Nielsen P L, Buchwald C, Nielsen L H, Tos M
Department of Pathology, Gentofte Hospital, Copenhagen, Denmark.
Laryngoscope. 1991 Oct;101(10):1094-101. doi: 10.1288/00005537-199110000-00012.
The initially removed tumors from 42 patients with inverted papillomas of the nasal cavity and paranasal sinuses were subjected to an extensive histopathological examination in order to define the characteristics associated with multiple recurrences and development of malignancy. Two of the patients subsequently developed squamous cell carcinoma and eight patients had more than one recurrence. No specific histological characteristic was determined to be a predictor of multiple recurrences or development of malignancy. However, three patterns of characteristics emerged from the data which were found to be related to the development of malignancy, multiple recurrences, and benign behaviour. Malignancy was found to be associated with bilateral inverted papilloma, a predominance of mature squamous epithelium, the presence of all three epithelial types (metaplastic squamous, mature squamous, and cylindrical), severe hyperkeratosis, a mitotic index greater than or equal to 2 per high-power field (HPF), absence of inflammatory polyps among the papillomas, an abundance of plasma cells, and an absence of neutrophils. Multiple recurrences (without malignancy) were associated with a mitotic index greater than or equal to 2 per HPF and an absence of inflammatory polyps. Benign behaviour was associated with predominantly mucinous tumors, a mitotic index less than 1 per HPF, a ratio of neoplastic epithelium/connective tissue stroma greater than or equal to 6, and the presence of inflammatory polyps among the papillomas.
对42例鼻腔及鼻窦内翻性乳头状瘤患者最初切除的肿瘤进行了广泛的组织病理学检查，以确定与多次复发及恶变相关的特征。其中2例患者随后发生了鳞状细胞癌，8例患者有不止一次复发。未确定任何特定的组织学特征可作为多次复发或恶变的预测指标。然而，从数据中出现了三种特征模式，发现它们与恶变、多次复发及良性行为的发生有关。发现恶变与双侧内翻性乳头状瘤、成熟鳞状上皮占优势、三种上皮类型（化生鳞状上皮、成熟鳞状上皮和柱状上皮）均存在、严重角化过度、每高倍视野（HPF）有丝分裂指数大于或等于2、乳头状瘤中无炎性息肉、大量浆细胞以及无中性粒细胞有关。多次复发（无恶变）与每HPF有丝分裂指数大于或等于2以及无炎性息肉有关。良性行为与主要为黏液性肿瘤、每HPF有丝分裂指数小于1、肿瘤上皮/结缔组织基质比例大于或等于6以及乳头状瘤中有炎性息肉有关。
