Inverted Papilloma of the Orbit and Nasolacrimal System.
Inverted Papilloma of the Orbit and Nasolacrimal System.
复制标题
眼眶和鼻泪系统的内翻性乳头状瘤。
DOI：
10.1097/iop.0000000000001719
复制
发表时间：
2020
影响因子：
2
通讯作者：
A. Barmettler
中科院分区：
文献类型：
--
作者：
Jessie Wang;J. Ford;B. Esmaeli;P. Langer;N. Esmaili;Gregory J. Griepentrog;S. Couch;J. Nguyen;Katherine G. Gold;K. Duerksen;C. Burkat;M. Hartstein;P. Gandhi;R. Sobel;Jee;A. Barmettler
目的
眼周内翻性乳头状瘤（IP）是一种罕见的局部侵袭性肿瘤，具有复发和恶变的倾向。历史上通过广泛切除进行治疗，本研究检查了眼周IP的特征和治疗，比较了局限于鼻泪管系统和侵入眼眶的IP。
方法
对 15 个临床中心的眼眶或鼻泪系统 IP 患者进行了一项经机构审查委员会批准、符合健康保险流通和责任法案的回顾性、比较病例系列研究。
结果
在 25 名患者中，22 名符合纳入标准，其中 9 名仅限于鼻泪系统，13 名侵犯眼眶。平均年龄为60.4岁，55%为女性，均为单侧。平均随访时间为 48 个月。与普通人群相比，吸烟、灰尘和/或气溶胶暴露、人乳头瘤病毒 (HPV) 状态和炎性息肉的发生率均升高（分别为 45%、18%、18% 和 14%）。计算机断层扫描显示的骨侵蚀与侵入眼眶的 IP 在统计学上显着相关（p = 0.002）。治疗涉及所有局限性 IP 单独接受手术，而 39% 的眼眶侵犯 IP 还接受放射治疗和/或化疗 (p = 0.054)。与局限于鼻泪系统的 IP 相比，侵入眼眶的 IP 更有可能被大范围切除（85% vs. 22%，p = 0.007）。 IP 导致的总体恶性肿瘤率、复发率和患者死亡率分别为 27%、23% 和 9%。
结论
侵入眼眶的 IP 通常需要积极治疗，而局限于鼻泪系统的 IP 可能需要更保守的治疗。利用风险因素、特征和结果，创建了治疗算法来指导管理。
PURPOSE
Periocular inverted papilloma (IP) is a rare, locally aggressive tumor with a propensity for recurrence and malignant transformation. Historically treated via wide excision, this study examines the characteristics and management of periocular IP, comparing those confined to the nasolacrimal system with those invading the orbit.
METHODS
An Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant retrospective, comparative case series was conducted in patients with IP of the orbit or nasolacrimal system across 15 clinical sites.
RESULTS
Of 25 patients, 22 met inclusion criteria with 9 limited to the nasolacrimal system and 13 invading the orbit. Mean age was 60.4 years, 55% were women, all were unilateral. Mean follow-up was 48 months. Rates of smoking, dust and/or aerosol exposure, human papillomavirus (HPV) status, and inflammatory polyps were elevated compared to rates in the general population (45%, 18%, 18%, and 14%, respectively). Bony erosion on computed tomography scans was statistically significantly associated with orbit-invading IP (p = 0.002). Treatment involved all confined IP undergoing surgery alone while 39% of orbit-invading IP also received radiation therapy and/or chemotherapy (p = 0.054). Orbit-invading IP was more likely to be excised with wide margins than IP confined to the nasolacrimal system (85% vs. 22%, p = 0.007). Overall rates of malignancy, recurrence, and patient mortality from IP were found to be 27%, 23%, and 9%, respectively.
CONCLUSIONS
IP invading the orbit typically requires aggressive therapy, while IP confined to the nasolacrimal system may be treated more conservatively. Using risk factors, characteristics, and outcomes, a treatment algorithm was created to guide management.