Papilloma associated with recurrent respiratory papillomatosis (RRP), caused by human papilloma virus (HPV) infection types 6 and 11, is the most common benign neoplasm of the larynx. The clinical features of RRP vary widely from mild to aggressive forms. RRP in children is known as juvenile-onset recurrent respiratory papillomatosis (JORRP). Its outcome may be poor or even fatal due to the high rate of recurrence and eventual spread to the entire respiratory tract. Pulmonary invasion is reported to occur in 3.3% of patients with RRP, and malignant transformation in 0.5% of patients. We report the case of a 39-year-old female patient with a diagnosis of JORRP from the age of 3 years, with extensive bilateral pulmonary involvement and malignant transformation. Analysis of the papilloma and carcinomatous tissues revealed the presence of HPV type 11, which is associated with rapid and aggressive progression. We discussed the case on the basis of a literature review on pulmonary invasion, malignant transformation, and HPV 11 aggressiveness.

Mirizzi syndrome (MS) is a rare condition whose clinical presentation is unspecific, with obstructive jaundice being the most common form. MS is often not recognized at initial presentation, which can result in morbidity and biliary injury. Preoperative diagnosis is uncommon and over 50% of patients with MS are diagnosed during surgery. There are no clinical features to distinguish MS from cholangiocarcinoma, except that patients with cholangiocarcinoma are on average ten years older than patients with MS. We report the case of a 51-year-old female patient who presented with jaundice and weight loss. Following investigation with laboratory and imaging exams, the initial diagnosis was Bismuth II cholangiocarcinoma. The patient underwent surgical intervention, and anatomopathological examination of the specimen showed the correct diagnosis to be MS. Despite the rarity of its incidence, physicians must keep MS in mind as a possible differential diagnosis for cholangiocarcinoma and vice-versa. We discuss this case in the context of a brief review of the literature on Mirizzi syndrome mimicking cholangiocarcinoma.

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