Papilloma of the nasal and paranasal sinuses: A clinical study of 32 cases

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  • Ueki Yuji
    Department of Otolaryngology, Southern TOHOKU Research Institute for Neuroscience
  • Mada Yusuke
    Department of Otolaryngology, Southern TOHOKU Research Institute for Neuroscience
  • Konno Akiyoshi
    Department of Otolaryngology, Southern TOHOKU Research Institute for Neuroscience

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  • 鼻副鼻腔乳頭腫の臨床的検討

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Abstract

Clinical outcome of sinonasal inverted papilloma (IP) surgery in 32 cases.<br>Objective: To analyze the clinical outcome of our 9 years of experience (2003-2011) in treating IP.<br>Patients and method: A retrospective study was performed in 32 sinonasal IP patients (average age: 57.5) assessing sex, age, origin of the lesion, staging (Krouse stage), method of treatment and rate of recurrence and associated malignancy.<br>Results: Krouse stage was 5 in stage T1, 11 in stage T2, 14 in stage T3 and 2 in stage T4. The mean follow-up period was 3 months and 5 years (range: 8 months-9 years). Five stage T1, two stage T2 and one stage 3 patients were treated endoscopically and another patient was treated by an endoscopic assisted combined approach including the canine fossa approach and lateral rhinotomy. Recurrence was observed in two stage T3 patients treated by the combined approach. The average time to recurrence was 19 months. Reoperation was performed endoscopically with no further recurrence. Two patients had malignant IP. In one patient malignancy was diagnosed preoperatively by biopsy but in another, the result of preoperative biopsy was IP and a portion of the large tumor was found to have malignant transformation during operation by histopathological study (frozen section) of the resected tumor.<br>FDG PET-CT was performed in eight patients including two patients with malignant IP. <br>FDG accumulated strongly in the tumor and no difference was observed in SUV values between the malignant and the non-malignant tumors.<br>Conclusion: Endoscopic surgery is the first choice of treatment in cases in which en bloc resection of IP is considered possible endoscopically. However, in cases with large tumor, the approach should be determined individually depending chiefly upon Krouse stage and location of the tumor, because preoperative diagnosis of malignant transformation of IP is frequently difficult. Close follow-up is important postoperatively to detect early recurrence of the tumor.

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