Bronchogenic Squamous Cell Carcinoma Complicating Localized Recurrent Respiratory Papillomatosis

doi:10.1378/chest.105.6.1887

Chest

Volume 105, Issue 6, June 1994, Pages 1887-1888

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Bronchogenic squamous cell carcinoma has been reported in patients with recurrent respiratory papillomatosis (RRP) extending into the tracheobronchial tree even in the absence of a history of radiation therapy or smoking. We present a case of bronchogenic squamous cell carcinoma developing in a patient with RRP localized to the larynx for 45 years.

Section snippets

CASE REPORT

A 48-year-old woman was originally diagnosed as having RRP at 2 years of age when she presented with hoarseness and dyspnea. She had six separate tracheostomies for laryngeal papilloma resection in childhood. Following these, about 18 endoscopic laryngeal papilloma resections were performed. Between 1988 and July 1991, five endoscopic laser resections were performed.
After the last procedure, she developed a persistent cough. In November 1991, she developed fever and purulent sputum. She denied

DISCUSSION

Bronchogenic squamous cell carcinoma is a rare complication of RRP in the absence of a history of irradiation or smoking. In previous cases, it arose as a complication of RRP that extended into the tracheobronchial tree before diagnosis of the malignancy. In some cases, the malignancy was an incidental finding at autopsy of patients with RRP dying of pneumonia or respiratory failure.⁵

The unique feature of this case was the development of a bronchogenic squamous cell carcinoma in a patient in

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AbramsonA.L. et al.
Laryngeal papillomatosis: clinical, histopathologic and molecular studies
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(1987)

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Citation Excerpt :
SCJs have been detected in bronchial spurs82 and may explain how laryngeal papillomatosis spreads to the trachea and bronchi.83 The recurrent respiratory papillomatosis may result from the development of laryngeal and tracheobronchial papillomas81 and the subsequent development of well-differentiated squamous cell carcinoma of the pulmonary airways.84 Previous findings indicated that the existence of HPV infection in the upper respiratory or aerodigestive tract possibly resulted in HPV transmission to pulmonary airways and the subsequent development of lung tumor.
Lung cancer is the leading cause of cancer among women worldwide, and adenocarcinoma is the most common histological subtype among non-smoking women. Previous studies showed that human papillomavirus (HPV) infection may relate to the tumorigenesis of pulmonary adenocarcinoma. Women with anogenital malignancy have a higher risk of lung cancer, which raises the possibility of HPV transmission from the cervix to the lung. Two postulated pathways are discussed in this work. First, HPV may infect the female cervix and then move to the lung by blood circulation. The second transmission route is the HPV infection of oral cavity resulting from dangerous sexual contacts, and subsequently transmitted to the lung. This chapter also reviews the techniques for detecting the existence, subtypes, and viral load of HPV. Future studies are needed to demonstrate the causal inference between HPV infection and the risk of female lung adenocarcinoma.
Lung involvement in juvenile onset recurrent respiratory papillomatosis: A systematic review of the literature
2008, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
Two publications reported testing for only one type [36,66], and three publications reported testing for only HPV 6 and HPV 11 (10 patients) [5,86,110]. Fourteen patients, however, had tests for multiples types, including types 16 and 18 [1,14,28,30,37,41,52,85,92,100,105]. The other publications did not differentiate between type 6 and 11 [40,71,77] or type 16 and 18 [3,59].
Determine the exact incidence of pulmonary involvement in recurrent respiratory papillomatosis (RRP); explore available treatments and their effectiveness; determine the characteristics of cases that progress to lung cancer.
MEDLINE, EMBASE, and the Cochrane Library databases between 1966 and 2007; reference lists of retrieved publication.
Studies investigating recurrent respiratory papillomatosis with lung involvement. Age limited to 20 years of age to qualify for the diagnosis of juvenile-onset RRP.
Data pertaining to study design, population demographics, risk factors, site of involvement, investigation including the determination of the human papillomavirus type, treatment, and outcomes including the development of cancer.
No randomized control trials were retrieved. Hundred and one studies met our inclusion criteria (23 cohorts, 4 case series, 72 case reports, 2 open trials) with 161 cases of lung involvement identified. From the cohort studies we could estimate the incidence of lung involvement in RRP at 3.3%. The incidence of cancer in cases with lung involvement was 16%. We could not draw conclusions regarding treatment effectiveness in lung involvement, as that was not evaluated except in case studies. It would nevertheless appear that Interferon is not effective and the use of intravenous Cidofovir needs to be better evaluated.
Well-designed, hypothesis-driven randomized control trials and prospective cohort studies are warranted to improve our understanding of the mechanisms underlying the development of lung involvement in RRP, the risks associated with different HPV types, the efficacy of potential therapeutic options as well as the risk of progression to cancer.

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Selected ReportsBronchogenic Squamous Cell Carcinoma Complicating Localized Recurrent Respiratory Papillomatosis

Section snippets

CASE REPORT

DISCUSSION

Papilloma of the larynx in children: a clinicopathologic study

Am J Surg

Tracheal involvement in laryngeal papillomatosis

Laryngoscope

Laryngeal papillomatosis: clinical, histopathologic and molecular studies

Laryngoscope

Selected Reports
Bronchogenic Squamous Cell Carcinoma Complicating Localized Recurrent Respiratory Papillomatosis