Endoscopic Management of Inverted Papilloma Using CT Scan as the Predictor of Tumour Origin
Article Sidebar
Main Article Content
Abstract
Introduction
Inverted papillomas are notorious for recurrence. The surgical cause attributed to recurrence is failure to achieve good surgical exposure and inadequate clearance of disease. Pre-operative prediction about the site of origin by CT Scan may contribute to a better surgical outcome. This study was undertaken to assess if focal hyperostosis on pre-operative CT scan can be considered to be a predictor of the site of tumour origin and correlate with endoscopic finding of the site of origin.
Materials and Method
A prospective descriptive study was carried out between Jan 2014 and May 2016. Fifteen patients of histopathologically proven inverted papilloma that reported during this time period were evaluated using contrast enhanced CT Scan and subsequently underwent endoscopic excision of tumour identifying the tumour origin. Assessment of age, gender, symptoms, pre-operative staging, location of the tumour origin on CT Scan and surgical correlation of origin was done. Post-operative follow-up was done at 1 month, 3 months and 6 monthly thereafter.
Results
Six (40%) were classified as Krouse II and nine (60%) were classified as Krouse III. 12 (80%) arising from maxillary sinus, 02 (13.3%) arising from maxillary sinus and anterior ethmoids and 01 (6.7%) from sphenoid. Thirteen (86.7%) cases CT scan could predict the tumour origin which was confirmed during surgery. All cases managed by endoscopic technique with no recurrence or co-existence of malignancy.
Discussion
Focal hyperostosis in the walls of paranasal sinus is seen to be associated with IP tumour origin, the cause of which is not fully understood. It is hypothesized that tumour induced inflammation at the site of origin leads to bone remodeling and increased bone deposition with vascularity at the site of attachment.
Conclusion
CT scan is a good predictor of tumour origin and a conservative endoscopic approach can be planned accordingly for complete clearance of disease.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
Ward N. A mirror of the practice of medicine and surgery in the hospitals of London. London Hosp Lancet. 1854; 2:480-2
Kramer R, Som ML. True papilloma of the nasal cavity. Arch Otolaryngol. 1935; 22-43
Ringertz N. Pathology of malignant tumors arising in the nasal and paranasal cavities and maxilla. Acta Otolaryngol (Stockh). 1938; 27 (Suppl): 31-42
Shanmugaratnam K, and Sobin LH. The World Health Organization histological classification of tumors of the upper respiratory tract and ear. A commentary on the second edition. Cancer 1993; 71:2689-97
Shafik N. Wassef, Pete S. Batra, Samuel Barnett. Skull Base Inverted Papilloma: A Comprehensive Review. International Scholarly Research Network. 2012, Article ID 175903, 34 pages
Woodruff WW, Vrabec D P. Inverted papilloma of the nasal vault and parana-
sal sinuses: spectrum of CT findings. AJR Am J Roentgenol. 1994; 162:419-23
Krouse JH. Development of a staging system for inverted papilloma. Laryngoscope 2000; 110(6):965-8
Fábio de Azevedo Caparroz, Luciano Lobato Gregório, Eduardo Macoto Kosugi. Evolution of endoscopic surgery in the treatment of inverted papilloma. Braz J Otorhinolaryngol. 2013;79(1):13-7
Dong-Young Kim, MD; Sung-Lyong Hong, MD; Chul Hee Lee, MD et al. Inverted Papilloma of the Nasal Cavity and Paranasal Sinuses: A Korean Multicenter Study. Laryngoscope 2012; 122:487-94
Cheng TY, Ueng SH, Chen YL, et al. Oncocytic Schneiderian papilloma found in a recurrent chronic paranasal sinusitis. Chang Gung Med J. 2006; 29:336-41
Savy L, Lloyd G, Lund VJ, et al. Optimum imaging for inverted papilloma. J Laryngol Otol. 2000; 114:891-3
Lee DK, Chung SK, Dhong HJ, Kim HY, Kim HJ, Bok KH. Focal hyperostosis on CT of sinonasal inverted papilloma as a predictor of tumour origin. AJNR Am J Neuroradiol. 2007; 28(4):618-21
Bhalla RK, Wright ED. Predicting the site of attachment of sinonasal inverted papilloma. Rhinology 2009; 47(4):345-8
Chiu AG, Jackman AH, Antunes MB, Feldman MD, Palmer JN. Radiographic and histologic analysis of the bones underlying inverted papilloma. Laryngoscope 2006;116(9):1617-20
Lund VJ, Lloyd GA. Radiological changes associated with inverted papilloma
of the nose and paranasal sinuses. Br J Radiol. 1984; 57:455-61
PD Karkos, G Fyrmpas, SC Carrie, AC Swift. Endoscopic versus open surgical interventions for inverted nasal papilloma: a systematic review. Clinical Otolaryngology 2006; 31:499-503.