Respiratory Medicine (1996) 90, 53-55 Case Reports Recurrent respiratory papillomatosis with malignant transformation in a young adult D. ORPHANIDOU, K. DIMAKOU, P. LATSI, M. GAGA, M. TOUMBIS, A. RASIDAKIS AND J. JORDANOGLOU Respiratory Medicine Department, School of Medicine, Athens University, Greece Introduction The term ‘papilloma’ was first used by Mackenzie 100 years ago, who claimed that this was the most benign tumour of the larynx (1). Today papillomas are considered to be caused by the Human Papilloma Virus group (H.P.V.) (2-6). The majority of patients suffering from this disease which is also referred to as ‘recurrent respiratory papillomatosis’ (2,7) require multiple surgical operations for tumour removal (8). Malignant transformation of papillomas, which is a rare condition, is considered to occur mainly to irradiated patients (5). The following report describes the case of a male patient, with a history of vocal cord papillomas since his first year of age, who developed bronchial and pulmonary spread of the disease. He died at the age of 26 years because of squamous cell carcinoma which was related to the malignant transformation of the pulmonary papillomas. Case Report The patient was a 26-year-old male, non-smoker, builder in profession, with a history of vocal cord papillomas since the age of 1 year. At this early age, surgical excision of papillomas was performed and at the age of 2 years a tracheostomy was performed. His general condition was good until the age of 20 years, when the patient underwent electric cauterization of the papillomas which subsequently relapsed again. Following this, the patient had frequent respiratory infections, sometimes accompanied with haemopty- sis. At the age of 25, he was first admitted to a respiratory unit because of low grade fever for 6 months and a few days duration of pleuritic chest pain. The chest X-ray showed a left pleural effusion Received 26 January 1994 and accepted 3 February 1994 which proved to be exudate with predominance of polymorphonuclear white blood cells. In addition, the chest computed tomography revealed bilateral small cavitating nodules. The patient improved clini- cally on antimicrobial therapy. Seven months later, he was admitted to our department with fever, cough with purulent expectoration, bloody sputum and cervical pain. Physical examination showed a young patient with kyphoscoliosis and tracheostomy. Ausculation of the thorax revealed bilateral inspira- tory crackles over the middle and bases of both lungs. The findings of the remainder of the examination were within normal limits. Chest X-ray showed a shadow in the left mid zone and left lower lobe atelectasis (Plate 1). Fibre-optic bronchoscopy was then performed which demon- strated polypoidal protrusions of the mucosa in the left lower lobar bronchus, that caused obstruction. Pathological examination of the endobronchial biop- sies showed the presence of papillomas. Cytological examination of the bronchial washing and brushing were negative. High-resolution computed tomogra- phy of the thorax revealed multiple bilateral pulmo- nary solid and cavitating nodules in addition to the X-ray findings (Plate 2). Bone scanning showed increased radioactivity at the cervical part of the spinal column. After control of the infection, laser treatment was recommended in order to widen the lumen of the left lower bronchus, but the patient refused. Two months later, he was admitted to a hospital again because of increasing cervical pain and pro- found oedema of the neck. A new bronchoscopy was then performed. Cytological examination of the bronchial secretions, as well as the material obtained by percutaneous needle aspiration of the left periph- eral solid nodule under ultrasound control, revealed the presence of squamous cell carcinoma. 0954-6111/96/010053+03 $12.0010 Q 1996 W. B. Saunders Company Ltd brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Elsevier - Publisher Connector