2009 Southern Regional Meeting Abstracts

Case Report: Introduction: Recurrent respiratory papillomatosis (RRP) is the result of exposure to Human Papilloma Virus (HPV) that occurs during delivery. Development of RRP is a result of HPV infection that involves the larynx and trachea. Patients with laryngo/tracheal involvement of HPV will progress to RRP in five percent of cases. Of those that progress to RRP only one percent will develop invasive squamous cell cancer of the lung. This tends to effect younger patients and is, thus, even more devastating.
Case Presentation: We present the case of a 32-year old non-smoking white female who presented with a long history of laryngeal and tracheal papillomatosis. She had numerous interventions including laser ablation of lesions, tracheostomy, and myomectomies. On computed tomography (CT) scan of the neck she was incidentally found to have a lung lesion that was assumed to be papillomatosis. On subsequent CT imaging one area increased in size rapidly and was noted to have a necrotic center. She was taken to surgery, and the mass was removed along with two other viscera pleural-based masses, all of which revealed invasive well differentiated squamous cell carcinoma.
Conclusion: While RRP is uncommon and conversion of papillomas to overt lung malignancy is even less common, the results can be devastating. Little more that intermittent case reports, some at the time of autopsy, guide clinical treatment. Oral tyrosine kinase inhibitors such as gefitinib and erlotinib show some promise in these lesions. Treating the underlying HPV infection may also be beneficial in some cases. With the advent of HPV vaccination this may become even less common than it is at the present time.