Clinical features of malignant transformation in benign laryngeal papillomata

Abstract

Laryngeal papillomata can undergo spontaneous malignant transformation without being detected histologically and, in some instances, the disease may become so advanced, before the diagnosis is confirmed, that it is beyond any form of curative treatment.Because of this limitation imposed by histopathological investigation, a study was undertaken in 17 adults with benign laryngeal papillomata, (three of whom underwent malignant transformation) to determine whether malignant transformation can be predicted from the clinical behaviour of the tumour. The following features were analysed: age, sex, patient's symptoms, frequency of excision of the papillomata, site of lesion, presence or absence of laryngeal oedema, the need for tracheostomy, vocal fold mobility and presence or absence of cervical lymph nodes.It was found that decreased vocal fold mobility, the presence of cervical lymph nodes, exuberant and rapid growth requiring very frequent excisions, oedema of the larynx with airway obstruction requiring a tracheostomy are clinical features suggestive of malignant transformation.

Malignant Transformation in a Young Adult With Recurrent Laryngeal Papillomatosis

“…Multiple HPV infections can occur in the same lesion. Type 16 and its DNA integration is thought to contribute to the occurrence of severe dysplasia and carcinoma [5].…”

A possible role for human papillomaviruses in head and neck cancer

“…Spontaneous conversion, although rare, is represented in the literature by a number of individual case reports [90][91][92][93][94]. For carcinomas arising from laryngeal papillomas in the absence of radiation, Yoder and Batsakas [95] estimated a conversion rate of 3%, while Singh and Ramsaroop [96] suggested a spontaneous conver- Table 2. Effects of retinoids on laryngeal papilloma cells in culture sion rate of 19%.…”

Laryngeal carcinoma ex-papilloma in a non-irradiated, non-smoking patient: a clinical record and review of the literature

“…Here the authors have observed that decreased vocal fold mobility, exuberant and rapid growth requiring frequent excisions, laryngeal oedema and obstruction requiring tracheostomy and the presence of cervical lymph nodes are features suggestive of malignant transformation. In the case described in this paper, most of the features described by them (Singh and Ramsaroop, 1994) were conspicuously absent and the diagnosis of malignant change was based purely on histology. However, with all the features described by them in mind and with a high index of suspicion, it should be possible to diagnose malignant change in respiratory papillomata at the earliest opportunity.…”

“…1965;Kashima et al, 1988) or those who had smoked tobacco for several years (Toso, 1971;Matsuba et al. 1985: Singh andRamsaroop, 1994). It is well established that there are definite carcinogenic factors and agents in tobacco and that tobacco smoking and irradiation can induce malignancy.…”

“…Notable breakthroughs in this direction have been the demonstration of human papilloma virus (HPV type 11) in both the papilloma and the carcinomatous tissue (Byrne et al, 1987;Helmuth and Strate, 1987;Kashima et al, 1988;Zarod et al, 1988;Chaput et al, 1989;Guillou et al, 1991). A recent article by Singh and Ramsaroop (1994) vividly elucidates the clinical features of malignant transformation in benign laryngeal papillomata. Here the authors have observed that decreased vocal fold mobility, exuberant and rapid growth requiring frequent excisions, laryngeal oedema and obstruction requiring tracheostomy and the presence of cervical lymph nodes are features suggestive of malignant transformation.…”