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A SCITECHNOL JOURNAL
2Department
3Department
*Corresponding
author: Guillaume Michel, Service d'ORL et de chirurgie cervicofaciale, CHU Htel Dieu, 1, Place A. Ricordeau, BP 1005, 44093 Nantes Cedex
01, Tel: 0240083475; FAX: 0240083477 ; E-mail: guillaumemichel@live.fr
Rec date: Jun 19, 2014, Acc date: Aug 08, 2014, Pub date: Aug 18, 2014
Abstract
Case Report
A 59-year-old patient consulted for an historical nasal polyposis; a
polypectomy had been performed 10 years before, with effective but
temporary results.
He had no personal history, no allergy nor aspirin intolerance, no
asthma; he had quit smoking 45 years before, with estimated tobacco
smoking at less than five pack-years. He worked as a technical
inspector, without wood dust or nickel exposure.
He was taking no local treatment or oral corticotherapy.
Introduction
Nasal polyposis is a chronic inflammatory disease of the nasal
mucosa, characterized by bilateral polyps arising from the anterior
ethmoid complex [1]. The presenting symptoms (nasal obstruction,
rhinorrhea, hypo- or anosmia, facial pressure) had evolved for more
than 12 weeks and were associated with a suggestive nasofibroscopy
[2].
All articles published in Journal of Otology & Rhinology are the property of SciTechnol, and is protected by copyright
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Citation:
Michel G, Espitalier F, Cassagnau E, Malard O (2014) Malignant Transformation of Nasal Polyposis: Case Report and Review of the Literature. J
Otol Rhinol 3:4.
doi:http://dx.doi.org/10.4172/2324-8785.1000176
Because of this advanced and disabling nasal polyposis, surgical
treatment was performed, complementary to medical treatment. The
surgery consisted of a bilateral ethmoidectomy of the meatus with
bilateral sphenoidotomy. The nasal polyps were sent for routine
histopathological examination.
The histopathological examination revealed inflammatory polyps as
commonly described in nasal polyposis (Figure 3a); the chorion was
oedematous, highly vascularized, with moderate inflammatory
infiltration of mononuclear cells and eosinophils.
Figure 3: Histological sections a) Normal respiratory epithelium; b) In situ epidermoid carcinoma, with loss of maturation, cytonuclear atypia
and mitosis over the entire epithelium height.
There was no inverted papilloma, meaning this histological analysis
was a multifocal degeneration of an evolved nasal polyposis. There was
no bacteria on the direct examination, but rare colonies of Escherichia
coli, Citrobacter koseri and Streptococcus agalactiae were found after
culture.
Discussion
Nasal polyposis is a chronic disease of the nasal mucosa, and the
etiology of the primitive form is still unknown. The Bernstein model
considers nasal polyposis a multifactorial disease [4], with an
important role played by mediators such as cell adhesion molecules
and cytokines, causing an inflammatory reaction.
Nasal polyps are bilateral and benign, and characterized in
histopathological terms by epithelial and vascular remodelling as well
as the presence of an inflammatory infiltration of the stroma [5].
The development of nasal polyps is bilateral and symmetric. The
presence of unilateral nasal polyps must challenge the nasal polyposis
diagnosis and points to benign or malignant tumours.
However, a number of authors have described the presence of
benign or malignant tumours incidentally discovered after surgery for
bilateral nasal polyps. This warrants systematic histopathological
examination after a surgical intervention for nasal polyposis.
The most common diagnose is an inverted papilloma [6].
Page 2 of 3
Citation:
Michel G, Espitalier F, Cassagnau E, Malard O (2014) Malignant Transformation of Nasal Polyposis: Case Report and Review of the Literature. J
Otol Rhinol 3:4.
doi:http://dx.doi.org/10.4172/2324-8785.1000176
mediators. Epithelial lesions caused by inflammatory mediators induce
increased cell proliferation, via processes of epithelial repair and
secretion of growth factors [9]. A recent study [10] showed that
STAT3 (signal transducer and activator of transcription 3) was overexpressed in a phosphorylated form in nasal polyps, compared to
control subjects, indicating an activation of STAT3 in polyps. The
authors conclude that pSTAT3, which can promote oncogenesis by
being constitutively active [11], plays a crucial role in the proliferative
development of nasal polyps.
Late in the natural history of nasal polyposis, it can be assumed that
cell proliferation becomes deregulated, responsible for a malignant
transformation.
Conclusion
We report a case of a patient presenting a classic but extensive nasal
polyposis. Histopathological examination after surgery revealed
multiple epidermoid carcinomas in the nasal polyposis, with no
primary tumour such as an inverted papilloma.
Potential long-term transformation has not been reported in the
literature, although a higher proliferation index in nasal polyposis has
already been demonstrated.
Conflict of Interest
There is no conflict of interest among authors.
References
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