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DOI: 10.1055/a-1211-2889
Tumornachsorge sinunasaler Papillome – Risikofaktoren für Rezidiv-Entwicklung und maligne Entartung
Follow-up care of sinonasal papillomas – risk factors for recurrence and malignant progression![](https://www.thieme-connect.de/media/lro/202104/lookinside/thumbnails/lro-0912_10-1055-a-1211-2889-1.jpg)
Zusammenfassung
Hintergrund Sinunasale Papillome sind Tumoren der Nasenhaupt- und Nasennebenhöhlen. Therapie der Wahl ist die vollständige Resektion unter tumorchirurgischen Kautelen. Zwei Eigenschaften machen die Tumornachsorge zu einer Herausforderung: Erstens die häufige Rezidiv-Entwicklung (auch viele Jahre nach Erstdiagnose) und zweitens die Möglichkeit der malignen Entartung. Diese Übersichtsarbeit beleuchtet diesbezügliche Risikofaktoren, um „Hochrisikopatienten“ zu identifizieren, die in der Tumornachsorge besondere Aufmerksamkeit verdienen.
Materialen und Methoden Es erfolgte eine ausführliche Literaturrecherche in PubMed (NCBI).
Ergebnisse Hauptrisikofaktor für Rezidive ist die unvollständige Tumorresektion. Daraus ergeben sich weitere Faktoren wie unzureichend radikale Operationstechnik, ausgedehnte Tumoren, erschwerte intraoperative Verhältnisse aufgrund der Tumorlokalisation oder bei der Rezidiv-Chirurgie. Zudem neigen junge Patienten und Raucher vermehrt zu Rezidiven. Risikofaktoren für eine maligne Entartung sind große Tumoren, Rauchen, höheres Alter bei Erstdiagnose, weibliches Geschlecht, Knocheninvasion und fehlende inflammatorische Polypen. Histopathologische Risikofaktoren für Rezidive sowie für maligne Entartung sind Dysplasien, Hyperkeratose, plattenepitheliale Hyperplasie und – sofern bestimmt – eine erhöhte Proliferationsrate, Aneuploidie sowie eine Infektion mit humanen Papillomaviren.
Schlussfolgerungen Eine vollständige Resektion der sinunasalen Papillome unter tumorchirurgischen Kautelen ist der Goldstandard. Postoperativ ist eine engmaschige Tumornachsorge (analog zu malignen Tumoren) zwingend erforderlich. Die meisten Autoren empfehlen einen Nachsorgezeitraum von mindestens 5 Jahren, manche sogar eine lebenslange Nachsorge. Patienten mit einem oder mehreren Risikofaktoren sollten engmaschiger nachbetreut werden.
Abstract
Objective Sinonasal papillomas are tumors of the nasal cavity and paranasal sinuses. They are treated through complete resection under oncologic conditions. Two characteristics complicate follow-up: 1) frequent tumor recurrences (even many years after initial diagnosis), 2) possibility for malignant progression. This review elucidates risk factors for these two characteristics to depict “high-risk patients” for whom a closer follow-up is mandatory.
Materials and methods Literature was searched in Pubmed (NCBI).
Results The most important risk factor for recurrence is incomplete tumor resection. This comprises several more factors: inappropriate surgical procedure, large tumors, difficult surgical conditions due to tumor localization or to prior surgery. Young age and tobacco smoking are risk factors for frequent recurrences. In regard to malignant progression, extended tumors, smoking, senior age, female sex, bone invasion, and lack of inflammatory polyps have been identified as risk factors. Histopathological factors for both – recurrences and malignant progression – are epithelial dysplasia, hyperkeratosis, squamous hyperplasia, as well as (if known) increased proliferation, aneuploidy, and infection with human papillomaviruses.
Conclusions Complete resection of sinunasal papillomas under oncologic conditions is of utmost importance. A careful postoperative follow-up is mandatory. Most authors suggest at least a five-year, some a lifelong follow-up. Patients with one or more risk factors should be monitored more closely.
Schlüsselwörter
invertierte Papillome - Risikofaktoren - operatives Vorgehen - Papillomaviridae - KanzerogeneseKey words
inverted papilloma - risk factors - surgical procedures - papillomaviridae - carcinogenesisPublikationsverlauf
Eingereicht: 21. Juni 2020
Angenommen: 30. Juni 2020
Artikel online veröffentlicht:
30. März 2021
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