title: Clinical and pathological analysis of recurrent inverted papilloma.
abstract: OBJECTIVE
  We analyzed the clinical characteristics, pathological findings, and treatment outcomes of patients with recurrent sinonasal inverted papilloma (IP).
  
  
  METHODS
  This retrospective study consisted of 13 patients with recurrent IP. Patient data were collected on prior treatment, sites of recurrence, surgical procedures, pathological findings, and postoperative time to recurrence.
  
  
  RESULTS
  Eleven of the 13 patients (85%) had recurrence in the ethmoid sinus, particularly at the lamina papyracea (n = 8; 62%). Inverted papilloma with severe dysplasia (SD) was observed in 4 patients, 3 of whom showed malignant transformation of the recurrent tumor. Craniofacial resection was performed in 2 of the 4 patients, resulting in no further recurrence. However, the tumor was not managed in the remaining 2 patients. In the 9 patients without SD, lateral rhinotomy was performed in 6 patients and endoscopic sinus surgery was selected in 3 patients who had a small tumor without scar formation. No further recurrence was observed in the 9 patients.
  
  
  CONCLUSIONS
  Careful management of IP around the lamina papyracea is essential during initial surgery. Recurrent IP without SD can be successfully managed by lateral rhinotomy in most cases, and by endoscopic sinus surgery in selected cases. However, more aggressive treatment, including craniofacial resection, should be considered in IP with SD, which is associated with a high rate of recurrence and malignant transformation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Oikawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Furuta
authors.forename: Tomoo
authors.initials: T
authors.lastname: Itoh
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Oridate
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fukuda
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D009669:Nose Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010212:Papilloma / Q000175:diagnosis* / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed