Current advances in the basic research and clinical management of sinonasal inverted papilloma (review).
Current advances in the basic research and clinical management of sinonasal inverted papilloma (review).
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DOI：
10.3892/or.17.3.495
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发表时间：
2007-03
期刊：
影响因子：
4.2
通讯作者：
A. Sauter;R. Matharu;K. Hörmann;R. Naim
中科院分区：
文献类型：
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作者：
A. Sauter;R. Matharu;K. Hörmann;R. Naim
内翻性乳头状瘤（IP）是一种良性鼻窦病变，已知有复发倾向，局部侵袭性和与鳞状细胞癌转化相关。由于高复发率，与恶性肿瘤的联系和多中心的趋势，手术治疗方法是有争议的。多年来，鼻内窥镜技术已从侧鼻切开术的侵袭性（整块）切除术缓慢发展。这一进展与内窥镜鼻窦手术在过去15年中取得的进展相对应。技术的进步使得在IP扩展到鼻窦区域之外之前就可以检测到IP，从而使微创技术能够用于治疗选定的IP病例。与鼻侧切开术或唇下脱套术相比，内窥镜治疗的复发率没有差异。在病因学方面，有一定的证据表明IP中HPV的存在可以预测恶性转化。尽管IP是单克隆增殖，但它们不符合原型前驱病变的特征。相反，EGFR和TGF-α表达增加与IP致癌的早期事件相关。角化过度、鳞状上皮增生和高有丝分裂指数等参数是阴性预后指标，可用于IP患者的未来随访。目前的文献应鼓励我们推荐使用一个统一接受的分期系统。延迟复发的倾向和最高13%的恶变发生率要求仔细，长期随访。
Inverted papilloma (IP) is a benign sinonasal lesion that has a known propensity for recurrence, local aggressiveness and an association with transformation to squamous cell carcinoma. Due to the high rate of recurrence, association with malignancy and a tendency of multicentricity, the surgical approaches to treatment are controversial. Over the years there has been a slow evolution from aggressive (en bloc) resection by lateral rhinotomy to endoscopic techniques. This progress corresponds to the advances that have been made in endoscopic sinus surgery over the past 15 years. Technological advances have allowed the detection of sinonasal IP before its extension beyond the sinonasal region, thus enabling minimally invasive techniques to be used in the treatment of selected cases of IP. Differences in recurrence rates were not observed for endoscopic management as compared with lateral rhinotomy or sublabial degloving approaches. In terms of aetiology there is certain evidence that the presence of HPV in IP could be predictive of malignant transformation. Although IPs are monoclonal proliferations, they do not fit the profile of a prototypic precursor lesion. In contrast, an increased EGFR and TGF-alpha expression is associated with early events in IP carcinogenesis. Parameters such as hyperkeratosis, squamous epithelial hyperplasia and a high mitotic index are negative prognostic indicators, which could be useful in the future follow-up of patients with IP. Present literature should encourage us to recommend the use of a uniformly accepted staging system. The propensity for delayed recurrences and the maximal 13% incidence of malignant transformation mandates careful, long-term follow-up.