Clinical Characteristics And Expression Of C-myc, PCNA In Nasal Inverted Papilloma

Objective:To investigate the clinical characteristics and optimum management of sinonasal inverted papilloma and examine the expression of C-myc and proliferating cell nuclear antigen (PCNA) in nasal inverted papilloma of different stage. Methods:Retrospective analysis of inverted papilloma treated from 1987 to 2002 in the First Affiliated Hospital of Jinan University. 48 specimens of inverted papilloma confirmed by pathology were subjected to immunohistochemistry analysis of C-myc and PCNA. 30 cases of nasal polyps were selected as control. Results:Part I Result of clinical observation: Totally 14 cases of inverted papilloma undergo recurrence and the recurrence rate was 29.17%.A11 the 14 patients with recurrence had the history of sinonasal surgery. Among them, the recurrence time are as follows: 5 cases for 1 time,6 cases for 2 times,! case for 3 times,! case for 4 times,! case for 5 times. The recurrence interval was from 2 months to 12 years.Total operation number of 48 cases is 86 times.The recurrence ratio of different approach was different,for example, the recurrence ratio of intranasal approach was 76.31%, the recurrence ratio of Caldwell-luc operation was 66.67%, the recurrence ratio of lateral rhinotomy was 16.13%, the recurrence ratio of endoscopic surgery was 14.29% (P=0.000). 5 patients of malignant transformation received lateral rhinotomy and were given radiation therapy after operation. 1 case of recurrence was found one year later post-operation. 2 cases lost follow-up.The trend of malignant transformation in tumor involving the maxillary sinus,the ethmoid sinus and the sphenoid sinus is increasing.Part II Result of immunohistochemical analyses: The positive rate of C-myc in primary tumor, recurrent tumor and malignant transformation tumor is respectively 6.90%(2/29),14.29%(2/14),60.00%(3/5). The significance of difference is obvious(P=0.008). The positive rate of PCNA in primary tumor, recurrent tumor and malignant transformation tumor is respectively 58.60%(17/29),100%(14/14),100% (5/5). The significance of difference is obvious (P=0.005). Furthermore,the expression of C-myc is significantly correlated with PCNA (r=0.382). No positive expression of C-myc and PCNA were found in tissue of nasal polyp. Conclusion:The recurrence of inverted papillonia is significantly correlated with the select of operative method. Lateral rhinotomy is still a reliable therapeutic method for inverted papillonia in nose.The endoscopic approach should be restricted to carefully selected patients. Combining endoscopy with limited external approaches may be a better choice.Extension of tumor beyond the nasal cavity and paranasal sinuses correlates with a poor prognosis.The result of this study suggests that expression of C-myc and PCNA may be related to the recurrence and canceration of nasal inverted papilloma. C-myc and PCNA may play a role in the development of the tumor.lt is possible to be an objective marker of predicting the prognosis of nasal inverted papilloma.