Furuta Y
Department of Otolaryngology, Hokkaido University School of Medicine, Sapporo.
Hokkaido Igaku Zasshi. 1990 Nov;65(6):568-82.
Nasal inverted papilloma (IP) is a rare benign tumor that involves the mucous membranes of the nasal cavity and paranasal sinuses. Postoperative recurrences of this tumor have been observed frequently, and an association with squamous cell carcinoma (SCC) has been described occasionally. The etiology of IP remains unknown, but some studies have suggested a possible causative role of human papillomavirus (HPV) in IP. To determine the etiological role of HPV in IP and SCC associated with IP, to clarify the relationship between HPV and malignant transformation of IP, and to study the possibility of HPV implication in SCC of the nasal cavities and paranasal sinuses, retrospective analysis of HPV infection was performed in the surgically resected specimens of inverted papilloma (n = 26, in which 7 patients had SCC) and SCC (n = 40) of the nasal cavities and paranasal sinuses. Pathologically, koilocytosis, which is known to be closely related to HPV infection, and epithelial atypia were investigated. To detect the HPV protein antigen or nucleic acids, immunohistochemical method and molecular pathologic techniques, or in situ hybridization (ISH) and polymerase chain reaction (PCR) of DNA extracted from paraffin embedded tissues were used. By ISH we detected HPV 11 DNA in three cases (12%) of IP and HPV 16 DNA in one case (4%) of IP with SCC. By PCR HPV16 was detected in 2 of 7 cases in which IP was associated with SCC. However, no protein antigen was detected in any cases of IP by immunostaining, and viral mRNA was not detected by the study of ISH after DNase digestion. Pathologically, there was a closed relationship between HPV infection and koilocytosis, and severe epithelial atypia was frequently seen in the cases of IP coexisted with SCC. But there was no clear relationship between HPV infection and recurrence of IP. In SCC, HPV 16 and HPV 18 were detected by PCR in 4 cases (10%) and in one case (2.5%), respectively. Thus, it was suggested that HPVs were involved in the development of IP in some cases (19%, 5/26), but the state of infection is somewhat different from other papillomatous lesions, such as genital condylomas or laryngeal papillomas. HPV 16 and HPV 18 were found to be related to the malignant transformation of IP and to the pathogenesis of SCC originated in the nasal cavities and paranasal sinuses.
鼻腔内翻性乳头状瘤（IP）是一种罕见的良性肿瘤，累及鼻腔和鼻窦黏膜。该肿瘤术后复发较为常见，偶尔也有与鳞状细胞癌（SCC）相关的报道。IP的病因尚不清楚，但一些研究表明人乳头瘤病毒（HPV）在IP中可能起致病作用。为确定HPV在IP及与IP相关的SCC中的病因学作用，阐明HPV与IP恶变之间的关系，并研究HPV在鼻腔和鼻窦SCC中的可能作用，对手术切除的鼻腔和鼻窦内翻性乳头状瘤标本（n = 26，其中7例合并SCC）及SCC标本（n = 40）进行了HPV感染的回顾性分析。病理上，研究了与HPV感染密切相关的凹空细胞及上皮异型性。为检测HPV蛋白抗原或核酸，采用免疫组化方法、分子病理技术，或对石蜡包埋组织提取的DNA进行原位杂交（ISH）和聚合酶链反应（PCR）。通过ISH，在3例（12%）IP中检测到HPV 11 DNA，在1例合并SCC的IP中检测到HPV 16 DNA。通过PCR，在7例合并SCC的IP中有2例检测到HPV16。然而，免疫染色在任何IP病例中均未检测到蛋白抗原，DNase消化后ISH研究也未检测到病毒mRNA。病理上，HPV感染与凹空细胞密切相关，IP合并SCC时常见严重上皮异型性。但HPV感染与IP复发之间无明确关系。在SCC中，通过PCR分别在4例（10%）和1例（2.5%）中检测到HPV 16和HPV 18。因此，提示HPV在某些病例（19%，5/26）中参与了IP的发生，但感染状态与其他乳头状病变如生殖器尖锐湿疣或喉乳头状瘤有所不同。发现HPV 16和HPV 18与IP的恶变及起源于鼻腔和鼻窦的SCC的发病机制有关。
