2025 Proffered Presentations
S082: SINONASAL INVERTED PAPILLOMA WITH CONCURRENT EXOPHYTIC AND ONCOCYTIC SUBTYPES: INCIDENCE AND CLINICAL OUTCOMES
Alexis H Kim, BA1,2; Charles C Tong, MD1,2; 1Department of Otolaryngology- Head and Neck Surgery, Lenox Hill Hospital Northwell, New Hyde Park, NY; 2Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
Sinonasal papillomas are benign tumors with three subtypes as defined by the WHO: oncocytic (OP), exophytic (EP), and inverted papillomas (IP), that arise in the nasal cavity and paranasal sinuses. Subtypes of oncocytic and exophytic papilloma are rare with lower rates of recurrence and potential for malignancy compared to inverted papilloma. This study aims to explore the clinical characteristics and outcomes of patients with multiple tumor subtypes.
Methods: This is a multi-institutional study of patients with mixed sinonasal papillomas from 2002 to 2023. Pertinent demographics, clinicopathological data, surgical approaches, and outcomes were obtained. Only patients with multiple subtypes of sinonasal papillomas were included in the study. All tumors were confirmed by specialized Head and Neck pathologists at each respective institution.
Results: A total of 502 patients with IP were identified, with twenty-nine patients meeting the study criteria and an overall incidence of multiple tumors of 6%. The average age of the cohort was 59.3 years, with 62% (n=18) being male. Patients with no smoking history consisted of 55.2% (n=16) of our cohort and of the remaining 44.8% of patients with a smoking history, 20.7% (n=6) were active smokers. The presence of EP with IP was most frequent (n=16/29; 55.2%) followed by OP with IP (n=10/29; 34.5%). IP with concurrent OP and EP consisted of 6.9% (n=2/29, IP with SCCa and EP (n=1; 3.4%) had one case.
Mixed tumors commonly involved the maxillary sinus (n=17; 58.6%), the extra sinus (n=4, 13.8%), and ethmoid (n=3, 10.3%). The septum was involved in 3 patients (10.3%). Most of the mixed tumors had a unifocal attachment pattern (n=21; 72.4%) and unilateral presentation (n=23; 79.3%). Of the patients treated, 7 cases (24.1%) had an associated sinus diagnosis, 4 cases (13.8%) had prior sinus surgeries for IP, and 5 patients were immunocompromised (17.2%). No patients died related to treatment for mixed tumors. Mixed tumors presented primarily with no dysplasia (n=28; 96.6%) and one case with moderate dysplasia for the IP with EP tumor. Only 1 case (3.4%) recurred after 44 months from treatment with IP and no cases with CSF leak or vision change related complications.
Conclusion: Of mixed tumors, EP with IP was most common with one case of IP with EP and invasive disease. Compared to the recurrence rate for IP only tumors from our previous study of 11.6%, mixed tumors show a lower recurrence rate of 3.4%. Mixed tumors are most commonly present in the maxillary and ethmoid sinuses with 96.6% having no dysplasia compared to 74.3% for IP only tumors with no dysplasia. Although IP with EP or OP presenting with invasive disease is rare, the surgeon should remain vigilant as our cohort includes a unique case of squamous cell carcinoma in the setting of mixed tumors. It is important to be aware that mixed tumors occur in sinonasal papillomas and to counsel patients accordingly to their pathological findings.
