificity, and accuracy of 90.48%, 90.36%, and 92.31%, respectively. Compared with assessing independent risk factors of CCP mutation, ADCr and WII, and the quantitative parameter model, the comprehensive model could improve the differential diagnosis ability of SNIP and SNIP-SCC, which provides an important imaging basis for the possible accurate preoperative evaluation of the malignant transformation of SNIP.

Endoscopic dissection of the infraorbital canal in patients with sinonasal inverted papilloma

Intrоduction. Sinonasal papilloma is a benign tumor. The standard treatment for sinonasal inverted papilloma (SIP) is surgical intervention. The tumor is located primarily in the maxillary sinus (50.9 %). Sinonasal inverted papilloma originated from the maxillary sinus has aggressive characteristics and can dislodge local anatomical structures, infraorbital canal in particular.Aim. To present a descriptive characteristic of structural changes in the infraorbital canal during SIP growth and determine the optimal volume of canal dissection.Materials and methods. A retrospective study of patients with SIP was performed. From the total cohort (n = 37), 15 patients with primary localization of sinonasal inverted papilloma in the maxillary sinus were selected. In all cases, the same diagnostic algorithm was used. Separately, evaluation of infraorbital canal anatomy based on preoperative analysis of computed tomography of the paranasal sinuses and intraoperative endoscopic exam was performed. Surgical strategy used in all cases consisted of endoscopic SIP tissue removal, total resection of the mucoperiosteum and subperiosteal dissection of all walls of the maxillary sinus using a bur. During surgery material was collected for control histological examination.Results. In 20 % of cases, changes in the walls of the infraorbital canal in the form of hyperostosis, erosion and dehiscence were observed. In 13.3 % of cases, growth of sinonasal inverted papilloma caused distortions in the structure of infraorbital canal walls. In all cases, computed tomography data showed the same results as intraoperative endoscopic visualization. For removal of the lesion and pathologically changed walls of the infraorbital canal, transnasal endoscopic partial maxillectomies (type 3 or 4) were performed. Follow-up duration varied between 1 and 5 years, mean follow-up duration was 3 years. SIP resection was effective in all patients, no recurrences were observed.Conclusion. For SIPs growing in the maxillary sinus, condition of the infraorbital canal must be of special interest. The study showed the effectiveness and flexibility of the surgical strategy consisting of the combination of total mucoperiosteum resection with subperiosteal dissection of all walls of the maxillary sinus.

A Metagenomic Analysis of the Virome of Inverted Papilloma and Squamous Cell Carcinoma.

Inverted papilloma (IP) is a sinonasal tumor with a well-known potential for malignant transformation. The role of HPV in its pathogenesis has been controversial. The purpose of this study was to determine theviromeassociated with IP, with progression to carcinoma-in-situ, and invasive carcinoma. To determine the HPV-specific types, a metagenomics assay that contains 62,886 probes targeting viral genomes in a microarray format was used. The platform screens DNA and RNA from fixed tissues from 8 control tissue, 16 IP without dysplasia, 5 IP with carcinoma-in-situ, and 13 IP-associated squamous cell carcinoma (IPSCC). Paired with next-generation sequencing, 48 types of HPV with 857 region-specific probes were interrogated against the tumors. The prevalence of HPV16 was 14%, 42%, 70% and 73% in control tissue, IP without dysplasia, IP with CIS, and IPSCC, respectively. The prevalence of HPV18 had a similar progressive increase in prevalence, with 14%, 27%, 67%, and 74%. The assay allowed region-specific analysis which identified the only oncogenic HPV type 18 E6 to be statistically significant when comparing to control tissue. The prevalence of HPV18-E6 was 0% in control tissue, 25% in IP without dysplasia, 60% in IP with CIS, and 77% in IPSCC. There are over 200 HPV types that infect human epithelial cells, of which only a few are known to be high-risk. Our study demonstrated a trend of increasing prevalence of HPV18-E6 that correlated with histologic severity, which is novel and supports a potential role for HPV in the pathogenesis of IP. This article is protected by copyright. All rights reserved.

Sinonasal inverted papilloma extirpation by endoscopic approach: a case report

Introduction: Inverted papilloma is a benign tumor that generally arises from the lateral wall of the nasal cavity and mostly grows on the middle meatus.The incidence is rarely found in the ear, throat, nose, throat, head and neck, which is around 0.5% -4% of all nasal and paranasal sinus tumors.The etiology of inverted papilloma remains unknown.Clinical features of inverted papilloma are unilateral nasal obstruction, rhinorrhea, epistaxis, anosmia, tinnitus and some other symptoms.The diagnostic examination are histopathological examinations, CT scans and magnetic resonance imaging (MRI). Histopathology is the gold standard in diagnosing of inverted papilloma.Management of inverted papilloma is carried out with surgical approach including lateral rhinotomy, maxillectomy, degloving, and non-invasive surgery via endoscopy depending to the krouse classification. Case description: A 44-year-old female patient diagnosed with inverted papilloma was reported.The patient complained of progressive right nasal obstruction appeared two years ago which turned into total obstruction and rhinorrhea in the last 6 months.A biopsy was done with the result of inverted papilloma. CT scan of the paranasal sinuses showed a mass filling the right nasal cavity, right maxillary sinus and right ethmoid sinus. Patientwas diagnosed with sinonasal inverted papilloma with Krouse 2 classification based on clinical examination, radiological findings and preoperative endoscopy. The patient was treated with sinonasal inverted papilloma extirpation via endoscopic approach. Conclusion: Inverted papilloma is a benign tumor of the nasal and paranasal sinuses in which biopsy is the gold standard for diagnostic test while the main treatment is done by surgical approach depending on the krouse classification.

Study on Endoscopic Approach for Sinonasal Inverted Papilloma

Objectives: The purpose of this study is to evaluate the endoscopic approach for sinonasal inverted papilloma and outcome of the surgical management. Study design: Retrospective. Place and duration of study: Dhaka Medical college Hospital and Bangladesh ENT Hospital Ltd. of Bangladesh, from January 2006 to December2020. Materials and methods: 189 cases of Inverted papillomas (confirmed by histopathology) presented in last 15 years were managed by Endoscopic Sinus Surgery and the outcome evaluated. Results: The age of the patients ranged from 41 to 80 years. The mean age was 60 years with Male Female ratio 2.04:1.165 patients had unilateral disease and 24 patients had bilateral. Hundred &amp; seventy two patients with inverted papilloma resected by the endoscopic approach,09 patients by nasoendoscopy in combination with modified Caldwell-Luc approach and 8 patients by combined external and nasoendoscopic approach. Follow up revealed recurrence in nine patients. Conclusion: Findings suggest that endoscopic approach is a safe and effective way of treating sinonsal inverted papilloma. Most lesions were entirely resected through endoscopic approach. Importantly surgical strategies need to be thoughtfully chosen based on tumor stage to achieve maximum removal of the lesion and prevent recurrence. J Shaheed Suhrawardy Med Coll 2021; 13(2): 126-129

Human Papillomavirus Infection and EGFR Exon 20 Insertions in Sinonasal Inverted Papilloma and Squamous Cell Carcinoma.

This study aimed to clarify the roles of high-risk human papillomavirus (HR-HPV) infection and epidermal growth factor receptor (EGFR) exon 20 mutations in sinonasal inverted papilloma (IP) and sinonasal squamous cell carcinoma (SNSCC). Samples were collected from 20 cases with IP, 7 with IP and squamous cell carcinoma (IP-SCC), and 20 with SNSCC and examined for HPV infection and EGFR exon 20 mutations. Low- or high-risk HPV DNA was observed in 25% of IP, 57.1% of IP-SCC, and 35% of SNSCC cases. Transcriptionally active HR-HPV infections in IP-SCC and SNSCC, accompanied by p16 overexpression, were observed in 28.5% and 25% of cases, respectively. Heterozygous EGFR exon 20 amino acid insertions (ex20ins), located between amino acids 768-774, were observed in 45% of IP, 28.5% of IP-SCC, and 0% of SNSCC and chronic sinusitis cases. EGFR phosphorylation sites were located at tyrosine (Y) 845, Y1068, Y1086, and Y1197 and induced PI3K/AKT/mTOR activation. The phosphorylation pattern of EGFR with ex20ins resembled that of HPV-related SNSCC and oropharyngeal cancer. The transcriptionally active HR-HPV infection and ex20ins might be responsible for the pathogenesis of IP-SCC cases with different fashions. Since IP-SCC might be a multifactorial disease, further investigation is needed to understand IP-SCC etiology.

Clinical outcomes of sinonasal inverted papilloma: a retrospective analysis of 139 cases.

Sinonasal inverted papilloma has a high tendency for recurrence, local bone destruction and risk of malignant transformation. Therefore, complete resection of the tumour is required, and close follow up is essential. This article describes the clinical outcomes, recurrence rate and malignant transformation rate of sinonasal inverted papilloma. In this study, 139 patients diagnosed with sinonasal inverted papilloma in our hospital from December 2010 to May 2022 were retrospectively analysed. All patients underwent endoscopic surgery. Sinonasal inverted papilloma occurred more often in males than in females. The mean age of patients with sinonasal inverted papilloma was 67.3 ± 5.7 years at diagnosis. The most prevalent site of origin was the maxillary sinus (50.4 per cent). The recurrence rate was 5.75 per cent, and the malignant transformation rate was 6.5 per cent. All patients in this study underwent endoscopic surgery. Meticulous resection and regular long-term follow ups are crucial to reducing sinonasal inverted papilloma recurrence after surgery.

Development and validation of apparent diffusion coefficient histogram-based nomogram for predicting malignant transformation of sinonasal inverted papilloma.

To develop and validate a nomogram based on whole-tumour histograms of apparent diffusion coefficient (ADC) maps for predicting malignant transformation (MT) in sinonasal inverted papilloma (IP). This retrospective study included 209 sinonasal IPs with and without MT, which were assigned into a primary cohort (n = 140) and a validation cohort (n = 69). Eight ADC histogram features were extracted from the whole-tumour region of interest. Morphological MRI features and ADC histogram parameters were compared between the two groups (with and without MT). Stepwise logistic regression was used to identify independent predictors and to construct models. The predictive performances of variables and models were assessed using the area under the curve (AUC). The optimal model was presented as a nomogram, and its calibration was assessed. Four morphological features and seven ADC histogram parameters showed significant differences between the two groups in both cohorts (all p < 0.05). Maximum diameter, loss of convoluted cerebriform pattern, ADC10th and ADCSkewness were identified as independent predictors to construct the nomogram. The nomogram showed significantly better performance than the morphological model in both the primary (AUC, 0.96 vs 0.88; p = 0.006) and validation (AUC, 0.96 vs 0.88; p = 0.015) cohorts. The nomogram showed good calibration in both cohorts. Decision curve analysis demonstrated that the nomogram is clinically useful. The developed nomogram, which incorporates morphological MRI features and ADC histogram parameters, can be conveniently used to facilitate the pre-operative prediction of MT in IPs.

Preoperative Prediction of Sinonasal Inverted Papilloma-associated Squamous Cell Carcinoma (IP-SCC).

Sinonasal inverted papillomas (IP) can undergo transformation into IP-squamous cell carcinomas (IP-SCC). More aggressive treatment plan should be established when IP-SCC is suspected. Nevertheless, inaccuracy of the preoperative punch biopsy results to detect IP-SCC from IP raises the need for an additional strategy. The present study aimed to investigate significant clinicoradiological remarks associated with IP-SCC than IP. Postoperative surgical specimens obtained from patients with confirmed IP or IP-SCC at a single tertiary medical center from 1997 to 2018 were retrospectively evaluated. Patients' demographic and clinical characteristics, preoperative in-office punch biopsy results, and preoperative computed tomography (CT) or magnetic resonance images were reviewed. Univariate and multivariate analyses were performed to assess the odds ratio (OR) associated with IP-SCC. The area under the curve (AUC) in the receiver Operating Characteristic (ROC) curve was calculated in the prediction model to discriminate IP-SCC from IP. The study included 44 IP-SCC and 301 patients with IP. The diagnostic sensitivity of in-office punch biopsy to detect IP-SCC was 70.7%. Multivariate analysis showed that factors significantly associated with IP-SCC included tobacco smoking >10PY (adjusted-OR [aOR]: 4.1), epistaxis (aOR: 3.4), facial pain (aOR: 4.2), bony destruction (aOR: 37.6), bony remodeling (aOR: 36.3), and invasion of adjacent structures (aOR: 31.6) (all p < 0.05). Combining all significantly related clinicoradiological features, the ability to discriminate IP-SCC from IP reached an AUC of 0.974. IP patients with a history of tobacco smoking, facial pain, epistaxis, and bony destruction, remodeling, or invasion of an adjacent structure on preoperative images may be at higher risk for IP-SCC. 3 Laryngoscope, 133:2502-2510, 2023.

The choice of endoscopic surgical approach and four steps of operation of inverted papilloma of the maxillary sinus

ObjectiveThe aim of this study was to determine the long-term efficacy of four steps of operation on the treatment of maxillary sinus (MS) inverted papilloma (IP).Methods83 patients who were diagnosed with IP that originated from the MS, underwent four step procedure of attachment sites, including mucosal stripping, periosteum ablation, bone drilling and bone ablation and had postoperative follow-up of 3 years were enrolled.ResultsOf the 83 patients, 59 (71.1%) patients were primary surgery and revision surgery in 24 (28.9%), single attachment was in 31(37.3%) patients and multifocal attachments in 52 (62.7%).When the numbers were not mutually exclusive, the most common origin sites of IPs were the medial wall in 54 (37.2%), lateral wall in 29 (20.0%), anterior wall in 18 (12.4%), inferior wall in 22 (15.2%), posterior in 15 (10.3%), and superior wall in 7 (4.8%). Large MMA alone was performed in 5 (6.0%), MMA combined with medial maxillectomy 76 (91.6%), and MMA combined with Caldwell-Luc approach in 2 (2.4%). No major intra- or postoperative complications were observed. The average follow-up was 41 months (range, 37–61 months). CT and endoscope showed that tumor and symptom recurrence occurred in 2 patients (2.41%). In addition, although the opening of antrostomy was closed and CT revealed the uniform soft tissue shadow and hyperostosis of MS in 11(13.3%) patients, they didn’t report any symptoms and showed well epithelization of middle meatus mucosa.ConclusionThe four steps of operations of attachment sites of MS IP, including mucosal stripping, periosteum ablation, bone drilling and bone ablation, may effectively prevent the recurrence of MS IP.

Quality of life after operative treatment of sinonasal inverted papilloma - a prospective study.

Studies assaying morbidity related to sinonasal inverted papilloma (SNIP) and its treatment are lacking. We evaluated how operative treatment of SNIP affects patients' health-related quality of life (HRQoL) and symptoms. We prospectively recruited consecutive patients (n=52) operated for SNIP at Helsinki University Hospital, between years 2016 and 2019. In total, 42 patients filled in the 15D, a generic HRQoL instrument and a symptom questionnaire preoperatively and at 1 year and at 2 years postoperatively. The 15D HRQoL scores were compared to those of age- and sex-standardized general population. Patients' mean baseline score for discomfort and symptoms (one of the 15D dimensions) was significantly better compared to general population, but this difference faded postoperatively. Frequency of epistaxis, nasal obstruction, lowered sense of smell, headache, tinnitus and epiphora decreased significantly during follow-up whereas frequency of numbness of the face or mouth increased. Difference in the mean 15D score of the patients compared with general population was insignificant at baseline and at 1 year and at 2 years postoperatively. Measured by a generic HRQoL questionnaire, the mean score for discomfort and symptoms deteriorated after operative treatment of SNIP. Despite a relief of many symptoms, care should be taken when operating a benign tumour, as surgery may cause morbidity.

Evaluation of inverted papilloma recurrence rates and factors associated recurrence after endoscopic surgical resection: a retrospective review

BackgroundSinonasal inverted papillomas (IP) are benign tumours arising from the mucosal lining of the nasal cavity and paranasal sinuses with a high propensity for recurrence and malignant transformation. Advances in endoscopic surgery and improved radiologic navigation have increased the role of endoscopic surgical resection in the treatment of IPs. The current study aims to evaluate the rate of IP recurrence after endoscopic endonasal resection and to evaluate factors which impact recurrence.MethodsThis was a single-centre retrospective chart review of all patients who underwent endoscopic sinus surgery for management of IP between January 2009 and February 2022. Primary outcomes were the rate of IP recurrence and time to IP recurrence. Secondary outcome measures were patient and tumour factors that contributed to IP recurrence.ResultsEighty-five patients were included. The mean age was 55.7 and 36.5% of patients were female. The mean follow-up time was 39.5 months. Of the 85 cases, 13 cases (15.3%) had recurrence of their IP and the median time to recurrence was 22.0 months. All recurrent tumours recurred at the attachment site of the primary tumour. The univariate analysis did not identify any significant demographic, clinical, or surgical predictors of IP recurrence. There were no significant changes in sinonasal symptoms at the time IP recurrence was detected.ConclusionEndoscopic endonasal resection of IPs represents an effective surgical approach, however, the relatively high rate of recurrence and lack of symptomatic changes at the time of recurrence necessitates long term follow up. Better delineation of risk factors for recurrence can help identify high-risk patients and inform postoperative follow up strategies.

Synchronous nasal mass: a wolf in sheep’s disguise

Aim: To highlight the possibility of synchronous benign and malignant nasal masses. Schneiderian papilloma, also known as inverted papilloma, despite being a common benign epithelial sinonasal tumour, remains a conundrum to otorhinolaryngologists due to its locally aggressive nature, tendency to recur as well as potential of malignant transformation. A synchronous nasal lesion adds on to the complexity of patient management. Case presentation: Herein, we are reporting an unusual case of synchronous lesions: sinonasal inverted papilloma and low-grade mucoepidermoid carcinoma. Initial biopsy of the sinonasal mass revealed inverted papilloma. However, histopathological examination post endoscopic medial maxillectomy revealed evidence of both inverted papilloma and low-grade mucoepidermoid carcinoma. Conclusion: We want to highlight that seemingly benign sinonasal inverted papillomas ought to be taken seriously considering the possibility of a synchronous malignant nasal mass, as in our case.

Sinonasal Inverted Papilloma Extirpation by Endoscopic Approach: a Case Report

Introduction :Inverted papilloma is a benign tumor that generally arises from the lateral wall of the nasal cavity and mostly grows on the middle meatus.The incidence is rarely found in the ear, throat, nose, throat, head and neck, around 0.5% -4% of all nasal and paranasal sinus tumors.The etiology of inverted papilloma remains unknown.Clinical features of inverted papilloma are unilateral nasal obstruction, rhinorrhea, epistaxis, anosmia, tinnitus and other symptoms.The diagnostic examination are histopathological examinations, CT scans and MRI.Histopathology is the gold standard in diagnosing of inverted papilloma.Management of inverted papilloma is carried out with surgical approach including lateral rhinotomy, maxillectomy, degloving, and non-invasive surgery via endoscopy depend to the krouse classification. Case description : A 44 year-old female patient diagnosed with inverted papilloma was reported.The patient complained of progressiveright nasal obstructionappeared two years ago that turn into total obstruction and rhinorrhea in the last 6 months.A biopsy was done with the result of inverted papilloma. CT scan of the paranasal sinuses showed a mass filling the right nasal cavity, right maxillary sinus and right ethmoid sinus. Patientwas diagnosed with sinonasalinverted papilloma with krouse 2 classificationbased on clinical examination, radiological finding and preoperative endoscopy. Patient was treated with sinonasal inverted papiloma extirpation via endoscopic approach. Conclusion: Inverted papilloma is a benign tumor of the nasal and paranasal sinuses, and biopsy is the gold standard for diagnostic tests. At the same time, the main treatment is done by surgical approachdepend on the krouse classification.

Exclusive Endoscopic Approach in the Management of Sinonasal Inverted Papilloma.

The online version contains supplementary material available at 10.1007/s12070-022-03332-6.

Diagnostic strategy and therapeutic management of sinonasal inverted papilloma: our experience with review of literature

BackgroundThe sinonasal inverted papilloma is a rare benign tumor, characterized by local aggressiveness, a high rate of recurrence after surgical resection, and the possibility of malignant transformation. The aims of this study are to analyze diagnostic strategy and therapeutic modalities and to evaluate results after surgery.MethodsWe report a retrospective study, including patients operated for inverted sinonasal papilloma in our department. Preoperatively, all patients were assessed by CT scan (computed tomography), 9 of them by MRI (magnetic resonance imaging).ResultsThe average age of our patients was 52 years with a male predominance. The most common symptom was unilateral nasal obstruction. The endoscopic appearance was suggestive of inverted papilloma (IP) in 75% of cases. Thirty-two patients underwent an exclusive endonasal endoscopic surgery; one patient was operated with a combined approach. Two patients underwent external approaches. A recurrence was observed in 4 patients (11%).ConclusionPreoperative investigation for IP is essentially based on MRI, also required in case of recurrence. Histological examination of the entire tumor is crucial to rule out an associated carcinoma. The “all endoscopic” management is not always achievable for these tumors.

HPV Infection is Associated with FoxM1 Overexpression in Dysplastic Changes of Sinonasal Inverted Papilloma

This study aims to describe the factors associated with dysplastic changes in sinonasal inverted papilloma (SIP) including somatic EGFR mutation, FoxM1 expression, HPV status, and their association with dysplastic changes. A cross-sectional, analytical study was conducted comprising 34 samples of histologically-confirmed diagnosis of SIP. The samples were further grouped into 2 groups: 20 samples without associated dysplastic changes, and 14 samples with associated dysplastic changes. The numbers of FoxM1 positively-expressed cells, EGFR mutation, and HPV status were compared among two groups using appropriate comparative statistics. There was statistically-significant difference of FoxM1 expression between SIP and SIP with dysplasia (10% vs 100%; p<0.001). EGFR mutation was identified in 6 samples (30.0%) of the SIP and 5 samples (35.7%) of SIP with dysplasia. No difference of EGFR mutant proportion among two groups. HPV DNA was detected in 5 samples (25.0%) of SIP versus 9 samples (64.3%) of SIP with dysplasia. There was significant difference of HPV status among two groups (p=0.022). The high-risk subtypes were found in most HPV positive samples (57.1%), while low-risk subtypes and out panel subtypes were found 14.3% and 21.4%, respectively. FoxM1 was overexpressed in SIP with malignant transformation. FoxM1 along with HPV status is associated with dysplastic changes in the SIP. FoxM1 immunostaining is potential to be a biomarker of malignant transformation in SIP.