Figure 3 - available via license: Creative Commons Attribution 3.0 Unported
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Representative image of sinonasal inverted papilloma with atypical hyperplasia. The section shows the transitional cell growth of papillary epithelial cells. The cells have a disordered arrangement and the nuclei are of different sizes. Atypic epithelial cells and severe dysplasia are evident (hematoxylin and eosin staining; magnification, x100).
Source publication
To investigate the clinicopathological features and prognosis of patients with the malignant transformation of sinonasal inverted papilloma.
Thirty-two consecutive cases encounted between January 1991 and January 2008 were retrospectively reviewed. Survival rates and prognostic factors were caculated with SPSS 17.0 software using the Kaplan-Meier m...
Context in source publication
Context 1
... characteristics. In the same period of continuous treatment of 356 patients with SNIP, 8.99% (32/356) of patients exhibited the malignant type. These 32 patients were selected for the retrospective analysis and comprised 25 males and seven females, with a male to female ratio of 3.6:1. The median age of onset was 56.5 years old. All 32 patients were diagnosed with pathologically malignant SNIP that had progressed to SCC (Fig. 1). Nasal inverted papilloma was the diagnosis in 18 patients, which included two cases of pathological nasal inverted papilloma dysplasia (Fig. 2), and the remaining 16 cases were of pathological nasal inverted papilloma with atypical hyperplasia (Fig. ...
Citations
... The 5year survival rate varies from 39.6% to 72.5%. [17][18][19][20] In this study, inverted papilloma malignancy of the maxillary sinus was observed in 25 cases, and their 5-year cumulative survival rate was 77.7%. ACC has a relatively good prognosis and a high 5-year survival rate. ...
Objectives
To investigate the prognosis and quality of life for primary malignant maxillary sinus tumors.
Methods
This was a retrospective analysis. 164 patients diagnosed with primary malignant maxillary sinus tumors between 2005 and 2018 were recruited. Patients were treated according to the pathological type and the lesion range. Prognostic differences of different pathological types, surgical resection methods, repair methods, treatment methods, and different local recurrence sites were analyzed. Survival analysis and prognostic factors analysis were performed.
Results
Overall survival (OS) rate was 74.7% at 3 years, 60.5% at 5 years, and 45.8% at 10 years. Disease-free survival (DFS) rate was 67.2% at 3 years, 45.6% at 5 years, and 30.8% at 10 years. There was significant difference in OS rate among different pathological types (χ ² = 14.18, P < 0.05). The order of 5-year OS rate was as follows: malignant transformation of inverted Papilloma (77.7%) > adenoid cystic carcinoma (74.1%) > squamous cell carcinoma (48.4%) > sarcoma (22.1%). The order of disease-free survival was as follows: total maxillary resection > subtotal maxillary resection > endoscopic nasal tumor resection ≥enlarged maxillary resection, the 5-year DFS rate were 68.6%, 53.5%, 46.2%, and 42.9%, respectively. The OS of postoperative radiotherapy was significantly better than that of preoperative radiotherapy (χ ² = 7.16, P < 0.05). There was significant difference in OS between recurrent and non-recurrent patients (χ ² = 68.57, P < 0.05).
Conclusions
The pathological type and the timing of radiotherapy are independent prognostic factors for primary malignant tumor of maxillary sinus. In addition, different local surgical resection methods are independent factors affecting the recurrence rate.
... Because intratumour heterogeneity is not accounted for in these methods, they do not represent the whole tumour and often miss slight but important tumour information. 8,9 To avoid this sampling error, a whole-tumour histogram analysis method that involves placing a ROI on the entire lesion has been proposed to evaluate tumour characteristics more precisely. 10 Recently, a preliminary study reported that wholetumour ADC histogram analysis may provide valuable information for predicting MT-IP. ...
Objectives:
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).
Methods:
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.
Results:
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.
Conclusions:
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.
... Similarly, in a prior study from Japan, T4 disease occurred less frequently in IP-SCC patients than in DN-SCC patients, but a significantly higher proportion (61%) underwent debulking surgery in comparison to DN-SCC patients (32%) [20]. Thus, the current AJCC system seems to be inadequate for an accurate assessment of the extent of IP-SCC [17,28]. ...
Background:
Sinonasal squamous cell carcinoma (SNSCC) can arise as either inverted papilloma-associated SCC (IP-SCC) or as de novo SCC (DN-SCC). It is controversial as to whether survival differences between IP-SCC and DN-SCC exist.
Methods:
Between January 2000 and December 2016, 234 patients with SNSCC were analyzed retrospectively, including 68 with IP-SCC and 166 with DN-SCC. Propensity score matching (PSM) was performed to balance baseline characteristics. The Kaplan-Meier method and Cox proportional hazard model were used to determine risk factors on survival outcomes.
Results:
The median follow-up time was 98.4 months. Before PSM, lymph node metastasis was noted to be lower in patients with IP-SCC. After PSM, the 5-year DFS, DSS and OS between IP-SCC and DN-SCC were 43.0% vs. 44.5% (p = 0.701), 49.2% vs. 56.2% (p = 0.753), and 48.2% vs. 52.9% (p = 0.978). The annual hazards of local failure, respectively, peaked at 28.4% and 27.8% for IP-SCC and DN-SCC within 12 months after treatment. Afterward, the hazards gradually decreased and the hazard for IP-SCC was always higher before approaching null.
Conclusions:
This study provides novel evidence to support the clinical utility of improved distinction between IP-SCC and DN-SCC. Further studies are necessary to validate these findings before considering escalation of IP-SCC.
... Additionally, XRT should be considered for inoperable tumors (poor patient candidate, involvement of neurovascular structures) [1,13]. Patients should be counselled that for SCC ex-IP, complete surgical resection followed by XRT has a superior 5-year survival (84%) compared to 41% for XRT alone [66,67]. There has also been limited evidence of response to carboplatin/paclitaxel for inoperable IP with CIS that significantly debulked the tumor and allowed for surgical resection [68]. ...
Simple Summary
Inverted papillomas are benign sinonasal tumors that can recur or become cancerous. The mainstay of treatment is surgical resection. We summarize the biology of inverted papillomas and review surgical outcomes in an effort to define the current treatment strategy.
Abstract
Inverted papillomas (IP) are the most common sinonasal tumor with a tendency for recurrence, potential attachment to the orbit and skull base, and risk of malignant degeneration into squamous cell carcinoma (SCC). While the overall rate of recurrence has decreased with the widespread adoption of high-definition endoscopic optics and advanced surgical tools, there remain challenges in managing tumors that are multiply recurrent or involve vital neurovascular structures. Here, we review the state-of-the-art diagnostic tools for IP and IP-degenerated SCC, contemporary surgical management, and propose a surveillance protocol.
... Similarly, the 5-year OS rate of 62% in this study is much lower than previously reported survival rates of IP alone. 15,21 Our findings are consistent with a single institutional study by Lin et al., which reported significantly worse OS and disease-specific survival in IP-SCC (62% and 66%) compared to IP (95% and 98.6%) alone. This information, along with ability to undergo malignant transformation in up to 15% of cases 5 suggests the need for close follow-up in patients with IP to prevent IP-SCC transformation whenever possible. ...
Long‐term survival and recurrence patterns of squamous cell carcinoma arising from inverted papilloma (IP‐SCC) have not been thoroughly investigated. Four electronic databases were searched and primary studies describing overall survival (OS), recurrence, and mean time to recurrence of patients with IP‐SCC were included for review. Our search yielded 662 studies. The 28 studies selected for inclusion identified 663 patients with IP‐SCC. In 596 patients with reported T classification, 439 (73.7%) were T3/T4 on presentation. Of the 650 participants with recurrence data (local, regional, and distant), 155 (23.8%) experienced a recurrence, with an aggregate mean time‐to‐recurrence of 24.3 months. In 565 patients with 5‐year OS rates, the aggregate 5‐year OS was 62%. Based on the literature to date, IP‐SCC is associated with a 5‐year OS rate of 62%. 23.8% of patients experienced recurrence at a mean time of 24.3 months, suggesting the need for long‐term surveillance.
... For non-operable patients, the mean dose of radiotherapy is 61 Grays. In cases of carcinoma preferred treatment is surgery followed by Radiotherapy [7]. ...
... Inverted papilloma cases need to be follow-up for a minimum duration of 3 -5 years or even lifetime [7]. ...
Background
Sinonasal inverted papilloma or Schneiderian papilloma is a rare benign tumor of paranasal sinuses and nasal cavities. It can cause bone remodeling and has a significant malignant potential. Hence, it is very important to diagnose and treat the tumor at the earliest. Recurrence can occur even after surgical extensive resection.
Case presentation
This case report highlights a case of a 36-year-old male patient who presented with right-sided reduced vision, nasal blockage, headache, and occasional blood-tinged nasal discharge.
CT scan of paranasal sinuses revealed chronic sinonasal polyposis with secondary fungal colonization. MRI of the brain with orbit and PNS was suspicious for aggressive neoplastic disease with encasement of the cavernous sinuses and involvement of orbital fissure. The patient was operated for extended functional endoscopic sinus surgery. Histopathology revealed moderately differentiated invasive squamous cell carcinoma associated with Schneiderian (inverted) papilloma. Post-operatively, the patient received radiation for 4 weeks. Post-operative check nasal endoscopy was done 3 and 6 months after completion of radiotherapy which showed no evidence of recurrent disease with good healing and mucosalization of all the sinuses.
Conclusions
Sinonasal inverted papilloma, though a benign tumor, may turn malignant. Diagnosis is based on radiological investigations (in order to know the extent of the disease) and biopsy (to check if it is benign or additional malignancy present). Staging of the tumor helps in outlining the treatment protocol in each case. Post-surgery radiotherapy is indicated in cases where there is malignancy or complete resection of the tumor cannot be achieved. Meticulous follow-up of the post-operative patients is vital to check for recurrence.
... There is no consensus regarding whether clinical stage, treatment method, age, or occupation predict the malignant transformation of IP. Gender and history of sinus disease are found to be irrelevant to prognosis [23]. Controversies exist with regards to whether smoking increases the risk of malignant transformation of IP [14,26,27]. ...
Background:
Inverted papilloma (IP) is an unusual type of benign tumor that has high recurrence rates and the potential to transform into squamous cell carcinomas (SCC). The mechanism of the transformation process from IP to IP-SCC is uncertain and there is no consensus regarding the best practice for IP-SCC detection. The goal of this study is to identify the best clinical methods to detect for IP-SCC.
Methods:
An evidence-based review was performed using Medline and Ovid to obtain all articles up to October 10th, 2019 pertaining to identification of IP malignant transformation. All manuscripts discussing clinical methods or biomarkers were included.
Results:
Based on clinical research studies, convoluted cerebriform pattern and apparent diffusion coefficient values on Magnetic Resonance Imaging (MRI) can help differentiate benign IP from SCC and increased SUVmax on PET/CT is associated with higher probability of malignancy although not as specific. No consensus about the best biomarker for IP-SCC has been reached among researchers and continues to be exploratory.
Conclusion:
Endoscopy with biopsy is the gold standard practice to identify IP-SCC; however, MRI is the preferred imaging modality to recognize malignant transformation in cases where biopsy is difficult. Multiple biomarkers have shown positive results, but no single indicator with clinical significance for monitoring malignant transformation process has been found.
... x 10 -3 mm 2 /sec) (3). However, the mean ADC value is limited in that it does not represent the whole tumor, and malignant transformation may occur in small foci in the background of IP (2). ...
Objective:
Preoperative differentiation between inverted papilloma (IP) and its malignant transformation to squamous cell carcinoma (IP-SCC) is critical for patient management. We aimed to determine the diagnostic accuracy of conventional imaging features and histogram parameters obtained from whole tumor apparent diffusion coefficient (ADC) values to predict IP-SCC in patients with IP, using decision tree analysis.
Materials and methods:
In this retrospective study, we analyzed data generated from the records of 180 consecutive patients with histopathologically diagnosed IP or IP-SCC who underwent head and neck magnetic resonance imaging, including diffusion-weighted imaging and 62 patients were included in the study. To obtain whole tumor ADC values, the region of interest was placed to cover the entire volume of the tumor. Classification and regression tree analyses were performed to determine the most significant predictors of IP-SCC among multiple covariates. The final tree was selected by cross-validation pruning based on minimal error.
Results:
Of 62 patients with IP, 21 (34%) had IP-SCC. The decision tree analysis revealed that the loss of convoluted cerebriform pattern and the 20th percentile cutoff of ADC were the most significant predictors of IP-SCC. With these decision trees, the sensitivity, specificity, accuracy, and C-statistics were 86% (18 out of 21; 95% confidence interval [CI], 65-95%), 100% (41 out of 41; 95% CI, 91-100%), 95% (59 out of 61; 95% CI, 87-98%), and 0.966 (95% CI, 0.912-1.000), respectively.
Conclusion:
Decision tree analysis using conventional imaging features and histogram analysis of whole volume ADC could predict IP-SCC in patients with IP with high diagnostic accuracy.
... Detection of tumors at an early stage is thus of utmost importance, and may have a significant prognostic advantage. Regarding surgical margins, our findings for this aspect are also in accordance with the findings from several studies, 14,27,28 which have shown positive margins to be associated with poor survival outcomes. However, the positive margin rate noted in our study was higher compared with other studies. ...
Background
The prognostic factors and survival difference between inverted papilloma (IP)-associated sinonasal squamous cell carcinoma (SCC) and de novo SCC are unclear.
Objective
This study aimed to compare the clinical features and oncologic outcomes in patients with IP-associated SCC and de novo SCC; and additionally, to analyze the prognostic factors of the two types of SCCs.
Methods
Data from 173 SCC patients treated for IP-associated SCC (n = 89) and de novo SCC (n = 84), were reviewed retrospectively for demographic features, tumor characteristics, treatment modality, and clinical outcomes. 5-year overall survival (OS) and disease free survival (DFS) was analyzed using the Kaplan-Meier method, and Cox proportional hazards model was used to analyze factors influencing prognosis.
Results
A higher proportion of IP-associated SCC occurred in frontal and sphenoid sinus compared to de novo SCC. The two groups demonstrated similar 5-year OS and DFS (5-year OS: 63.3% and 55.4%, DFS: 45.4% and 50.1%, respectively). The metachronous tumor had a relatively better prognosis outcome than synchronous tumor and de novo SCC (5-year OS: 73.1%, 54.5% and 55.4%, respectively). Both groups showed similar loco-regional recurrence rates ( p > 0.05); however, de novo SCC tumors demonstrated an increased incidence of distant metastasis. Multivariate analysis indicated that age >70 years, advanced tumor stage and surgical margin were independent predictive factors for the risk of mortality (HR 2.047, 1.581 and 1.931, respectively).
Conclusion
IP-associated SCCs have an aggressive loco-regional tendency, whereas de novo SCCs have a higher aggressive distant metastatic propensity. Age, tumor stage and surgical positive margin are key factors for poor prognosis and should be routinely taken into consideration during treatment planning and subsequent surveillance.
... Apesar de histologicamente não apresentar atipia na sua forma primária, o PIN tem potencial para trans-formação maligna, sendo a taxa de conversão em carcinoma pavimento-celular (CPC) relatada de 5-15%. [14,15] Alguns autores consideram-no como uma lesão pré-maligna, apesar de não haver ainda evidência robusta sobre os factores de risco para malignização. [1,8] Recentemente, a desmogleína-3, uma proteína presente em 90% dos CPC, foi identificada em certas regiões do PIN (53%), podendo no futuro a sua análise ter utilidade como preditor de transformação maligna. ...
