Abstract
Background The malignant transformation of laryngeal papillomatosis (LP) into squamous cell carcinoma (SCC) can occur in up to 4% of LP cases. The low-risk HPV types 6 and 11 are those that are most commonly related to LP; however, high-risk HPV types may be present. The present study reviews the literature on cases of malignant transformation of LP in adults and reports a clinical case. Case Report A 47-year-old male patient exhibiting hoarseness for 4 months presented an exophytic lesion in the right palatine tonsil and a digitiform-like lesion in the right vocal fold. The biopsy revealed a well-differentiated SCC in the vocal cord, which showed a transition zone with a squamous papillomatous lesion. By using the chromogenic in situ hybridization (CISH) test, both lesions showed a positive result for high-risk HPV types 16 and 18 and negative for low-risk HPV types 6 and 11. The final diagnosis was SCC arising from LP. The patient underwent surgical treatment. After 36 months of follow-up, no signs of recurrence were observed. Results The literature review revealed 25 cases of malignant transformation into SCC of LP with adult onset. Of these, only 9 cases were assessed by CISH and/or PCR for HPV identification, of which 7 were positive. The current study focuses on the eighth case, suggesting the involvement of the high-risk HPV types in its pathogenesis. Conclusions LP is considered a benign lesion with the potential for malignant transformation, which reinforces the need for its early diagnosis and the constant monitoring of patients with LP.
Highlights
Papilloma is the most common benign tumor affecting the larynx, which may present as a single event or as recurring and/or affecting more than one topography, as occurs in laryngeal papillomatosis (LP) [1]
Materials and Methods A search for English language articles was carried out in the PubMed, Scopus, and Web of Science databases using the following keywords: malignancies in ALP and epidermoid carcinoma/squamous cell carcinoma from ALP. e search period extended from 1988 to the present, and only the reports in which the onset of the disease occurred in the adult phase were considered; cases in which malignancy occurred in patients of juvenile onset LP were discarded
The exact mode of infection is controversial; transmission during sexual contact and reactivation of a slow-progressing latent infection acquired in childhood has been suggested [1]. e aggressive clinical course of LP can lead to malignant transformation and death by extending through the lower respiratory tract [1]. e rates of LP malignancy are around 1 to 4% [1]; there are few studies with an extensive review of these cases [21]
Summary
Papilloma is the most common benign tumor affecting the larynx, which may present as a single event or as recurring and/or affecting more than one topography, as occurs in laryngeal papillomatosis (LP) [1]. LP is distributed bimodally, affecting juvenile patients (JLP), with onset of disease before 5 years of age and adult patients, aged 20–40 years (ALP) [1]. ALP is considered to be the most important clinical manifestation of human papillomavirus (HPV) larynx infection and is correlated mainly with low-risk HPV’s of malignancy types 6 and 11 [3]. Malignant transformation of LP is rare, having been described in about 1–4% of cases [1]. E following is a case of malignant transformation of LP in an adult patient with no history of recurrence, a rare case that shows that even nonrecurrent lesions have a potential for malignancy. We performed a brief review of the literature, looking for cases of malignancy in patients who had suffered their first manifestation of the disease in adulthood
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