Management of sinonasal inverting papilloma with recurrence and malignant transformation

Objective: To investigate the clinical characteristics and optimum management of sinonasal inverting papilloma with recurrence and malignant transformation.

Methods: Retrospective analysis of inverting papilloma with recurrence and malignant transformation treated from 1990 to 2000 in PLA general hospital.

Results: All the 22 patients with recurrence had the history of sinonasal surgery. Among them, 13 patients recurred once, 7 recurred 2 times, 1 recurred 3 times and 1 recurred 4 times. The recurrence time was from 3 months to 11 years. Among the 22 patients with recurrence, the recurrence ratio of different surgery was different, for example intranasal approach was 100%, maxillectomy 60% and lateral rhinotomy 42%, 10 patients were operated with endoscope or endoscopic assisted surgery with no recurrence after 1-5 year's follow-up. Among 8 patients with malignant transformation, 4 received lateral rhinotomy, 1 Caldwell-Luc operation, all of them were given radiation therapy after operation (40-70 Gy) and no recurrence were found during 2 to 6 years follow-up. Of the other 3 patients, 2 died and 1 lost follow-up.

Conclusions: The endoscopic surgery(including the method of endoscopy combined with extranasal incision) is the optimum management for inverting papilloma in nasal cavity and paranasal sinuses. To the patients with malignant tumors, extensive excision and post-operative radiotherapy should be considered, but the prognosis is not satisfactory.