Malignant transformation in a young adult with recurrent laryngeal papillomatosis

Abstract

The term “papilloma” was first described by Mackenzie in 1880 when he described papillomas in the larynx of a child and used the term “Juvenile laryngeal papillomatosis”; he also claimed that it was the most benign tumour of the larynx [1]. Human Papilloma Virus (HPV) types 6 and 11 have been associated with recurrent respiratory papillomatosis (RRP). In view of the recurrent nature of this condition majority of patients require multiple surgical procedures for tumour removal and maintenance of airway [2, 3]. Malignant transformation of RRP is uncommon, however squamous cell carcinoma (SCC) can arise in RRP but is uncommon in the absence of aggravating factors such as tobacco smoking, irradiation and exposure to chemical agents. Genetic mutation of p53 in association with integration of HPV-11 is seen in histologically malignant lesions. This association may promote a progressive genetic instability that can lead to the development and clonal expansion of malignant lesions in RRP [3]. We report a rare case of a 28 year old JCO, non-smoker, non-irradiated patient who underwent malignant transformation of benign recurrent papillomatosis during LASER treatment. He was treated with widefield laryngectomy with primary tracheo-oesophageal puncture (TEP) and insertion of PROVOX -2 voice prosthesis for voice restoration.