Kuan Edward C, Frederick John W, Palma Diaz Miguel F, Lim Dean W, Suh Jeffrey D
Allergy Rhinol (Providence). 2017 Jun 1;8(2):105-108. doi: 10.2500/ar.2017.8.0201.
Inverted papilloma (IP) is the most common benign sinonasal neoplasm. Endoscopic techniques, improved understanding of pathophysiology, and novel surgical approaches have allowed rhinologists to treat IPs more effectively, with surgery being the mainstay of therapy. Frontal sinus IP poses a challenge for surgical therapy due to complex anatomy and potentially difficult surgical access.
We reported a unique case of a massive frontal sinus IP that presented with intracranial and orbital extension, with near resolution after chemotherapy.
A retrospective case review of a patient with a frontal sinus IP treated at a tertiary academic medical center.
A 75-year-old male patient presented with nasal obstruction, purulent nasal discharge, and a growing left supraorbital mass. Endoscopy demonstrated a mass that filled both frontal and ethmoid sinuses, with orbital invasion. There also was substantial erosion of the posterior table, which measured 1.73 × 1.40 cm. A biopsy specimen demonstrated IP with carcinoma in situ. The patient was deemed unresectable on initial evaluation and, subsequently, underwent chemotherapy (carboplatin and paclitaxel). The tumor had a dramatic response to chemotherapy, and the patient elected for definitive surgery to remove any residual disease. During surgery, only a small focus of IP was found along the superior wall of the frontal sinus. No tumor was found elsewhere, including at the site of skull base erosion. The final pathology was IP without carcinoma in situ or dysplasia.
This was the first reported case of chemotherapeutic "debulking" of IP, which facilitated surgical resection, despite substantial intracranial and orbital involvement. Although nearly all IPs can be treated surgically, rare cases, such as unresectable tumors, may benefit from systemic chemotherapy.
内翻性乳头状瘤（IP）是最常见的鼻窦良性肿瘤。内镜技术、对病理生理学认识的提高以及新颖的手术方法使鼻科医生能够更有效地治疗IP，手术是主要治疗手段。由于解剖结构复杂且手术入路可能困难，额窦IP给手术治疗带来挑战。
我们报告了1例巨大额窦IP伴颅内和眶内侵犯的独特病例，化疗后肿瘤几乎完全消退。
对在一家三级学术医疗中心接受治疗的额窦IP患者进行回顾性病例分析。
一名75岁男性患者出现鼻塞、脓性鼻涕和左侧眶上肿块增大。内镜检查显示肿块充满额窦和筛窦，并侵犯眼眶。后筛板也有明显侵蚀，大小为1.73×1.40 cm。活检标本显示为伴有原位癌的IP。患者在初始评估时被认为无法切除，随后接受化疗（卡铂和紫杉醇）。肿瘤对化疗反应显著，患者选择行确定性手术以清除任何残留病灶。手术中，仅在额窦上壁发现一小片IP病灶。其他部位未发现肿瘤，包括颅底侵蚀部位。最终病理结果为无原位癌或发育异常的IP。
这是首例报道的IP化疗“减瘤”病例，尽管肿瘤有大量颅内和眶内侵犯，但化疗促进了手术切除。虽然几乎所有IP都可通过手术治疗，但罕见病例，如无法切除的肿瘤，可能从全身化疗中获益。
