INVERTED PAPILLOMAS THAT INVADE THE ORBIT

We describe 10 patients with inverted papillomas (IPs), uncommon endop hytic epithelial tumors that arose in the nose, paranasal sinuses, and lacrimal sac, that invaded the orbit; review the world literature on IF; and discuss treatment options, Patients ranged in age from 49 to 7 2 years (mean age, 62 years; median age, 66 years), Six patients were men and four were women, Presenting symptoms and signs included a medi al canthal mass (n=5), epiphora/lacrimal drainage obstruction (n=3), i nability to wear eyeglasses (n=2), diplopia (n=1), and painful denture s (n=1), Histopathologic examination was performed in each patient and revealed all patients to have areas with malignant transformation: si x patients with IPs that contained areas of squamous cell carcinoma an d four with areas of transitional cell carcinoma in the tumor within t he orbit, Eight of the patients with IPs had a recurrence after initia l resection, In two patients, the IPs were completely excised and did not recur; yet, follow-up was short, Eight patients required orbital e xenteration for local control of disease. Nevertheless, local spread o f tumor through bone to brain occurred in three patients with orbital involvement. Indeed, IPs that invade the orbit have a high incidence o f malignancy and are locally aggressive tumors, Treatment is difficult , and the recurrence rate is high, Early, wide excision of this aggres sive tumor provides the best chance of cure.