Page 64 - Revista Portuguesa - SPORL - Vol 62. Nº1

Introduction by case basis. However, establishing a high
The study of sinonasal papillomas (SPs),
which are benign epithelial neoplasms, is of
significant interest due to their aggressive
behavior, predisposition to recurrence and
risk of malignancy. Despite being considered
1
benign neoplasms, their biological behavior
confers them aggressive characteristics,
leading them to invade structures adjacent
to the nose and paranasal sinuses, even
in the absence of associated malignancy.
2
Timely clinical diagnosis of these neoplasms
is a complex task, considering that they are
rarely discovered in their early stages and
that late diagnosis leads to more challenging
treatment options and a worse prognosis. 3
Adequate clinical management of these
neoplasms includes early diagnosis, complete
surgical excision, and rigorous postoperative
follow-up. Even tough these neoplasms are
4
considered benign, their biological behavior,
as noted above, can be very worrisome, even in
the absence of associated malignancy, because
these tumors grow in a narrow anatomical
space, surrounded by critical organs such
as the brain and the orbital cavities. SPs are
4
usually asymptomatic in their early stages.
Therefore, their early detection is fundamental.
Their clinical presentation is usually unilateral
and asymptomatic in the early stages of
growth. Symptoms begin to appear only
after the tumor has reached a significant
volume and can cause nasal obstruction,
nasal secretions, bleeding, headaches, smell
alterations and ophthalmologic and audiologic
manifestations. Based on the general
5
endoscopic, imaging and histopathological
diagnostic evidence commonly observed
in SPs, it is crucial to determine when a
complementary study should be indicated
to facilitate and clarify the timely diagnosis of
these neoplasms. This may allow a higher rate
6
of early diagnosis to favor prompt treatment
with a better evolution and prognosis for
the patient. The endoscopic, imaging and
4
histopathological assessment of SPs play an
essential role in the diagnostic task of SPs, and
these have been studied in detail on a case-
64 Revista Portuguesa de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço
clinical Index of Suspicion (IS) for these lesions
and the close correlative interrelationship
of all the studies mentioned above, has not
been analyzed in depth and together may be
relevant to confirm or dismiss the definitive
diagnosis of these neoplasms. 7
Histopathologically, three subtypes of SPs
are distinguished: Inverted Papillomas (IPs),
Fungiform or Exophytic Papillomas (FPs) and
Columnar Cell Papillomas or Oncocytic (OPs).
Although the histopathological diagnosis of
these neoplasms is one of the key aspects in
the final diagnosis of these lesions, it is not free
of inconveniences derived from the sampling,
examination and interpretation of the tumor
specimen by the pathologist. Knowledge
2
about the etiology, clinical features, behavior
and evolution of SPs has been influencing the
state of the art in the diagnosis, management
and treatment of SPs, especially in its early
diagnosis and early treatment and the
complex management scenarios that may
arise in cases of advanced neoplasms of this
disease in its advanced stages. The present
1
work focuses on the early identification of
SPs based on the formulation of a Suspicion
Index Scale (SIS) based on endoscopic and
imaging evidence commonly observed in SPs
for adequate surgery planning.
Purpose of this study
To design and evaluate the effectiveness of a
quantitative and correlative Suspicion Index
Scale (SIS), based on endoscopic, imaging
and histopathological findings commonly
observed in SPs from the establishing of an
IS, to build a scale based on different findings
commonly observed in these neoplasms.
Materials and methods
A retrospective, descriptive, longitudinal,
quantitative and correlational investigation
of 103 patients diagnosed with SPs, evaluated
and treated from 1993 to June 2021 was done.
The selected population sample was obtained
from a database of 27,416 medical records
reviewed.