Early Identification and Intervention in Malignant Transformation of Respiratory Papillomatosis

Abstract

Unusual clinical course Background:Human papilloma virus is a ubiquitous and preventable disease with the potential to cause recurrent respiratory papillomatosis. These papillomas affect the mucosal surface of the airways and may lead to airway obstruction. The papillomas require excision when breathing is compromised, and may be fatal if untreated. Rarely, these papillomas progress to cancer. Case Report:We report the case of a 21-year-old woman with a history of HPV 11-and 16-positive recurrent laryngeal and respiratory papillomatosis (RRP) since the age of 7 months, requiring multiple local resections in her respiratory tract. Chest CT demonstrated multiple cavitary lesions throughout both lungs with a rapidly growing mass that occupied most of her right lung. Imaging supported a diagnosis of malignant transformation to squamous cell carcinoma of the lung. Bilateral involvement of the lungs indicated stage IVa squamous cell lung cancer, which is not curable. Conclusions:Clinicians should suspect malignant transformation in patients with HPV type 11, especially if they have required multiple excisions. Earlier age at onset and number of excisions may be predictors for severity of the disease course. These patients need continued surveillance imaging to allow early interventions if malignant transformation occurs. We present the case of a 21-year-old being diagnosed with an incurable disease that may have been avoided with adequate preventive care.

Accretion and Excrescence-Papilloma Lung

“…Lesion appears immune nonreactive to thyroid transcription factor-1 [TTF-1] and CK20. A subset of neoplasms appearreactive for human papilloma virus [HPV], as discerned by in situ hybridization [ISH] or polymerase chain reaction [PCR] [4,5]. Papilloma emerging within pulmonary parenchyma requires segregation from neoplasms such as inflammatory polyp, mucoepidermoid carcinoma or papillary squamous cell carci-noma [4,5].…”

“…A subset of neoplasms appearreactive for human papilloma virus [HPV], as discerned by in situ hybridization [ISH] or polymerase chain reaction [PCR] [4,5]. Papilloma emerging within pulmonary parenchyma requires segregation from neoplasms such as inflammatory polyp, mucoepidermoid carcinoma or papillary squamous cell carci-noma [4,5]. Upon frozen section or examination of miniature tissue samples, papilloma lung may be challenging to discern or segregate from squamous epithelial carcinoma.…”

“…Papilloma lung may be incidentally discovered upon cogent imaging studies. Alternatively, clinical symptoms concurrent with airway obstruction may ensue [4,5].…”

“…Computerized tomography enunciates shadowing of the tumefaction. Upon positron emission tomography [PET] scan, tumour may depict avidity for 18F-fluorodeoxyglucose [18F-FDG] [4,5]. Papilloma arising within pulmonary parenchyma may be appropriately managed with endoscopic eradication of the lesion.…”

“…Surrounding stroma delineates mild to moderate infiltrate of inflammatory cells which may engender airway obstruction. Mitotic figures and tumour necrosis are absent [3][4][5][6][7] (Figures 1 & 2; Tables 1 & 2).…”