Inverted papillomas: Description, Causes and Risk Factors:
Inverted papillomas are rare tumors of the nasal cavity and paranasal sinuses. These tumors are commonly regarded as benign lesions; nevertheless, malignant transformation occurs in up to 13% of cases.
Currently, human papilloma viruses (HPVs) are accepted as tumor-inducing and -promoting agents involved in benign and malignant tumors of mucosal tissues in the upper aerodigestive tract. To date more than 80 HPV types have been identified by differences in the nucleotide sequences. Several types (e.g., HPV16, HPV18) are associated with an increased risk for developing cancer. Other types (e.g., HPV6/11) are identified more frequently in benign lesions of stratified mucous membranes. We detected HPV genomes by universal and specific primer polymerase chain reaction. Using degenerated primers derived from the L1 major envelope gene, an amplification of HPV DNA fragments of the correct size was observed in 7 of 21 cases. In one specimen, where an Inverted papillomas associated with a squamous cell carcinoma was histologically confirmed, HPV18-specific primers detected the HPV18 genome. The tumors in which an amplification of HPV DNA fragments were observed showed the highest proliferation scores along with the highest rate of aneuploid cells detected by quantitative DNA analysis.
The nasal papilloma is not to be confused with a nasal polyp. While polyps usually occur bilaterally, the nasal papilloma is usually found only on one side. The cells, which forms a papilloma are similar, while those of the polyps, they can change but as they grow they no longer look like the actual nasal mucosa. Papillomas grow displacing, meaning that the adjacent tissue is pushed aside, but not destroyed.
A special feature is the Inverted papillomas here in the nasal cavity. The inverted papilloma displaced not only the adjacent tissue, but also destroyed it. It is even able to destroy the bone. In an inverted papilloma malignant tumors can occur - this being what causes the cancer.
Surgery is the primary treatment of inverted papilloma. The likelihood of local recurrence varies from less than 5% to over 50%, depending on the extent of resection. There is likely no significant difference in the risk of local recurrence after open compared with endoscopic resection. The probability of local recurrence and/or death from tumor is increased if Inverted papillomas is associated with squamous cell carcinoma. The likelihood of cure is approximately 50% when malignancy is present and postoperative radiotherapy should be considered for the majority of patients. A small subset of patients with inverted papilloma present with incompletely resectable disease. Definitive radiotherapy using doses between 65 and 70 Gy will locally control gross disease in the majority of patients.
With the growth of nasal polyps which usually occur on both sides of the nose of the persons, the person concerned increasingly difficult to breathe through the nose. They breathe therefore through the mouth, which can be very unpleasant. Breathing through the mouth can provoke snoring and it promotes recurrent infections of the upper respiratory
way, the sinus and ear infections
. Patients often complain that they suffer more often from headaches and have a double vision.
A large nasal papilloma appears, upon closer look into the nose, as a shiny glassy structure, which the doctor can see with the naked eye. Small polyps are known only by a nose reflection, being recognized only at a rhinoscopy. This thing is being observed with a nose spreader or by using a nasal endoscope, a rigid or a flexible tube, built with a light source and a camera, so the doctor can see the condition of the nasal mucosa.
In order to know how much of the nasal papilloma has already been extended, and what size it has reached, a computed tomography (CT) and a magnetic resonance imaging (MRI) will be done. The advantage of the magnetic resonance imaging is that it is used in contrast to computed tomography for the investigation of any X-rays. This is very benefic for the patient, because during the examination, he is not exposed to any radiation. These studies are very important because it can be seen clearly the extent of the nasal papilloma, and the doctor will know what to do next.
The preferred treatment of inverted papilloma is surgery; postoperative radiotherapy is added if it is associated with squamous cell carcinoma. The likelihood of local recurrence after surgery for inverted papilloma may be substantial and varies with the extent of resection. Definitive radiotherapy may be used to successfully treat patients with incompletely resectable inverted papilloma.
From an inverted papilloma of the nasal cavity it may develop a malignant tumor. Therefore, it is important to completely remove the nasal papilloma in order to prevent the appearance of cancer. In some cases, after a successful operation the pacient can experience a relapse of the papilloma, and thus a further formation of a new papilloma occur. This should then be operated again and removed.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.