Gilain L, Planquart X, Le Lièvre G, Gamain J, Coste A, Peynègre R
Service d'Oto-Rhino-Laryngologie, Centre Hospitalier Intercommunal, Créteil.
Ann Otolaryngol Chir Cervicofac. 1992;109(8):402-8; discussion 408-9.
The authors report about 18 cases of inverted papillomas treated between 1981 and 1991. The average age of the patients is 51 years, with a marked male predominance. The average follow-up is of 4 years. The most often noted revealing sign is unilateral nasal obstruction. A history of polypectomy and nasosinual surgery is found in 45% of the cases in our series. The treatment was surgical in all cases, including 4 De Lima's procedures, 11 procedures through a paralateronasal approach, 2 ethmoidectomies through an endonasal approach, and 1 degloving for a septal lesion. Endonasal surgery was performed for two limited tumors, for which the diagnosis of inverted papilloma never could be made preoperatively. The recurrence rate observed in our series is 5%. Out of 18 patients, 4 presented with a malignant change, either at once (2 cases) or some time after the primary exeresis of the inverted papilloma (2 cases). In the light of the results, and after analyzing the literature, the authors reassert the necessity of radical exeresis for inverted papilloma. Rhinosinual endoscopy must remain a diagnostic means and never is an indication of exeresis of inverted papilloma. The authors emphasize the difficulty of the histological diagnosis and set forth the various problems arising from the malignant degeneration of inverted papillomas. Recent discoveries on viral etiopathogenesis and on the oncogenic potential of the type-16 papilloma virus may allow characterizing the evolutive and prognostic features of inverted papillomas in the future.
作者报告了1981年至1991年间治疗的18例内翻性乳头状瘤病例。患者的平均年龄为51岁，男性明显居多。平均随访时间为4年。最常出现的首发症状是单侧鼻塞。在我们的系列病例中，45%的患者有息肉切除术和鼻窦手术史。所有病例均采用手术治疗，包括4例德利马手术、11例经鼻旁途径手术、2例经鼻内途径筛窦切除术以及1例因鼻中隔病变行掀翻术。有两个局限性肿瘤采用了鼻内手术，术前均未能诊断为内翻性乳头状瘤。我们系列病例中的复发率为5%。18例患者中，4例出现恶变，其中2例为即刻恶变，2例为内翻性乳头状瘤初次切除术后一段时间恶变。根据结果并分析文献后，作者重申了内翻性乳头状瘤根治性切除的必要性。鼻内镜检查必须始终作为一种诊断手段，绝不能作为内翻性乳头状瘤切除的指征。作者强调了组织学诊断的困难，并阐述了内翻性乳头状瘤恶变引发的各种问题。关于病毒病因学和16型乳头状瘤病毒致癌潜力的最新发现，可能有助于在未来明确内翻性乳头状瘤的演变和预后特征。
