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Inverted Papilloma Originating Primarily from the Nasolacrimal Duct: A Case Report and Review of the Pertinent Literature.

Walijee HZ, Berry S, Quine S, Lane C, Morris DS, Bowman B - Case Rep Otolaryngol (2015)

Bottom Line: Case.The patient made an uneventful recovery with unchanged visual acuity and normal extraocular movements.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant CF72 8XR, UK.

ABSTRACT
Introduction. Inverted papilloma (IP) is an uncommon, benign yet aggressive neoplasm characterised by high recurrence rates and tendency towards malignant transformation. The majority of IP cases originate in the ethmoid region, lateral wall of the nasal fossa, and maxillary sinus. The authors report a case of an IP originating primarily from the nasolacrimal duct (NLD). Case. A 69-year-old Caucasian gentleman presented with a lump in his right medial canthal region, epiphora, and discharge bilaterally. Radiological investigation revealed a well-defined, heterogeneous mass within the proximal NLD eroding the bony canal, protruding into the middle meatus and into the right orbit. The tumour was excised en bloc utilizing a combined external and endoscopic approach based on its location. Histology revealed hyperplastic ribbons of basement membrane-enclosed epithelium growing endophytically into the underlying stroma with no evidence of invasive malignancy. The patient made an uneventful recovery with unchanged visual acuity and normal extraocular movements. Conclusion. The case demonstrates variability within the sinonasal tract that IP can develop and the individuality of each case necessitating tailored operative techniques for complete excision whilst minimising recurrence rates. We also present a combined endoscopic approach for the en bloc resection of a NLD IP with no clinical recurrence at 15-month follow-up.

No MeSH data available.


Related in: MedlinePlus

(a) Hyperplastic squamous epithelium growing endophytically. The inverted papilloma is seen to arise from nasolacrimal duct epithelium (arrow). Haematoxylin and Eosin, 20x. (b) Foci of atypia amounting to moderate dysplasia. No invasive malignancy is seen. Haematoxylin and Eosin, 40x. (c) Inverted pattern of growth. Haematoxylin and Eosin, 20x. (d) Immunohistochemistry for P16 showing block positivity. P16 IHC Syntech antibody, 20x.
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fig4: (a) Hyperplastic squamous epithelium growing endophytically. The inverted papilloma is seen to arise from nasolacrimal duct epithelium (arrow). Haematoxylin and Eosin, 20x. (b) Foci of atypia amounting to moderate dysplasia. No invasive malignancy is seen. Haematoxylin and Eosin, 40x. (c) Inverted pattern of growth. Haematoxylin and Eosin, 20x. (d) Immunohistochemistry for P16 showing block positivity. P16 IHC Syntech antibody, 20x.

Mentions: Histological examination revealed hyperplastic ribbons of basement membrane-enclosed epithelium growing endophytically into the underlying stroma (Figures 4(a) and 4(c)). The epithelium is multilayered, 5–30 cell layers thick, and formed of squamous epithelial cells admixed with scattered mucocytes. Multiple foci of atypia, interpreted as moderate dysplasia, were reported with no overall evidence of invasive malignancy (Figure 4(b)). The patient was therefore a Krouse Stage 3 on the Krouse Staging System [4]. Immunohistochemistry was positive for p16 (Figure 4(d)).


Inverted Papilloma Originating Primarily from the Nasolacrimal Duct: A Case Report and Review of the Pertinent Literature.

Walijee HZ, Berry S, Quine S, Lane C, Morris DS, Bowman B - Case Rep Otolaryngol (2015)

(a) Hyperplastic squamous epithelium growing endophytically. The inverted papilloma is seen to arise from nasolacrimal duct epithelium (arrow). Haematoxylin and Eosin, 20x. (b) Foci of atypia amounting to moderate dysplasia. No invasive malignancy is seen. Haematoxylin and Eosin, 40x. (c) Inverted pattern of growth. Haematoxylin and Eosin, 20x. (d) Immunohistochemistry for P16 showing block positivity. P16 IHC Syntech antibody, 20x.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663298&req=5

fig4: (a) Hyperplastic squamous epithelium growing endophytically. The inverted papilloma is seen to arise from nasolacrimal duct epithelium (arrow). Haematoxylin and Eosin, 20x. (b) Foci of atypia amounting to moderate dysplasia. No invasive malignancy is seen. Haematoxylin and Eosin, 40x. (c) Inverted pattern of growth. Haematoxylin and Eosin, 20x. (d) Immunohistochemistry for P16 showing block positivity. P16 IHC Syntech antibody, 20x.
Mentions: Histological examination revealed hyperplastic ribbons of basement membrane-enclosed epithelium growing endophytically into the underlying stroma (Figures 4(a) and 4(c)). The epithelium is multilayered, 5–30 cell layers thick, and formed of squamous epithelial cells admixed with scattered mucocytes. Multiple foci of atypia, interpreted as moderate dysplasia, were reported with no overall evidence of invasive malignancy (Figure 4(b)). The patient was therefore a Krouse Stage 3 on the Krouse Staging System [4]. Immunohistochemistry was positive for p16 (Figure 4(d)).

Bottom Line: Case.The patient made an uneventful recovery with unchanged visual acuity and normal extraocular movements.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant CF72 8XR, UK.

ABSTRACT
Introduction. Inverted papilloma (IP) is an uncommon, benign yet aggressive neoplasm characterised by high recurrence rates and tendency towards malignant transformation. The majority of IP cases originate in the ethmoid region, lateral wall of the nasal fossa, and maxillary sinus. The authors report a case of an IP originating primarily from the nasolacrimal duct (NLD). Case. A 69-year-old Caucasian gentleman presented with a lump in his right medial canthal region, epiphora, and discharge bilaterally. Radiological investigation revealed a well-defined, heterogeneous mass within the proximal NLD eroding the bony canal, protruding into the middle meatus and into the right orbit. The tumour was excised en bloc utilizing a combined external and endoscopic approach based on its location. Histology revealed hyperplastic ribbons of basement membrane-enclosed epithelium growing endophytically into the underlying stroma with no evidence of invasive malignancy. The patient made an uneventful recovery with unchanged visual acuity and normal extraocular movements. Conclusion. The case demonstrates variability within the sinonasal tract that IP can develop and the individuality of each case necessitating tailored operative techniques for complete excision whilst minimising recurrence rates. We also present a combined endoscopic approach for the en bloc resection of a NLD IP with no clinical recurrence at 15-month follow-up.

No MeSH data available.


Related in: MedlinePlus