A case of malignant transformation of recurrent respiratory papillomatosis

Abstract

Recurrent respiratory papillomatosis (RRP) is a rare, difficult to treat benign tumor disease of the respira­tory tract with a progressive course caused by human papillomavirus and most often occurs in the larynx in the form of papillomas. They may be present at any age, but most often between the ages of 1 and 4. They can recur after treatment, undergo malignant transformation, and spread to the vocal cords, trachea, or lungs.
 Objective — to present our own observation of the malignant transformation of RRP in a young man of 23 years old, who was diagnosed and treated at the SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the NAMS of Ukraine».
 Materials and methods. Prior to this non-systematic review, information was searched in MEDLINE/PubMed for systematic reviews, meta-analyses, and randomized controlled trials published in the past 5 years using such terms as human papillomavirus, recurrent respiratory papillomatosis, and malignant transfor­mation.
 Results and discussion. Patient H. 23 years old. From the anamnesis, it is known that the diagnosis of RRP was made at the age of 4, since then he regularly noticed the appearance of dry wheezing, shortness of breath, hoarseness, and sometimes its disappearance. Since childhood, the patient has been under the supervision of a pediatric otolaryngologist. The papillomas were localized on the vocal cords. It is known that more than 100 procedures were performed to remove papillomas using electrocoagulation under general anesthesia. For morphological verification of the diagnosis, it was decided to perform a video-assisted thoracoscopic surgery of the right lung.Pathological examination findings: «Respiratory papillomatosis with a tendency to malignant transforma­tion». The biopsy material was sent for the immunohistochemical examination. Findings: «G2 Non-keratinizing squamous cell lung carcinoma. There are signs of lymphovascular, perineural invasion, there are signs of pleural invasion, the immunohistochemical study shows that tumor cells are positive for p40, which allows to confirm the diagnosis». After that, the patient was consulted by an oncologist and an immunologist. A 2-component chemotherapy with Carboplatin and Paclitaxel was prescribed.
 Conclusions. RRP is a rare disease that can become malignant in case of untimely diagnosis and inadequate screening. Great attention should be paid to complementing of the surgical treatment with vaccination and immunotherapy.