title: Sinonasal papillomas in a private referral otorhinolaryngology centre: Review of 22 years experience.
abstract: OBJECTIVE
  To evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela).
  
  
  METHODS
  We reviewed 94 patients with SP that were treated at our otolaryngology center, from July 1st 1993 to June 31st 2015. The demographic data, clinical features, radiological findings, anatomical origin, disease extension into the adjacent structures, surgical approaches performed, histopathology outcomes, recurrent risk, malignant transformation rate and coadjuvant therapies were assessed.
  
  
  RESULTS
  Sixty-five patients (69.1%) were male and 29 (30.9%) female with an average age of 44.5 years (range 9-80 years). All patients underwent endoscopic sinus surgery. The most commont histologic subtypes of SP were inverted papilloma (58 patients; 61.7%), fungiform papilloma (35 patients; 37.2%) and oncocytic papilloma (one patient; 1.1%). SP was associated in 2 patients with undifferentiated squamous cell carcinoma. Twelve patients (12.8%) had disease with extension beyond the sinus without associated malignancy. All these patients received adjuvant treatment with advanced techniques of radiotherapy. The mean duration of the follow-up period was 9 years and 2 months. Eighteen patients (19.1%) had recurrent disease during the entire course of follow-up.
  
  
  CONCLUSIONS
  Complete endoscopic surgical removal of SP is the treatment of choice. In less endoscopically accessible tumours, with peripheral extension or incompletely resected, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy may be indicated. Timely post-operative endoscopic follow-up with biopsy of suspected lesions is important for early detection of recurrences and associated malignancy.
authors.affiliation: Unidad de Otorrinolaringoendoscopia, Instituto Médico La Floresta, Unidad Interdisciplinaria de Cirugía Endoscópica de base de cráneo, Post-grado de Neurocirugía, Hospital Militar Dr. Carlos Arvelo, Caracas, Venezuela. Electronic address: aderitodesousa@gmail.com.
authors.forename: Aderito
authors.initials: A
authors.lastname: de Sousa Fontes
authors.affiliation: Instituto Médico La Floresta, Cátedra de Histología y Embriología, Escuela de Medicina Luis Razetti, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Minaret
authors.initials: M
authors.lastname: Sandrea Jiménez
authors.affiliation: Unidad de Radioterapia Oncológica y Medicina Nuclear, Instituto Médico La Floresta, Smilow Cancer Hospital y Yale Cancer Center, Yale University, EE. UU., Cátedra de Radioterapia y Medicina Nuclear, Hospital Universitario UCV, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Nelson
authors.initials: N
authors.lastname: Urdaneta Lafée
authors.affiliation: Unidad de Radioterapia Oncológica, Instituto Médico La Floresta, Caracas, Venezuela.
authors.forename: Perfecto A
authors.initials: PA
authors.lastname: Abreu Durán
authors.affiliation: Equipo Interdisciplinario de Cirugía Endoscópica de base de cráneo, Instituto Médico La Floresta, Postgrado de Neurocirugía, Hospital Militar Dr. Carlos Arvel, Caracas, Venezuela.
authors.forename: Liwven E
authors.initials: LE
authors.lastname: Quintana Páez
authors.affiliation: Pasantía dirigida en Otorrinolaringología, Unidad de Otorrinolaringoendoscopia, Instituto Médico La Floresta, Caracas, Venezuela.
authors.forename: Andreina Carmina
authors.initials: AC
authors.lastname: de Sousa de Abreu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology; D010212:Papilloma / Q000175:diagnosis / Q000628:therapy; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis / Q000628:therapy; D017149:Private Sector; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Fungiform papilloma; Inverted papilloma; Oncocytic papilloma; Papiloma fungiforme; Papiloma invertido; Papiloma oncocítico; Papiloma rinosinusal; Sinonasal neoplasm; Sinonasal papilloma; Tumor nasosinusal