Keita Oikawa

Preoperative Staging of Sinonasal Inverted Papilloma by Magnetic Resonance Imaging

Objectives/Hypothesis: Sinonasal inverted papilloma is a rare but locally aggressive benign tumor. Inverted papilloma tends to recur after surgical resection and is occasionally associated with squamous cell carcinoma. Radical en bloc resection by lateral rhinotomy and medial maxillectomy has been recommended for initial management; however, endoscopic sinus surgery is effective in selected cases. To determine adequate surgical approaches, a staging system for inverted papilloma based on extent and location of the tumor has been advocated. The study investigated whether preoperative assessment by magnetic resonance imaging (MRI) accurately predicts the extent of inverted papilloma. Study Design: Magnetic resonance imaging was retrospectively reviewed in 21 cases of inverted papilloma without knowledge of the surgical and pathological findings. Methods: Patients were categorized into stages based on MRI findings, according to the staging system proposed by Krouse. The involvement of inverted papilloma in each sinus was also assessed. Results: Stages graded by MRI were coincident with postoperative staging verified by surgical and pathological findings in 18 of the 21 cases (86%), which included 1 case of stage T1, 3 cases of stage T2, and 14 cases of stage T3. Two cases of stage T2 were judged as T3, and one case of T3 was judged as T2 by MRI. Positive predictive value of MRI diagnosis for tumor involvement was 68% to 89% in each sinus, and negative predictive value was more than 93%. Conclusion: In most cases, MRI assessment of inverted papilloma can accurately predict the extent of tumor involvement. Preoperative staging of inverted papilloma by MRI may be useful for planning an appropriate surgical approach.

Preoperative Staging and Surgical Approaches for Sinonasal Inverted Papilloma

Objectives: We sought to determine the value of preoperative staging by magnetic resonance imaging (MRI) assessment in the surgical management of sinonasal inverted papillomas (IPs). Methods: Preoperative MRI staging was used to assess 22 patients with IPs. In addition to the Krouse staging system, T3 cases were categorized as subgroup T3-B if tumors extended into the frontal sinus or the supraorbital recess; otherwise, they were categorized as T3-A. Standard endoscopic sinus surgery (ESS) was the first choice for T1 and T2 cases. Endoscopic approaches, including ESS combined with endoscope-assisted transantral approach and endoscopic medial maxillectomy, were considered in T3-A cases, and external approaches were considered in T3-B cases. Patients were followed for a minimum of 1 year after surgery. Results: Preoperative MRI staging and postoperative staging were coincident in 21 of the 22 patients (95%). All 8 T2 cases were treated by an endoscopic approach. Of 10 T3-A cases, 9 (90%) were treated by an endoscopic approach and 1 (residual case) was treated by an external approach. All 3 of the T3-B cases underwent an external approach. One T4 case with malignant transformation underwent an external approach followed by radiotherapy. After a median follow-up period of 22 months, none of the 22 patients had had a recurrence. No major complications were observed after endoscopic approaches, but epiphora or hemorrhage requiring transfusion occurred in 3 of the 5 patients (60%) who underwent external approaches. Conclusions: Preoperative staging of IP by MRI is useful for selecting cases that can be managed by endoscopic approaches, resulting in lower rates of tumor recurrence and morbidity.

Clinical and pathological analysis of recurrent inverted papilloma.

Objectives: 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.

Microbially cleaved immunoglobulins are sensed by the innate immune receptor LILRA2.

Microbial proteases degrade a variety of host proteins1–3. However, it has remained largely unknown why microorganisms have evolved to acquire such proteases and how the host responds to microbially degraded products. Here, we have found that immunoglobulins disrupted by microbial pathogens are specifically detected by leukocyte immunoglobulin-like receptor A2 (LILRA2), an orphan activating receptor expressed on human myeloid cells. Proteases from Mycoplasma hyorhinis, Legionella pneumophila, Streptococcus pneumonia and Candida albicans cleaved the N-terminus of immunoglobulins. Identification of the immunoglobulin-cleaving protease from L. pneumophila revealed that the protease is conserved across some bacteria including Vibrio spp. and Pseudomonas aeruginosa. These microbially cleaved immunoglobulins but not normal immunoglobulins stimulated human neutrophils via LILRA2. In addition, stimulation of primary monocytes via LILRA2 inhibited the growth of L. pneumophila. When mice were infected with L. pneumophila, immunoglobulins were cleaved and recognized by LILRA2. More importantly, cleaved immunoglobulins were detected in patients with bacterial infections and stimulated LILRA2-expressing cells. Our findings demonstrate that LILRA2 is a type of innate immune receptor in the host immune system that detects immunoglobulin abnormalities caused by microbial pathogens.

Effect of Ultrahigh-Density Ionization of Resist Films on Sensitivity Using Extreme-Ultraviolet Free-Electron Laser

Extreme-ultraviolet free-electron lasers (EUVFELs) producing intense femtosecond pulse are able to superimpose ion-pair formation induced by a single photon onto the other in the resist polymer degradation. Electron beam resist (ZEP520A) sensitivity was obtained by using 61 nm EUVFEL at different dose densities in order to observe the multiple spur effect in a well-controlled environment. A higher ionization density has been identified to suppress the resist-degradation effectiveness due to the multiple spur effect for the first time. This is explained by two competing effects, namely, spatiotemporal overlap reducing the effectiveness, and high radical concentration enhancing cross-linking efficiency.

Fundamental Study on Reaction Mechanisms in Chemically Amplified Extreme Ultraviolet Resists by Using 61nm Free-Electron Laser

For chemically amplified EUV resists, secondary electrons derived from ionization events play a critical role in the sensitization of acid generators. In this study, we show the dependence of acid generation efficiency on dose rate (fluence per pulse duration) by using 61 nm free-electron laser (FEL) light irradiation. The wavelength of 61 nm (20.3 eV) is applied because single incident photon induces only single ionization event, in contrast to the 13.4 nm EUV photon that induces 4.2 ionization events on average. The acid yield efficiency has enhances with decreasing the dose rate. It is suggested that high density ionization enhances the multiple spur effect.

P038: Staging and Surgical Approaches for Inverted Papilloma

ing chemoradiotherapy (CRT) were analyzed. METHODS: From 1990 to 2004, 104 patients had undergone TL for laryngeal cancer at Hokkaido University Hospital. Patients were divided into three groups according to the preoperative treatments; group I (n 29), without preoperative treatment; group II (n 23), radiotherapy (40-65 Gy) alone; group III (n 52), concurrent chemotherapy (weekly carboplatin, a low daily dose of cisplatin, or weekly docetaxel) and radiotherapy (40-65 Gy). TL was performed as a consequence of poor response to RT or CRT at 40 Gy, residual or recurrent disease after completion of the treatments. Major wound complications, such as major pharyngocutaneous (PC) fistula, bleeding, wound infection or skin necrosis, in each group were analyzed. RESULTS: Major wound complications were observed in 28 of the 104 (27%) patients. PC fistula was the most prevalent complication and occurred in 14 of the 104 (14%) patients followed by wound infection or skin necrosis (11%) and bleeding (8%). The incidence of overall major wound complications in group III tended to be higher than that in the group I (35% vs. 21 %, p 0.067). Major wound complications were more prevalent in group III patients who had comorbidity (48%) or advanced-T stage diseases (58%). CONCLUSIONS: The high incidence of wound complications should be taken into account before the initiation of CRT and salvage surgery, especially in patients with comorbidity or advanced-T stage diseases.

Clinical and Pathological Analyses of Recurrent Inverted Papilloma

OBJECTIVES 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.