Inverted Papilloma of the Orbit and Nasolacrimal System.

Authors

Jessie Wang
Joshua Ford
Bita Esmaeli
Paul Langer
Neda Esmaili
Gregory J Griepentrog
Steven M Couch
John Nguyen
Katherine G Gold
Kathleen Duerksen
Cat N Burkat
Morris E Hartstein
Parag Gandhi
Rachel K Sobel
Jee-Young Moon
Anne Barmettler, Beaumont Health Fellow

Document Type

Article

Publication Date

3-1-2021

Publication Title

Ophthalmic Plastic and Reconstructive Surgery

Abstract

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.

Volume

37

Issue

2

First Page

161

Last Page

167

Recommended Citation

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 A. Inverted Papilloma of the Orbit and Nasolacrimal System. Ophthalmic Plast Reconstr Surg. 2021 Mar-Apr 01;37(2):161-167. doi: 10.1097/IOP.0000000000001719. PMID: 32501879.

DOI

10.1097/IOP.0000000000001719

ISSN

1537-2677

PubMed ID

32501879