Objective:To investigate the effectiveness of nasal endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum in resecting recurrent nasal inverted papilloma. Methods:Patients with recurrent nasal inverted papilloma who underwent reoperation in our hospital during the past 2 years were included . The nasal septum may hinder full access to and effective treatment of the lesions at the anterior and medial wall of the maxillary sinus by endoscope, aspirator and surgical instrument in the narrow aperture of the prelacrimal recess, although these lesions could be observed by 70° nasal endoscope. Results:The nasal septum is temporarily opened on the basis of the prelacrimal recess approach, and the nasal endoscope and instrument was introduced through trans-septal window, so as to provide a better view of the operative field and the angular range of the instrument's movement. Conclusion:The recurrent nasal inverted papilloma could be successfully managed by re-endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum, and no recurrence was observed during the 2-year follow-up. This surgical approach is recommended for the inverted papilla which originates from the anterior medial wall of the maxillary sinus, as the tumor can be removed completely using this surgical approach.
Humans ; Papilloma, Inverted/pathology* ; Endoscopy ; Maxillary Sinus/pathology* ; Lacrimal Apparatus/surgery* ; Treatment Outcome ; Retrospective Studies

Biliary papillomatosis is rare, and its pathogenic mechanisms are not yet clear. Because of its high risk for malignancy transformation, surgical resection is regarded as a standard treatment. Photodynamic therapy (PDT) has been used by the intravenous administration of hematoporphyrin derivative followed by laser exposure. A photochemical process causes disturbance of the microvascular structure and degradation of membrane. Cholangitis is a major complication after PDT. A healthy 56-year-old man was diagnosed with biliary papillomatosis involving the common hepatic duct, both proximal intrahepatic bile ducts (IHD), and the right posterior IHD. After biliary decompression by endoscopic nasobiliary drainage, PDT was performed to avoid extensive liver resection and recurrence using endoscopic retrograde cholangiographic guidance. After portal vein embolization, the patient underwent extended right hemihepatectomy. Following administration of chemoradiation therapy with tegafur-uracil and 45 Gy due to local recurrence at postoperative 13 months, there was no local recurrence or distant metastases. This is the first case report on PDT for biliary papillomatosis in Korea. Preoperative PDT is beneficial for reducing the lesion in diffuse or multifocal biliary papillomatosis and may lead to curative and volume reserving surgery. Thus, PDT could improve the quality of life and prolong life expectation for biliary papillomatosis patients.
Antineoplastic Agents/therapeutic use ; Bile Duct Neoplasms/*diagnosis/drug therapy/surgery ; Bile Ducts, Intrahepatic/pathology ; Embolization, Therapeutic ; Gamma Rays ; Hepatectomy ; Hepatic Duct, Common/pathology ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Papilloma/*diagnosis/drug therapy/surgery ; Photochemotherapy ; Tegafur/therapeutic use ; Uracil/therapeutic use

OBJECTIVE: To investigate the application of endoscopic nasal lateral wall dissection in lesions of the maxillary sinus. METHOD: Ten hospitalized patients with the maxillary sinus lesions were treated with the endoscopic nasal lateral wall dissection. RESULT: All 10 patients were unilateral invasion. Among them, 7 cases were inverted papilloma, 2 cases were recurrent antrochoanal polyps, 1 case was sinusal tooth. The tumors and antrochoanal polyps originated from the every part of the maxillary sinus wall during operation, especially from the anterior and media wall. During 10-62 months follow-up,epithelization of nasal occured and the shape of inferior turbinate was well. All of them had no epiphora. CONCLUSION Endoscopic nasal lateral wall dissection can remain the function of nasal lacrimal duct and nasal cavity,and may provide a new minimally invasive approach for complete resection of lesions of nasal cavity and the maxillary sinus.
Dissection ; Endoscopy ; Humans ; Lacrimal Apparatus ; Maxillary Sinus ; pathology ; Nasal Cavity ; Nasal Polyps ; surgery ; Papilloma, Inverted ; surgery ; Turbinates

OBJECTIVE: To review endonasal endoscopic surgeries aided by Fusion image guided system, and to explore the application value of Fusion image guided system in endonasal endoscopic surgeries. METHOD: Retrospective research. Sixty cases of endonasal endoscopic surgeries aided by Fusion image guided system were analysed including chronic rhinosinusitis with polyp (n = 10), fungus sinusitis (n = 5), endoscopic optic nerve decompression (n = 16), inverted papilloma of the paranasal sinus (n = 9), ossifying fibroma of sphenoid bone (n = 1), malignance of the paranasal sinus (n = 9), cerebrospinal fluid leak (n = 5), hemangioma of orbital apex (n = 2) and orbital reconstruction (n = 3). RESULT: Sixty cases of endonasal endoscopic surgeries completed successfully without any complications. Fusion image guided system can help to identify the ostium of paranasal sinus, lamina papyracea and skull base. Fused CT-CTA images, or fused MR-MRA images can help to localize the optic nerve or internal carotid arteiy . Fused CT-MR images can help to detect the range of the tumor. It spent (7.13 ± 1.358) minutes for image guided system to do preoperative preparation and the surgical navigation accuracy reached less than 1mm after proficient. There was no device localization problem because of block or head set loosed. CONCLUSION Fusion image guided system make endonasal endoscopic surgery to be a true microinvasive and exact surgery. It spends less preoperative preparation time, has high surgical navigation accuracy, improves the surgical safety and reduces the surgical complications.
Cerebrospinal Fluid Leak ; surgery ; Endoscopy ; instrumentation ; Fibroma, Ossifying ; surgery ; Humans ; Nasal Surgical Procedures ; methods ; Neurosurgical Procedures ; Nose ; pathology ; Papilloma, Inverted ; surgery ; Paranasal Sinuses ; pathology ; Retrospective Studies ; Sinusitis ; surgery ; Sphenoid Bone ; pathology ; Surgery, Computer-Assisted ; methods

OBJECTIVE: To evaluate the prognosis of Draf II b surgery in treating fontal sinus inverted papilloma. METHOD: A retrospective study was carried out among 15 patients diagnosed as fontal sinus inverted papilloma, which had underwent endoscopic Draf II b surgery. The clinical success rate and surgical success rate were calculated by survival analysis. RESULT: In all patients, there were 1 (6.67%) recurrence,1 (6.67%) stenosis, 4 (26.67)% complete closure, and 1 (6.67%) mucocele cyst. The 3-year clinical success rate was 93.3%, and the 3-year surgical success rate was 65.0%. CONCLUSION Draf II b surgery is feasible when the frontal sinus inverted papilloma is involved in the area of the pupil center line, and the frontal neo-ostium stenosis or complete closure is a common complication after surgery. Thus a close follow-up is recommended during the first year after the surgery. Further study is necessary to find a better way to reduce the complication rate.
Constriction, Pathologic ; pathology ; Endoscopy ; Frontal Sinus ; pathology ; Humans ; Mucocele ; pathology ; Nasal Surgical Procedures ; methods ; Neoplasm Recurrence, Local ; Papilloma, Inverted ; surgery ; Paranasal Sinus Neoplasms ; surgery ; Postoperative Complications ; pathology ; Prognosis ; Retrospective Studies ; Survival Analysis ; Treatment Outcome

PURPOSE: We evaluated the characteristics of and treatment outcomes in patients with benign tracheobronchial tumors. MATERIALS AND METHODS: We reviewed the records of patients with benign tracheobronchial tumors who underwent bronchoscopic intervention with mechanical removal and Nd: YAG laser cauterization, and evaluated the characteristics and treatment outcomes of 55 patients with hamartomas, leiomyomas, papillomas, typical carcinoids, or schwannomas seen between April 1999 and July 2012. RESULTS: The most common tumors were hamartoma (n=24), leiomyoma (n=16), papilloma (n=7), typical carcinoid (n=5), and schwannoma (n=3). Forty-one patients (75%) had symptoms. On chest computed tomography, 35 patients (64%) had round or ovoid lesions, accompanied by atelectasis (n=26, 47%) or obstructive pneumonia (n=17, 31%). Fatty components (n=9, 16%) and calcifications (n=7, 13%) were observed only in hamartomas, leiomyomas, and typical carcinoids. At bronchoscopy, the typical findings were categorized according to tumor shape, surface, color, and visible vessels. Fifty (91%) patients underwent complete resection. Forty patients (73%) achieved successful bronchoscopic removal defined as complete resection without complications or recurrence. Recurrences occurred in four papillomas, one leiomyoma, and one typical carcinoid. The proportions of tumor types (p=0.029) differed between the successful and unsuccessful removal groups, and a pedunculated base (p<0.001) and no spontaneous bleeding (p=0.037) were more frequent in the successful removal group. CONCLUSION: We described clinical, radiological, and typical bronchoscopic findings in patients with benign tracheobronchial tumors; these findings might help to differentiate such tumors. Bronchoscopic intervention was a useful treatment modality, and tumor type, pedunculated base, and vascularity may influence successful tumor removal.
Adolescent ; Adult ; Aged ; Bronchi/pathology/*surgery ; Bronchoscopy ; Carcinoid Tumor/pathology/surgery ; Female ; Hamartoma/pathology/surgery ; Humans ; Leiomyoma/pathology/surgery ; Male ; Middle Aged ; Neurilemmoma/pathology/surgery ; Papilloma/pathology/surgery ; Young Adult

Sinonasal inverted papilloma (SNIP) is one of the most common benign sinonasal tumors demonstrating a high recurrence rate after surgery, and sometimes presents malignant tendency or coexists squamous cell carcinoma. Therefore, it is essential to achieve complete surgical resection, especially the original location of SNIP. In this paper, we evaluated the predictability of preoperative CT and magnetic resonance imaging (MRI) for localization of SNIP origin.
Carcinoma, Squamous Cell ; diagnosis ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Nose Neoplasms ; diagnosis ; pathology ; surgery ; Papilloma, Inverted ; Paranasal Sinus Neoplasms ; diagnosis ; pathology ; surgery ; Prognosis ; Tomography, X-Ray Computed

OBJECTIVE: To assess the therapeutic effect and study the role of nasal mucosa epithelization after endoscopic surgery using the plasma radiofrequency ablation at low temperature in patients with nasal inverted papilloma. METHOD: The clinical data of 104 patients with nasal inverted papilloma underwent endoscopic surgery u sing the plasma radiofrequency ablation at low temperature from July, 2008 to July, 2012 were analyzed,and the recovery of mucosa was observed under nasal endoscope. RESULT: The mucosa recovery extent showed a decreasing trend from mucosa pattern degree I to III, where the difference was statistically significant by chi-square test between groups (P < 0.05). The average epithelialization time was 2.7 months. It showed a significantly decreasing trend among average epithelialization time of different degrees of mucosa (P < 0.05). The nasal mucosa of most patients completed epithelialization 2.9 months after surgery. CONCLUSION It is safe and effective to treat nasal inverted papilloma with plasma radiofrequency ablation at low temperature. The patients should be followed up with regular reexamination for at least three months after surgery.
Adult ; Aged ; Aged, 80 and over ; Catheter Ablation ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Nasal Cavity ; Nasal Mucosa ; pathology ; Nose Neoplasms ; surgery ; Papilloma, Inverted ; surgery ; Postoperative Period ; Retrospective Studies

Adult ; Female ; Humans ; Nasal Mucosa ; pathology ; Nose Neoplasms ; diagnosis ; surgery ; Papilloma ; diagnosis ; surgery

OBJECTIVETo study the clinicopathologic features and immunophenotype of endolymphatic sac tumor (ELST) and normal endolymphatic sac.

METHODSThe clinical and histologic features were evaluated in 5 cases of ELST. Eight cases of choroid plexus papilloma at cerebellopontine angle and 2 cases of normal endolymphatic sac were used as controls. Immunohistochemical study for vimentin, AE1/AE3, CK8/18, CK5/6, EMA, GFAP, synaptophysin, S-100 protein, CEA, TTF-1, VEGF, D2-40, calponin, calretinin and Ki-67 was carried out.

RESULTSThe age of onset of ELST ranged from 23 to 35 years (median = 24 years). The male-to-female ratio was 2:3. The clinical presentation was tinnitus, otalgia, hearing loss, otorrhagia with effusion and headache. The duration of symptoms ranged from 6 months to 10 years. Local recurrences were noted in 3 cases. Radiologically, the tumors were located at cerebellopontine angle and demonstrated petrous bone destruction. Histologic examination showed that the tumors had a papillary-glandular pattern. The papillae were covered by a single layer of low cuboidal cells. The tumor cells had distinct cell borders and contained eosinophilic to clear cytoplasm. The nuclei were slightly atypical and sometimes apically located. Focal dilated glandular structures with colloid-like material were also identified. The surrounding stroma was vascularized. All of the 5 cases had dural or petrous bone infiltration. Immunohistochemical study showed that all of the 5 cases were positive for AE1/AE3, CK8/18, CK5/6 and VEGF, 4 cases for EMA, 3 cases for calponin (focal), 2 cases for vimentin, 2 cases for S-100 protein, 1 case for GFAP and 1 case for synaptophysin (focal and weak). The Ki-67 index measured less than 1%. The staining for D2-40, calretinin, CEA and TTF-1 was negative. The 2 cases of the normal endolymphatic sac were positive for AE1/AE3 and CK8/18, and negative for CK5/6, EMA, S-100 protein, GFAP and synaptophysin. The 8 cases of choroid plexus papilloma were positive for synaptophysin. Seven cases were also positive for S-100 protein, 2 cases for GFAP and 1 case for D2-40. All of the 8 cases were negative for EMA, CK5/6 and calponin.

CONCLUSIONSELST is a rare slow-growing and potentially malignant tumor with a tendency of bone invasion and local recurrence. Distant metastasis is not observed. It must be distinguished from choroid plexus papilloma occurring at cerebellopontine angle. Correlation with clinical, radiologic and immunohistochemical findings would also be helpful.

Adenocarcinoma ; diagnostic imaging ; metabolism ; pathology ; surgery ; Adult ; Calcium-Binding Proteins ; metabolism ; Cerebellar Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Cerebellopontine Angle ; pathology ; Diagnosis, Differential ; Endolymphatic Sac ; pathology ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratin-5 ; metabolism ; Keratin-6 ; metabolism ; Male ; Microfilament Proteins ; metabolism ; Mucin-1 ; metabolism ; Neoplasm Recurrence, Local ; Papilloma, Choroid Plexus ; metabolism ; pathology ; Tomography, X-Ray Computed ; Young Adult