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Patterns of Recurrence and Malignant Transformation in Sinonasal Papilloma: Implications for Long-term Follow-up
Takayuki Kimura1, Satoru Koike1, Hisatomo Tamaki1
1Department of Otolaryngology-Head and Neck Surgery, Kindai University, Faculty of Medicine, Osaka-Sayama, Japan.
Background/Aim:
Sinonasal papilloma is a histologically benign tumor that demonstrates locally aggressive behavior, with a propensity for recurrence and potential for malignant transformation. This study aimed to evaluate the clinical characteristics, recurrence patterns, and malignant transformation of sinonasal papillomas and to propose appropriate follow-up strategies.
Patients And Methods:
A retrospective analysis was conducted on 83 patients diagnosed with sinonasal papilloma at our institution. Clinical features, surgical treatments, recurrence intervals, and oncologic outcomes were analyzed. Tumors were staged using the Krouse classification for benign cases and UICC TNM staging for carcinoma-associated with papilloma cases.
Results:
Among 83 patients (62 men, 21 women; median age 68), 74 (89.2%) were diagnosed as benign papillomas and nine (10.8%) as carcinoma-associated with papilloma. The recurrence rate among benign cases was 14.9% (11/74), with a median time to recurrence of 5 years and two months. Recurrence intervals exhibited a trimodal distribution: within two years (36.4%), between 2-10 years (36.4%), and after 10 years (27.3%). Malignant transformation occurred in one case (1.2%), and eight additional cases were found to be associated with carcinoma. Five of these were initially misdiagnosed as benign, underscoring the diagnostic limitations of imaging modalities. Krouse T3/T4 lesions were more frequently associated with recurrence and malignancy. Approximately 48.6% of patients discontinued follow-up, often before reaching the threshold for late recurrence.
Conclusion:
Sinonasal papillomas require long-term surveillance beyond five years due to their potential for late recurrence and malignant transformation. Preoperative suspicion of malignancy remains challenging, particularly in Krouse T3 lesions. Clinicians should consider extended follow-up, especially in patients with advanced tumor stage, and adopt a tailored surgical strategy to achieve complete resection. Patient education regarding recurrence risk is essential for optimizing long-term outcomes.
