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Unique characteristics of malignant schneiderian papilloma
D Nachtigal1, A Yoskovitch, S Frenkiel
1Department of Otolaryngology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Purpose:
To ascertain the characteristics unique to malignant schneiderian papilloma (MSP).
Methods:
A case-control study of all schneiderian papilloma (SP) patients treated between 1978 and 1997 was conducted. Comparison was made between patients with MSP and patients with benign SP (BSP).
Results:
A diagnosis of SP was made in 72 patients. Malignant changes, all of them the inverted papilloma subtype, were found in 8 of these patients. Three were diagnosed carcinoma in situ, and 5 were defined as invasive squamous cell carcinoma. At presentation, the MSP patients had significantly larger tumor spread into the ethmoid and sphenoid sinuses. The recurrence rate was significantly lower in SP patients treated with extensive surgical procedures. An association was found between the presence of malignant lesions and positive smoking history, subjective awareness of a nasal mass, and ethmoid and sphenoid sinus involvement. Also, histologic multicentricity was a feature more often seen in MSP than BSP and was a significant correlate with malignancy.
Conclusion:
The physician evaluating a patient with SP should be aware of the features described and of their possible association with a malignant lesion.
Insights
Malignant schneiderian papilloma (MSP) presents with larger tumor spread and is associated with smoking history. Awareness of these features aids in diagnosing malignant lesions in schneiderian papilloma (SP) patients.
Area of Science:
- Otolaryngology
- Head and Neck Surgery
- Pathology
Background:
- Schneiderian papilloma (SP) is a sinonasal tumor.
- Malignant transformation of SP is rare but significant.
- Understanding unique features of malignant SP (MSP) is crucial for diagnosis and management.
Purpose of the Study:
- To identify distinguishing characteristics of malignant schneiderian papilloma (MSP).
- To compare features of MSP with benign SP (BSP).
Main Methods:
- Case-control study of 72 SP patients treated from 1978 to 1997.
- Comparison between MSP and BSP patient groups.
- Analysis of tumor spread, recurrence rates, and associated factors.
Main Results:
- Eight patients (11%) had MSP, all of the inverted papilloma subtype.
- MSP cases included carcinoma in situ and invasive squamous cell carcinoma.
- MSP patients exhibited greater tumor spread to ethmoid and sphenoid sinuses.
- Positive smoking history, nasal mass awareness, and sinus involvement correlated with malignancy.
- Histologic multicentricity was more frequent in MSP and linked to malignancy.
Conclusions:
- Physicians should recognize specific features suggestive of malignant transformation in SP.
- Early identification of MSP can improve patient outcomes.
- Further research into risk factors and diagnostic markers for MSP is warranted.