Úvod: Invertovaný papilom (IP) je benigní nádor dutiny nosní a vedlejších dutiny nosních (VDN), který se často vyskytuje unilaterálně, s maximem výskytu ve věkové skupině 50–60 let a s vyšší incidencí mužského pohlaví. Diagnostika zahrnuje endoskopické vyšetření s odběrem biopsie a provedení zobrazovacího vyšetření k určení rozsahu nádoru. Léčba IP je primárně chirurgická s preferencí endoskopické endonazální resekce. Metody a materiál: V našem souboru bylo retrospektivně za období od 1. 1. 2013 do 31. 12. 2023 analyzováno 34 pacientů s IP, z nichž mělo 94 % jednostranný výskyt. Nejčastější lokalizací nádoru byla laterální stěna nosní, následovaná čelistní dutinou. Výsledky: V našem souboru byla endoskopická resekce IP použita u 42 % operací. U rozsáhlejších nádorů nebo recidiv byly použity kombinované či zevní přístupy. Recidiva IP se objevila u 52 % pacientů do 2 let od operace, z celkového počtu pacientů došlo u 26 % k jedné recidivě a u 10 % pacientů se recidiva vyskytla vícekrát za sledované období. Závěr: Radikalita operace (R0 okraj resekce) má zásadní význam pro vyléčení IP. Dlouhodobé sledování je doporučeno pro snížení rizika recidiv a sledování možné maligní transformace.
Introduction: Inverted papilloma (IP) is a benign tumor of the nasal cavity and paranasal sinuses (PNS) that typically manifests unilaterally, peaks in incidence in 50–60 year-olds, and is more common in men. An endoscopic examination, including biopsy and imaging to ascertain the tumor‘s extent, is part of the diagnosis. IP is mainly treated surgically, with endoscopic endonasal resection being the preferred procedure. Methods and materials: In total, 34 IP patients in our group between 2013 and the end of 2023 were retrospectively analysed. Approximately 94% of them experienced unilateral incidence. The maxillary cavity and lateral wall of the nasal cavity were the tumor‘s most frequent locations. Results: Endoscopic IP resection was utilized in 42% of the procedures in our group. Combined or external procedures were used for larger tumors or recurrences. Within two years following surgery, 52% of patients experienced a recurrence of IP. Of the total number of patients, 26% experienced one recurrence, and 10% experienced more than one recurrence throughout the monitored period. Conclusions: For the treatment of IP, the radicality of the procedure (negative resection margine) is crucial. Long-term follow-up is advised to lower the chance of recurrences and to distinguish any potential malignant transformation.
- MeSH
- Adult MeSH
- Natural Orifice Endoscopic Surgery classification methods instrumentation MeSH
- Papilloma, Inverted * surgery diagnostic imaging diagnosis classification MeSH
- Middle Aged MeSH
- Humans MeSH
- Nose Neoplasms surgery diagnosis classification pathology MeSH
- Recurrence MeSH
- Retrospective Studies MeSH
- Tertiary Prevention MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
Background: Papillary lesions of the breast are a heterogeneous group, encompassing a wide range of lesions. The histologic distinction between papillary breast lesions remains challenging, especially on core biopsy specimens. Aim: This study aimed to determine the rate of upgrade to atypia or malignancy of biopsy-proven papillary lesions on surgical follow-up and to assess for factors associated with an upgrade in Greater Vancouver, BC, Canada. Materials and Methods: This is a retrospective population-based study of all breast papillary lesions diagnosed on core biopsy between 2017 and 2019 in the Fraser Health Authority in Greater Vancouver, Canada. Patients were retrieved from the laboratory information system. Patient demographics, histopathologic, and radiologic findings were analyzed. Results: A total of 269 specimens from 269 patients (mean 61.1 years), including 265 female and 4 male patients, were included in the study. Of the 269 specimens, 129 (48%) were intraductal papillomas and 140 (52%) were atypical papillary lesions. The overall upgrade rate among papillomas was 11.6% (15 of 129) on final excision. The mean age of patients diagnosed with papilloma on core biopsy was significantly younger than those with atypical papillary lesions (55.6 vs 66.1 years, P < .0001). Lesion size in patients with papillomas on core biopsy was significantly smaller than those with atypical papillary lesions (11.1 vs 15.1 mm, P = .001). The upgrade rates in patients <55 and ≥55 years were 4.9% and 13.2%. Size (P = .004) and atypia on core biopsy (P = .009) were significantly associated with upgrade. Older age (>55 years) (OR = 5.3, 95% CI: 1.04-27.08) was an independent predictor of upgrade among papillomas. Size, location, and Breast Imaging-Reporting and Data System (BI-RADS) radiologic categories in our study were not associated with predicting the upgrade of papillomas. Conclusion: Our data suggest that the risk of upgrade to atypia or malignancy is sufficient to warrant the excision of benign papillomas of any size in patients aged ≥55 years. In patients younger than 55 years, observation with close clinical and radiological follow-up without surgery may be sufficient. Our findings also support surgical excision of papillomas diagnosed on core biopsy when associated with atypia.
- MeSH
- Papillomavirus Infections * diagnosis drug therapy prevention & control MeSH
- Humans MeSH
- Human Papillomavirus Viruses pathogenicity MeSH
- Uterine Cervical Neoplasms etiology virology MeSH
- Oropharyngeal Neoplasms etiology virology MeSH
- Papilloma etiology virology MeSH
- Primary Prevention methods MeSH
- Papillomavirus Vaccines therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Diagnostic Imaging methods MeSH
- Respiratory System diagnostic imaging pathology MeSH
- Humans MeSH
- Papilloma * diagnostic imaging MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Respiratory System pathology MeSH
- Histological Techniques MeSH
- Humans MeSH
- Papilloma * diagnosis MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Chemotherapy, Adjuvant MeSH
- Surgical Procedures, Operative MeSH
- Humans MeSH
- Papilloma * therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Larynx pathology MeSH
- Humans MeSH
- Papilloma * epidemiology physiopathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
