Il papilloma invertito naso-sinusale

difficoltà di diagnosi e terapia in una casistica di 26 casi e nella letteratura.

Translated title of the contribution: Rhinosinusal inverted papilloma: diagnostic and therapeutic difficulties in a series of 26 cases

M. Bussi, L. Cardarelli, E. Riontino

Research output: Contribution to journalArticle

Abstract

Inverted papilloma (IP) is a rare and yet complex pathology, particularly due to the risk of recurrence (approximately 50%) and the onset of carcinoma (approximately 15%). Moreover, in clinical practice it is difficult to diagnose and treat. The present work reviews a personal case study in order to make an essentially clinical evaluation of the problems of diagnosis and treatment. From 1989 to 1997, among approximately 1200 cases of surgery for phlogistic or neoplastic nasal-sinus pathologies, 26 cases of IP were treated. Of these 22 underwent a minimum follow-up of 12 months. In 5 out of the 22, it was a recurrence of 'nasal polyps' which had been surgically treated at another site (with histology performed for only 2 of the patients). In 8 of the 22, imaging did not indicate IP, resulting in an underestimation of the disorder and most likely affecting treatment. The following procedures were performed: 6 sphenoethmoidotomies through an endonasal approach (with and without endoscopy); 19 radical spheno-ethmoidomaxillotomies extended to varying degrees to the demolition of bone and, in 3 cases, using a paralatero-nasal approach (because of invasion of the anterior ethmoid); 4 endonasal exereses for IP arising in the septum (1 with reconstructive naso-genieno flap); 1 maxillectomy. Of the patients (22) who had undergone surgery in our Division, 5 showed recurrences and 3 of these had undergone spheno-ethmoidotomy through the endonasal approach. Moreover, all the cases of recurrence involved underestimated preoperative diagnosis (i.e. the 8 patients for whom IP was only recognized after histology). Among the 5 recurrences, for 2 carcinoma fields were diagnosed; for 3 additional surgery was required: one patient underwent additional surgery twice while another 3 times (lastly with a maxillectomy). The surgery did not lead to serious complications and at the present time all patients are alive and macroscopically disease free. Analysis of the literature and personal experience has lead to the following considerations: routine diagnostic evaluation of "polyps" is most likely still inadequate; it appears that the risk of recurrences can be controlled only with adequately aggressive surgery; endonasal forms (above all septal) could be disconnected, normally leading to peculiar histological and clinical features.

Original languageItalian
Pages (from-to)213-220
Number of pages8
JournalActa Otorhinolaryngologica Italica
Volume19
Issue number4
Publication statusPublished - Aug 1999

Fingerprint

Inverted Papilloma
Recurrence
Histology
Therapeutics
Pathology
Carcinoma
Nasal Polyps
Paranasal Sinuses
Polyps
Nose
Endoscopy
Bone and Bones

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Il papilloma invertito naso-sinusale : difficoltà di diagnosi e terapia in una casistica di 26 casi e nella letteratura. / Bussi, M.; Cardarelli, L.; Riontino, E.

In: Acta Otorhinolaryngologica Italica, Vol. 19, No. 4, 08.1999, p. 213-220.

Research output: Contribution to journalArticle

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abstract = "Inverted papilloma (IP) is a rare and yet complex pathology, particularly due to the risk of recurrence (approximately 50{\%}) and the onset of carcinoma (approximately 15{\%}). Moreover, in clinical practice it is difficult to diagnose and treat. The present work reviews a personal case study in order to make an essentially clinical evaluation of the problems of diagnosis and treatment. From 1989 to 1997, among approximately 1200 cases of surgery for phlogistic or neoplastic nasal-sinus pathologies, 26 cases of IP were treated. Of these 22 underwent a minimum follow-up of 12 months. In 5 out of the 22, it was a recurrence of 'nasal polyps' which had been surgically treated at another site (with histology performed for only 2 of the patients). In 8 of the 22, imaging did not indicate IP, resulting in an underestimation of the disorder and most likely affecting treatment. The following procedures were performed: 6 sphenoethmoidotomies through an endonasal approach (with and without endoscopy); 19 radical spheno-ethmoidomaxillotomies extended to varying degrees to the demolition of bone and, in 3 cases, using a paralatero-nasal approach (because of invasion of the anterior ethmoid); 4 endonasal exereses for IP arising in the septum (1 with reconstructive naso-genieno flap); 1 maxillectomy. Of the patients (22) who had undergone surgery in our Division, 5 showed recurrences and 3 of these had undergone spheno-ethmoidotomy through the endonasal approach. Moreover, all the cases of recurrence involved underestimated preoperative diagnosis (i.e. the 8 patients for whom IP was only recognized after histology). Among the 5 recurrences, for 2 carcinoma fields were diagnosed; for 3 additional surgery was required: one patient underwent additional surgery twice while another 3 times (lastly with a maxillectomy). The surgery did not lead to serious complications and at the present time all patients are alive and macroscopically disease free. Analysis of the literature and personal experience has lead to the following considerations: routine diagnostic evaluation of {"}polyps{"} is most likely still inadequate; it appears that the risk of recurrences can be controlled only with adequately aggressive surgery; endonasal forms (above all septal) could be disconnected, normally leading to peculiar histological and clinical features.",
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