A Case of Multiple Squamous Cell Papillomas of the Trachea

Abstract

We report a case of 68-year-old woman suffering from breathlessness on exertion with stridor. A chest computed tomography showed a tumor arising from the posterior wall of the trachea. The diagnosis was squamous cell papilloma of the surgically removed tumor, which had caused the asphyxiation. After removal of the tumor, the patient received radical therapy: semiconductor laser transpiration. Polymerase chain reaction (PCR) detected human papilloma virus (HPV) type 6, thought to be the cause of the respiratory papilloma.Key words: papilloma, human papilloma virus, polymerase chain reaction, semiconductor laser, trachea Case ReportA 68-year-old woman was admitted to our hospital because of breathlessness with stridor, which gradually worsened over the previous 2 months. She was a nonsmoker and had no history of radiotherapy to the trachea. Physical examinations were normal, except for inspiratory and expiratory stridor. Her routine laboratory results were normal. Pulmonary function test revealed a severe obstructive impairment: a forced vital capacity (FVC) of 3.09 L (135.5% of predicted), a forced expiratory volume in 1 s (FEV1.0) of 0.91 L (53.2% of predicted), and FEV1.0 to FVC ratio of 29.5%. Flow volume loop pattern showed intrathoracic upper airway obstruction. Chest computed tomography (CT) and flexible bronchoscopy documented a cauliflower-like, warty tumor. The main tumor size was 15 × 10 × 10 mm and was located 30 mm below the vocal cords ( Fig. 1a and 1b). In addition, we observed two other small polypoid lesions. We started an emergency tracheostomy of the patient under local anesthesia to remove the tumors and secure her airway.During the tracheostomy, she became nearly asphyxiated. Then, we administered general anesthesia. After completing the tracheostomy, we successfully removed the main tumor without preparing an extracorporeal cardiopulmonary bypass. Histologically, the tumor specimen contained squamous cell papilloma with mild, atypical koilocytes; thus, the diagnosis was multiple respiratory papillomas ( Fig. 1c and 1d). Polymerase chain reaction (PCR) amplification (Fig. 2) detected human papilloma virus (HPV) type 6 DNA in the tumor specimen. Otherwise, there was no viral DNA in normal tissue. After removal of the primary tumor, we used semiconductor laser transpiration, a radical therapy, to remove the remaining tumors. The patient got relief from her symptoms with no recurrence 8 months after treatment. DiscussionRespiratory papilloma has been reported in children and adults. Onset during adulthood is more common among men and often occurs in the third or fourth Ann

A Soft Tissue Aneurysmal Bone Cyst in Thoracic Cavity

“…In the case presented here, there were bone trabeculae containing osteoblastic rims and osteoid; however, there was no anaplasia and cytological atypia (17). Due to its thoracic location, juvenile bone cyst, Ewing's sarcoma, eosinophilic granuloma, metastasis of neuroblastoma and leukemia, osteochondroma, callus tumor of the rib and chest wall hamartoma and all benign and malignant lesions of the rib must be kept in mind in the differential diagnosis of ABCs in children (9). All aforementioned lesions are associated with the rib; however, radiological imaging did not show an association of the lesion with the rib in the present case.…”

“…Aneurysmal bone cysts can involve any bones, the most common site being end of the long tubular bones and vertebral column. The rib is a rare location of ABCs accounting for 2.7% of all cases (7,9). Although there have www.respircase.com been many cases of an intrathoracic ABC with rib involvement (7), there is only one case of an intrathoracic mass of the soft tissue without rib involvement (6,10).…”

“…Both aneurysmal bone cysts and giant cell tumors typically manifest as expansile osteolytic lesions and occasionally show fluid-fluid levels suggestive of the diagnosis. Juvenile bone cyst, Ewing's sarcoma, eosinophilic granuloma, osteochondroma, callus tumor of the rib, chest wall hamartoma, and leukemia are all benign and malignant lesions of the rib which must be kept in mind in the histopathological and radiological differential diagnosis of ABCs (9,18). Fluid-fluid levels can be seen in ABCs; however, this finding is not specific for ABCs.…”

Solitary fibrous tumor of the trachea: a case report

“…At least 90% of these tumors are progressive malignant tumors such as adenoid cystic carcinoma and squamous cell carcinoma [1,2]. On the other hand, less than 10% of these tumors are benign tumors, including relatively frequent squamous papilloma [3] and other tumors such as inflammatory myofibroblastic tumors [4] and leiomyoma [5], and SFTs are extremely rare.…”

An Isolated Tracheal Papilloma: A Case Report

“…The mechanism of transformation from RRP to a squamous-cell carcinoma remains unclear. Malignant degeneration to squamouscell carcinoma is reported in 3 to 5% of all cases of TP (11). Malignant transformation of TP is associated with HPV types, radiotherapy, chemotherapy with bleomycin, and a history of smoking (12).…”