Skip to main content

Advertisement

SpringerLink
Log in

Squamous Cell Papillomatosis in the Setting of Recurrent Respiratory Papillomatosis

  • Sine qua non Clinicopathologic Correlation
  • Published:
Head and Neck Pathology Aims and scope Submit manuscript

Abstract

A 23 year old male presented to the Otolaryngology clinic with 6 months of hoarseness and poor voice projection without improvement from speech therapy or medical anti-reflux medication. Upon examination he was found to have multiple polypoid lesions emanating from bilateral false vocal folds, left true vocal fold, and the anterior commissure. Biopsy and potassium titanyl phosphate (KTP) laser ablation with bevacizumab injection provided treatment and confirmed the clinical suspicion of squamous cell papilloma. Despite 3 years of treatment, the papillomatosis proved difficult to control, requiring a procedure approximately every 3 months. In an attempt to control the course of the disease the patient received a series of three bevacizumab and three cidofovir injections. Serial biopsies showed mild atypia within the squamous cell papillomas. Two separate biopsies confirmed presence of human papillomavirus (HPV) 6/11 via in situ hybridization with appropriate controls. There is promising research that the quadrivalent HPV (types 6, 11, 16, and 18) vaccine both reduces the disease burden in patients with active disease and reduces the incidence of recurrent respiratory papillomatosis (RRP). Other studies have shown that local immunologic dysregulation may play a role in RRP pathogenesis. Therefore new treatment options, to include PDL-1 blockade, offer hope in treating this benign condition with high morbidity and rare mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Omland T, Akre H, Lie KA, Jebsen P, Sandvik L, Brøndbo K. Risk factors for aggressive recurrent respiratory papillomatosis in adults and juveniles. PLoS ONE. 2014;9(11):e113584.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Chirilă M, Bolboacă SD. Clinical efficiency of quadrivalent HPV (types 6/11/16/18) vaccine in patients with recurrent respiratory papillomatosis. Eur Arch Otorhinolaryngol. 2014;271(5):1135–42.

    Article  PubMed  Google Scholar 

  3. Richardson M, Gale N, Hille J, Zidar N. Squamous cell papilloma and squamous cell papillomatosis. In: Chan JKC, Grandis JR, Takashi T, Slootweg PJ, El-Nagger AK, editors. WHO classification of head and neck tumours. Lyon: International Agency for Research on Cancer; 2017.

    Google Scholar 

  4. Dickens P, Srivastava G, Loke SL, Larkin S. Human papillomavirus 6, 11, and 16 in laryngeal papillomas. J Pathol. 1991;165(3):243–6.

    Article  CAS  PubMed  Google Scholar 

  5. Wiatrak BJ, Wiatrak DW, Broker TR, Lewis L. Recurrent respiratory papillomatosis: a longitudinal study comparing severity associated with human papilloma viral types 6 and 11 and other risk factors in a large pediatric population. Laryngoscope. 2004;114(11 Pt 2 Suppl 104):1–23.

    Article  PubMed  Google Scholar 

  6. Ruiz R, Achlatis S, Verma A, Born H, Kapadia F, Fang Y, Pitman M, Sulica L, Branski RC, Amin MR. Risk factors for adult-onset recurrent respiratory papillomatosis. Laryngoscope. 2014;124:2338–44.

    Article  PubMed  Google Scholar 

  7. Silverberg MJ, Thorsen P, Lindeberg H, Grant LA, Shah KV. Condyloma in pregnancy is strongly predictive of juvenile-onset recurrent respiratory papillomatosis. Obstet Gynecol. 2003;101(4):645–52.

    PubMed  Google Scholar 

  8. Karatayli-Ozgursoy S, Bishop JA, Hillel A, Akst L, Best SR. Risk factors for dysplasia in recurrent respiratory papillomatosis in an adult and pediatric population. Ann Otol Rhinol Laryngol. 2016;125(3):235–41.

    Article  PubMed  Google Scholar 

  9. Aslanzadeh J. Preventing PCR amplification carryover contamination in a clinical laboratory. Ann Clin Lab Sci. 2004;34(4):389–96.

    CAS  PubMed  Google Scholar 

  10. Papaioannou VA, Lux A, Voigt-Zimmermann S, Arens C. Treatment outcomes of recurrent respiratory papillomatosis: retrospective analysis of juvenile and adult cases. HNO. 2018;66(Suppl 1):7–15.

    Article  PubMed  Google Scholar 

  11. Novakovic D, Cheng ATL, Zurynski Y, Booy R, Walker PJ, Berkowitz R, Harrison H, Black R, Perry C, Vijayasekaran S, Wabnitz D, Burns H, Tabrizi SN, Garland SM, Elliott E, Brotherton JML. A prospective study of the incidence of juvenile-onset recurrent respiratory papillomatosis after implementation of a national HPV vaccination program. J Infect Dis. 2018;217(2):208–12.

    PubMed  Google Scholar 

  12. Villa LL, Ault KA, Giuliano AR, Costa RL, Petta CA, Andrade RP, Brown DR, Ferenczy A, Harper DM, Koutsky LA, Kurman RJ, Lehtinen M, Malm C, Olsson SE, Ronnett BM, Skjeldestad FE, Steinwall M, Stoler MH, Wheeler CM, Taddeo FJ, Yu J, Lupinacci L, Railkar R. Immunologic responses following administration of a vaccine targeting human papillomavirus Types 6, 11, 16, and 18. Vaccine. 2006;24(27–28):5571–83.

    Article  CAS  PubMed  Google Scholar 

  13. Makiyama K, Hirai R, Matsuzaki H. Gardasil vaccination for recurrent laryngeal papillomatosis in adult men: first report: changes in HPV antibody titer. J Voice. 2017;31(1):104–6.

    Article  PubMed  Google Scholar 

  14. Gi RETP., San Giorgi MR, Pawlita M, Michel A, van Hemel BM, Schuuring EM, van den Heuvel ER, van der Laan BF, Dikkers FG. Immunological response to quadrivalent HPV vaccine in treatment of recurrent respiratory papillomatosis. Eur Arch Otorhinolaryngol. 2016;273(10):3231–6.

    Article  Google Scholar 

  15. Lucs AV, DeVoti JA, Hatam L, Afzal A, Abramson AL, Steinberg BM, Bonagura VR. Immune dysregulation in patients persistently infected with human papillomaviruses 6 and 11. J Clin Med. 2015;4(3):375–88.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Ahn J, Bishop JA, Roden RBS, Allen CT, Best SRA. The PD-1 and PD-L1 pathway in recurrent respiratory papillomatosis. Laryngoscope. 2018;128(1):E27–E32.

    Article  CAS  PubMed  Google Scholar 

  17. Liu T, Greenberg M, Wentland C, Sepe B, Bowe S, Diercks G, Huynh T, Mino-Kenudson M, Schlegel R, Kodack D, Benes C, Engelman J, Hartnick C. PD-L1 expression and CD8 + infiltration shows heterogeneity in juvenile recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol. 2017;95:133–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anatomic Pathology, Naval Medical Center San Diego, San Diego, CA, USA

    Pasha L. Bentley & Brenda L. Nelson

  2. Department of Otolaryngology, Naval Medical Center San Diego, San Diego, CA, USA

    Michael J. Coulter

  3. Department of Pathology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA, 92134-5000, USA

    Pasha L. Bentley

Authors
  1. Pasha L. Bentley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael J. Coulter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brenda L. Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pasha L. Bentley.

Additional information

Disclaimer

The opinions and assertions expressed herein are those of the author and are not to be construed as official or representing the views of the Department of the Navy or the Department of Defense.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bentley, P.L., Coulter, M.J. & Nelson, B.L. Squamous Cell Papillomatosis in the Setting of Recurrent Respiratory Papillomatosis. Head and Neck Pathol 13, 235–238 (2019). https://doi.org/10.1007/s12105-018-0912-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12105-018-0912-8

Keywords

Search

Navigation