HEMOPTYSIS CAUSED BY NON-HUMAN PAPILLOMA VIRUS RESPIRATORY PAPILLOMA: A CASE REPORT

Abstract

SESSION TITLE: Fellows Lung Pathology Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Solitary respiratory papillomas (SRP) are uncommon, often verrucated growths arising from the respiratory epithelium. They are associated with human papilloma virus infection and are predominantly found in the upper respiratory tract, but can rarely be found in the lower respiratory tract. CASE PRESENTATION: Patient is a 61 year old male that have presented with two months of cough and new hemoptysis. CT Thorax had shown an endobronchial lesion in the left mainstem and he had been referred to pulmonology for biopsy. On bronchoscopy at the distal left mainstem just proximal to the take off to the left lower lobe there was a verrucated vascular tumor arising from the posterior wall. This tumor was nearly obstructing the left lower lobe. Argon plasma coagulation was used, followed by complete resection using a rigid bronchoscopy. Pathology was consistent with a benign squamous papilloma. Further evaluation showed that the papilloma was negative for HPV. Social history was only significant for 25 pack years of smoking. DISCUSSION: SRP is a rare pulmonary phenomenon with an estimated incidence of 3-4/100,000 patient years with a 3:1 male predominance. Patient’s are commonly 50-60 years of age and present with a chronic cough, dyspnea and hemoptysis. Depending on the size and positioning of the tumor, a localized wheezing may be found on auscultation. SRP are more commonly found in the upper respiratory tract and can also be seen on the larynx, lesions more distally are less commonly seen. As with our patient, tumors of sufficient size may show up as an endobronchial lesion may been seen on CT. Bronchoscopic evaluation often shows a verrucated endobronchial lesion. On histopathology a squamous lesion is most common (65%), glandular (20%), or a mixed subtype (15%). Resection is curative, with resolution of symptoms. Recurrence of papilloma is very rare with an incidence of 2/100,000. Although a typically benign disease, malignant transformation has been seen in up to 15% of cases. SRP is commonly secondary to a human papilloma infection, and non-HPV papillomas are extremely rare and have been postulated to be secondary to a significant smoking history. There is evidence that exposure to irritants such as tobacco, gastric reflux disease may lead to the development of papillomas. CONCLUSIONS: Although traditionally associated with human papilloma virus, in addition to it’s other deleterious effects, tobacco usage may also lead to the development of SRP. Usually a benign lesion, papilloma secondary to tobacco usage can also indicate other potential malignancies Reference #1: Agrawal A, Alagusundaramoorthy S. Respiratory papillomas. Lung India. 2016;33(5):522. doi:10.4103/0970-2113.188973? Reference #2: Harada H, Miura K, Tsutsui Y, et al. Solitary squamous cell papilloma of the lung in a 40-year-old woman with recurrent laryngeal papillomatosis. Pathol Int. 2000;50(5):431-439. doi:10.1046/j.1440-1827.2000.01055.x DISCLOSURES: No relevant relationships by Christian Castaneda, source=Web Response No relevant relationships by Tarek Dammad, source=Web Response No relevant relationships by Albert Magh, source=Web Response No relevant relationships by Crystal Verdick, source=Web Response