Chest Conference 3/5

tracheal-papilloma-2.jpgtracheal-papilloma1.jpgpapilloma-picture-1.jpgThis case was presented Wed 3/5 at chest conference.  This was a 70 year old female who presented with 3 months of progressive wheezing and shortness of breath.  PFT’s showed a typical upper airway obstruction pattern.  Examples of CT and bronchoscopy are above (click on image to enlarge)

Laryngealtracheal papillomatosis can involve either trachea or more commonly the larynx.  There is a bimodal age distribution and  can occur in childhood (<5 y/o) or adulthood (typically 20-30 years. They are closely associated with HPV 6 & 11 virus, which can be acquired during birth or later in life with oral contact .  HPV proteins are expressed exclusively in squamous epithelial cells.  Squamous papillomatosis can become malignant, but rarely.  Removal often results in recurrence, the resection removes the active infection but not the latent virus DNA.  This patient was treated with Heliox and laser removal with good results.

The abnormality can occur in the lung parenchyma with cavitation,and this has a poor prognosis.

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