Abstract：
BACKGROUND: Inverted papillomas (IP) are benign epithelial tumors with a tendency to be locally invasive and with disposition to recur. The aim of our study is to present the results of IP treatment, considering pathological, immunohistochemical and molecular features of recurrence.
METHODS: From 1978 to 2020, 186 sinonasal IPs surgeries corresponding to 152 patients were treated in our center. We performed a pathology evaluation of all the recurrent cases reviewing the histological diagnosis, the presence of mixed component other than IP, the koilocytic changes, the p16 over expression and HPV-DNA detection.
RESULTS: Overall recurrence rate was 19 % (35/186). The 35 IP recurrences correspond to 22 patients, 9 of whom presented a single recurrence (single recurrence group) while 13 of them presented more than one recurrence (multi-recurrent group). Immunohistochemical analysis showed a higher percentage of p16 overexpression (54 % vs 33 % p = 0.415) and HPV-DNA presence (23 % vs 0 % p = 0.240) in the multi-recurrent group compared with single recurrence group. In addition, the revision showed more IP with exophytic papilloma focus (38 vs 22 % p = 0.648) and a higher proportion of IP with koilocytotic changes (61 % vs 22 % p = 0.099) in the multirecurrent group. There is no significant difference between groups in our results.
CONCLUSIONS: The analysis of our patients may differentiate between two groups with recurrent papillomas. A single recurrence group where the cause of recurrence is probably an anatomical problem related to an incomplete resection, and a second pattern, the multi-recurrence group, where HPV infection may be the main cause of recurrence.
METHODS: From 1978 to 2020, 186 sinonasal IPs surgeries corresponding to 152 patients were treated in our center. We performed a pathology evaluation of all the recurrent cases reviewing the histological diagnosis, the presence of mixed component other than IP, the koilocytic changes, the p16 over expression and HPV-DNA detection.
RESULTS: Overall recurrence rate was 19 % (35/186). The 35 IP recurrences correspond to 22 patients, 9 of whom presented a single recurrence (single recurrence group) while 13 of them presented more than one recurrence (multi-recurrent group). Immunohistochemical analysis showed a higher percentage of p16 overexpression (54 % vs 33 % p = 0.415) and HPV-DNA presence (23 % vs 0 % p = 0.240) in the multi-recurrent group compared with single recurrence group. In addition, the revision showed more IP with exophytic papilloma focus (38 vs 22 % p = 0.648) and a higher proportion of IP with koilocytotic changes (61 % vs 22 % p = 0.099) in the multirecurrent group. There is no significant difference between groups in our results.
CONCLUSIONS: The analysis of our patients may differentiate between two groups with recurrent papillomas. A single recurrence group where the cause of recurrence is probably an anatomical problem related to an incomplete resection, and a second pattern, the multi-recurrence group, where HPV infection may be the main cause of recurrence.
摘要：
背景：内翻性乳头状瘤（IP）是良性上皮性肿瘤，具有局部侵袭性和复发倾向。我们研究的目的是介绍IP治疗的结果，考虑到病态，复发的免疫组织化学和分子特征。
方法：从1978年到2020年，在我们中心治疗了186例对应152例患者的鼻窦IPs手术。我们对所有复发病例进行病理评估，回顾组织学诊断，IP以外的混合成分的存在，肾细胞的变化，p16过表达和HPV-DNA检测。
结果：总复发率为19%（35/186）。35例IP复发对应于22例患者，其中9例出现单次复发（单次复发组），而13例出现一次以上复发（多次复发组）。免疫组织化学分析显示，与单次复发组相比，多复发组中p16过表达（54％vs33％p=0.415）和HPV-DNA存在（23％vs0％p=0.240）的百分比更高。此外,修订显示,在多复发组中,发生外生性乳头状瘤病灶的IP较多(38vs22%p=0.648),发生肾细胞改变的IP比例较高(61%vs22%p=0.099).我们的结果在组间没有显著差异。
结论：对我们患者的分析可以区分两组复发性乳头状瘤。单一复发组，复发的原因可能是与不完全切除有关的解剖学问题，还有第二种模式，多复发组，其中HPV感染可能是复发的主要原因。
方法：从1978年到2020年，在我们中心治疗了186例对应152例患者的鼻窦IPs手术。我们对所有复发病例进行病理评估，回顾组织学诊断，IP以外的混合成分的存在，肾细胞的变化，p16过表达和HPV-DNA检测。
结果：总复发率为19%（35/186）。35例IP复发对应于22例患者，其中9例出现单次复发（单次复发组），而13例出现一次以上复发（多次复发组）。免疫组织化学分析显示，与单次复发组相比，多复发组中p16过表达（54％vs33％p=0.415）和HPV-DNA存在（23％vs0％p=0.240）的百分比更高。此外,修订显示,在多复发组中,发生外生性乳头状瘤病灶的IP较多(38vs22%p=0.648),发生肾细胞改变的IP比例较高(61%vs22%p=0.099).我们的结果在组间没有显著差异。
结论：对我们患者的分析可以区分两组复发性乳头状瘤。单一复发组，复发的原因可能是与不完全切除有关的解剖学问题，还有第二种模式，多复发组，其中HPV感染可能是复发的主要原因。
