Sinonasal Inverted Papillomas: Predictors of Recurrence and Malignant Transformation

Area of Science:

• Otolaryngology
• Oncology
• Pathology

Background:

• Sinonasal inverted papillomas (IPs) are uncommon benign tumors with significant recurrence rates (~15%) and a risk of malignant transformation (~8%).
• Human papillomavirus (HPV) has been implicated as a potential risk factor in the malignant transformation of IPs.

Purpose of the Study:

• To identify clinical, molecular, and immunohistochemical factors predicting recurrence and malignant transformation in sinonasal inverted papillomas.
• To evaluate the association of HPV DNA and p16 expression with IP outcomes.

Main Methods:

• Retrospective analysis of 73 patients with histologically confirmed IPs treated at tertiary ENT centers.
• Inclusion of radiologic data, HPV DNA detection, and p16 immunohistochemistry.
• Univariate and multivariable logistic regression analyses to identify associated factors.

Main Results:

• Recurrence (19%) was linked to longer symptom duration, smoking, advanced Krouse stage (III-IV), frontal sinus origin, HPV+ DNA, and reduced p16 expression.
• Malignant transformation (12%) was associated with smoking.
• HPV+ status was not significantly associated with malignancy (p=1.00).

Conclusions:

• Advanced stage, smoking, longer symptom duration, frontal sinus origin, HPV positivity, and p16 loss are associated with IP recurrence.
• Smoking is a significant factor in the malignant transformation of IPs.
• Further research may clarify the role of HPV in IP progression.