원저

비·부비동 반전성 유두종에 관한 새로운 Pathologic Grading System

노환중1,*, 이현순1, 박도윤2, , ,
Hwan-Jung Roh1,*, Hyun-Sun Lee1, Do-Yoon Park2, Gary Procop3, Martin J Citardi4, Donald C Lanza4
Author Information & Copyright
1부산대학교 의과대학 이비인후과학교실
2병리학교실
3클리브렌드 클리닉 병리학교실
4클리브렌드 클리닉 이비인후과학교실
1Department of Otolaryngology, College of Medicine, Pusan National University, Busan, Korea
2Pathology, College of Medicine, Pusan National University, Busan, Korea
3Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.
4Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.
*교신저자: 노환중, 602-739 부산광역시 서구 아미동 1가 부산대학교 의과대학 이비인후과학교실 전화: (051) 240-7333·전송: (051) 246-8668 E-mail: rohhj@pusan.ac.kr

© Copyright 2004 The Busan, Ulsan, Gyeoungnam Branch of Korean Society of Otolaryngology-Head and Neck Surgery. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: Apr 11, 2004; Accepted: May 31, 2004

Published Online: May 31, 2020

ABSTRACT

Background: Despite textbook classifications for the varied forms of sinonasal papilloma, surgical pathologists nationwide often find it difficult to specifiy the histopathological nature of agiven papilloma. Moreover, previous reports of clinicopathological analysis of inverted papilloma (IP) to predict recurrence and associated malignancy has confusing issues and remains controversial. Purpose : To verify the existing histopathological classification of sinonasal papillomas, and to evaluate histologically the role of inflammation in the pathogenesis and ongoing neoplastic development of IP. Furthermore, this study proposes a novel pathological staging system for IP and suggests a hypothesis regarding its pathogenesis. Materials and Methods: Pathological and retrospective chart review was performed in 41 patients with sinonasal papillomas who underwent surgery between 1995 and 2001. Results: Sinonasal papillomas are classified as exophytic squamous papilloma (14 cases), IP (25 cases), and cylindrical papilloma (2 cases). The IP are staged as I (3/25), II (15/25), III (7/25), and IV (3/25) according to histopathological findings. Stage I is the earliest lesion having ciliated respiratory epithelium with transition to squamous metaplasia or to matured squamous epithelium and can be easily confused with inflammatory polyp. Stage II is the most commonly found lesion. The surface mucosa has ciliated respiratory epithelium with partial loss and underlying squamous metaplasia resulting in exophytic growth. Nume-rous inflammatory cells such as polymorphonuclear leukocytes (PMNLs) and macrophages are present in the epithelium. The stroma shows active inflammatory cells infiltration and squamous metaplasia of ductal epithelium. Stage III is IP with dysplasia. The mucosa shows total loss of ciliated respiratory epithelium and the squamous metaplasia changes into stratified squamous epithelium containing atypical cells. Stage IV is IP with invasive squamous cell carcinoma that includes stage II and III lesions. Conclusion: Sinonasal papilloma is adequately classified according to exisitng descriptions. Moreover, IP can present in different histopathological stages within a given individual. IP can undergo dynamic transformation from a polyp-like appearance associated with inflammation to eventually become squamous cell carcinoma (SCC). This novel staging system can be used a foundaion to further understand the pathogenesis of IP and can be used to predict its recurrence and associated malignancy. (J Clinical Otolaryngol 2004;15:109–118)

Keywords: 반전성 유두종; 병리; 부비동
Keywords: Inverted papilloma; Pathology; Paranasal sinus