Pulmonary Manifestations of Juvenile Laryngotracheal Papillomatosis: Case Report and Literature Review

Abstract

Abstract:In the present report, we report on a rare case of tracheobronchopulmonary spread of childhood recurrent laryngeal papillomatosis without ana association to prior HPV infection, in a 39-year-old female patient.Recurrent laryngeal papillomatosis (RRLP) is a rare benign disease seen in children and a fewcases are reported in adults. Although RRLP is histologically a benign proliferation of stratified squamous epithelium and is usually limited to the larynx its spread to the tracheobronchial tree occurs in 2% to 29% of cases and to the pulmonary parenchyma in less than 7% of cases. CASE REPORTA woman 39 years of age with bilateral focal lesions of the lung. Wedge excision of the lesion in the right lung filled with a purulent secretion. Macroscopic AppearanceThe lung tissue, 42x30x20 mm in size had multiple yellowish and graysh lesions of varying size from 2-15 mm with purulent content in the center of the largest lesion. HISTOLOGICAL FINDINGSA-E: In all tisuue sections, the findings were identical, as follows: in lung parenchyma several cavitated lesions lined with sheet-like solid masses of squamous proliferations or flat squamous epithelium could be observed. Similar free epithelial sheets could also be seen in the alveolár spaces without any relationship to the above-mentioned cysts. The epithelium showed dyskeratotic changes with evidence of clear maturation without mitoses or dysplastic changes. The given lesion had oval margins without evidence of invasive growth. Keratin and focal spumoid macrophages could be detected in the alveolar spaces and in the lumen of the lesion (Figs. 1, 2). Due to the peculiarity of the histological picture and vague information from the clinician, we searched the patient database and found that the patient had recurrent laryngeal papillomatosis.The above histological picture is compatible with pulmonary manifestation of juvenile laryngeotracheal papillomatosis or pulmonary parenchymal papillomatosis.*Address correspondence to this author at the Department of Pathology and Laboratory of Molecular Pathology, Medical Faculty, Palacky University, Olomouc, Czech Republic; E-mail: jojos@email.cz § Both authors contributed equally to the study. Fig. (1). In lung parenchyma several cavitated lesions lined with sheet-like solid masses of squamous proliferations or flat squamous epithelium could be observed. Similar free epithelial sheets could also be seen in the alveolar spaces without any relationship to the above-mentioned cysts. Fig. (2). The epithelium showed dyskeratotic changes with evidence of clear maturation without mitoses or dysplastic changes. The given lesion had oval margins without evidence of invasive growth. Keratin and focal spumoid macrophages could be detected in the alveolar spaces and in the lumen of the lesion 100x HE.