Inverted Papilloma of the Orbit and Nasolacrimal System. Ophthalmic Plast Reconstr Surg 2021 Mar-Apr 01;37(2):161-167
Date
06/06/2020Pubmed ID
32501879DOI
10.1097/IOP.0000000000001719Scopus ID
2-s2.0-85102657557 (requires institutional sign-in at Scopus site) 8 CitationsAbstract
PURPOSE: Periocular inverted papilloma (IP) is a rare, locally aggressive tumor with a propensity for recurrence and malignant transformation. Historically treated via wide excision, this study examines the characteristics and management of periocular IP, comparing those confined to the nasolacrimal system with those invading the orbit.
METHODS: An Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant retrospective, comparative case series was conducted in patients with IP of the orbit or nasolacrimal system across 15 clinical sites.
RESULTS: Of 25 patients, 22 met inclusion criteria with 9 limited to the nasolacrimal system and 13 invading the orbit. Mean age was 60.4 years, 55% were women, all were unilateral. Mean follow-up was 48 months. Rates of smoking, dust and/or aerosol exposure, human papillomavirus (HPV) status, and inflammatory polyps were elevated compared to rates in the general population (45%, 18%, 18%, and 14%, respectively). Bony erosion on computed tomography scans was statistically significantly associated with orbit-invading IP (p = 0.002). Treatment involved all confined IP undergoing surgery alone while 39% of orbit-invading IP also received radiation therapy and/or chemotherapy (p = 0.054). Orbit-invading IP was more likely to be excised with wide margins than IP confined to the nasolacrimal system (85% vs. 22%, p = 0.007). Overall rates of malignancy, recurrence, and patient mortality from IP were found to be 27%, 23%, and 9%, respectively.
CONCLUSIONS: IP invading the orbit typically requires aggressive therapy, while IP confined to the nasolacrimal system may be treated more conservatively. Using risk factors, characteristics, and outcomes, a treatment algorithm was created to guide management.
Author List
Wang J, Ford J, Esmaeli B, Langer P, Esmaili N, Griepentrog GJ, Couch SM, Nguyen J, Gold KG, Duerksen K, Burkat CN, Hartstein ME, Gandhi P, Sobel RK, Moon JY, Barmettler AAuthors
Neda Esmaili MD Associate Professor in the Ophthalmology and Visual Sciences department at Medical College of WisconsinGregory J. Griepentrog MD Associate Professor in the Ophthalmology and Visual Sciences department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
FemaleHumans
Male
Middle Aged
Nasolacrimal Duct
Neoplasm Recurrence, Local
Orbit
Papilloma, Inverted
Paranasal Sinus Neoplasms
Retrospective Studies
