Juvenile Papillomatosis Research Articles

Clinical and immunological effects of α-interferon in a child with juvenile laryngeal papillomatosis

A nine year-old girl with juvenile laryngeal papillomatosis (JLP) was treated with systemic administration of alpha-type interferon (IFN-α), and was investigated the immunological response to IFN-α.The patient had the onset of the disease under two years of age, and was of agressive type with frequent recurrence.The initial dosage of IFN-α, 1×106 units (alternate day), or 3×106 units (every day), and maintenance dosage of it, 1×106 units (weekly or two times a week), were given to the patient.Results were as follows.1. Clinical effects: The patient had no recurrence of the disease for three months laryngoscopically, and was markedly improved in speaking without hoarseness.2. Immunological effects: IFN-α in vivo inhibited the proliferative response of lymphocytes to mitogens and decreased immunoglobulin secreting cells in peripheral blood lymphocytes on the initialdosage of 3×106 units, IFN-α (every day).Furthermore, we showed that the addition of IFN-α to the culture in vivo gave the effects on the proliferative response of lmyphocytes to mitogen and immunoglobulin synthesis.These results indicated that IFN-α should be used in vivo with caution, since it gave various effects on the immune functions.

Interferon therapy in juvenile laryngeal papillomatosis.

Seventeen patients with severe juvenile laryngeal papillomatosis (12 in Stockholm and five in Umeå) were treated with exogenous leukocyte interferon (IFN-alpha) prepared in Helsinki and Umeå, respectively. Tumor progression occurred in all cases before treatment. During treatment tumor growth diminished in all cases, up to complete tumor disappearance. Of 17 patients, nine were cured and no longer are being treated, four exhibit no tumor growth but are still being treated, one has visible tumor but only slight growth, two still have active but diminished growth, and one, who has refused further treatment, is experiencing active tumor growth as before the start of interferon therapy. It is concluded that IFN-alpha therapy in a dosage of 3 X 10(6) units three times a week intramuscularly can arrest papilloma growth. Further trials are needed to optimize treatment.

Laryngeal carcinoma in childhood. Report of a case and review of the literature

A rare case of an 81/2 year old boy with a stage III well differentiated squamous cell carcinoma of the larynx, which responded to chemotherapy and irradiation, is reported. It is the 56th case in children up to 15 years of age and 20th case in children 10 years old or younger reported since 1868. Carcinoma of the larynx in children has similar clinicopathological features to those of adult laryngeal carcinoma, but markedly differs as concerning sex incidence ratio. The main differential diagnosis is juvenile papillomatosis and the principal risk factor is previous cervical irradiation. Delayed diagnosis is frequent since clinical manifestations might be attributed to the normal laryngeal maturation process or to a common respiratory infection. Treatment is problematic, for special effort must be made to preserve laryngeal anatomy and function and to avoid complications. Prognosis of childhood laryngeal cancer is unclear since the reported survival rates are not tumor stage related.

Interferon therapy in neoplastic diseases.

Three types of interferon preparation (alpha, beta and gamma) have been used in the treatment of tumours in vivo. At the time of writing no information is available on IFN-gamma treatment of tumour patients. Treatments with IFN-alpha and IFN-beta have been undertaken at many clinical centres. Both types of preparation can exert side effects. Both types have also been able to cause regression of certain tumours in individual patients. At our hospital, IFN-alpha has been given to tumour patients over the last decade. Antitumour effects have been registered on patients with juvenile laryngeal papillomatosis, Hodgkin's disease, myelomatosis, ovarian carcinoma, hypernephroma and glioblastoma. Further study is needed on how therapy with IFN should best be undertaken and also how such treatment compares with other treatments of various tumour diseases. IFN therapy should also be combined with other such treatments.

Leukocyte interferon in patients with juvenile laryngeal papillomatosis.

Fourteen patients with aggressive juvenile papillomatosis were treated with systemic administration of alpha-type interferon (IFN). This initial dosage of 2 million units alpha-interferon/m2 was modified if a favorable response in the papilloma growth occurred, or if persistent drug-related side effects developed. Half of the patients showed a sustained response while on IFN, and two patients had a complete response. Persistent elevation in SGOT was the main dose-limiting toxicity, especially in infants below age seven years. All side effects subsided after the drug was discontinued. Further studies are recommended.

Juvenile papillomatosis of the breast and family history of breast carcinoma.

Eighty-four patients included in the Juvenile Papillomatosis Registry were reviewed. The age of diagnosis ranged from 10-44 years (mean, 21). Sixty-nine percent of patients were less than or equal to 20 years of age. The left breast was affected slightly more often (52%) than the right (48%) when the lesion was unilateral. Two patients had bilateral lesions. Patterns of menarche, marital history, parity, and use of birth control pills were not exceptional for women in this age group. No instance was found of maternal use of estrogens during pregnancy. There were no instances of carcinoma developing after biopsy of juvenile papillomatosis, but a newly diagnosed patient had secretory carcinoma arising from juvenile papillomatosis. Two other examples of concurrent carcinoma were previously reported (ipsilateral lobular carcinoma in situ and contralateral secretory carcinoma). Particularly noteworthy is the finding that 26% of patients wih information available reported that breast carcinoma had occurred in one or more female relatives. The major were older, secondary relatives (grandmothers, great aunts), although maternal breast carcinoma (five cass) was also reported. The mothers of both girls who had secretory carcinoma associated with juvenile papillomatosis had been treated for breast cancer. These findings, based on incomplete reporting, are cause for concern in two respects: the findings suggest that juvenile papillomatosis may be a marker for breast cancer for the patient's family, and they indicate a need for continued long-term follow-up of juvenile papillomatosis patients who may themselves be at increased risk.

Treatment of Juvenile Laryngeal Papillomatosis

Seven patients with juvenile laryngeal papillomatosis, treated at the Kobe University Hospital, Japan mainly using a combination therapy of microsurgical removal and cryosurgery from 1974 to 1981 were investigated.The results are as follows.1. Two adults who were diagnosed for the first time in adulthood as having juvenile laryngeal papillomatosis were cured.2. One adult who suffered from papillomatosis in childhood and had a recurrence 17 years later is thought to be under control.3. One young adult who suffered from papillomatosis and was treated by radiation therapy in childhood died of radiation-induced cancer.4. Two children whoes papillomatosis were cured, but one has a vocal cord atresia after the treatment.5. One child who has frequent recurrences is under treatment.From the above results, the following conclusions were drawn.1. There is no absolutely effective therapy for juvenile laryngeal papillomatosis and multidisciplinary treatment is considered to be the best method at present.2. Irradiation for this disease especially for children must be avoided.3. In order to avoid dissemination, silastic tracheostomy tubes should be used and unnecessary suctioning should be avoided during treatment.4. Cryosurgery is superior to surgical resection in that the healing process of the treated area after cryosurgery is better than that after surgical resection. In our case, cryosurgery under local anesthesia was effective in the disseminated papillomatosis in the trachea. But care should be taken not to freeze too much tissue to avoid laryngeal adhesion and tracheal stenosis.5. Attention should be given to recurrent nerve palsy and vocal cord atresia probably due to frequent and excessive surgical removal and cryosurgery.In such cases, tracheostomy should be performed before operation.

Levamisole in the treatment of juvenile laryngeal papillomatosis

Three patients are described who were treated with levamisole for juvenile laryngeal papillomatosis. In two patients no effect of levamisole was noted during a treatment period of 8–9 months. In the third patient a remission of the disease was noted some months after starting levamisole treatment. In view of our experience with the other two patients the remission may be due to the capricious natural course of the disease rather than to the effect of levamisole. Levamisole does not seem to be an effective drug for the treatment of extensive juvenile papillomatosis and according to the literature not a harmless drug.

Regression of juvenile laryngobronchial papillomatosis with systemic bleomycin therapy

Regression of juvenile laryngobronchial papillomatosis with systemic bleomycin therapy

Juvenile papillomatosis (Swiss cheese disease) of the breast

Thirty-seven cases of juvenile papillomatosis of the breast were reviewed. The average age was 19 years (range 10-44 years). On examination the patients usually had a localized, multinodular mass that was interpreted as a fibroadenoma. Microscopically, typical lesions featured papillomatosis, sometimes with severe atypia, cysts with or without apocrine metaplasia, duct stasis, and sclerosing adenosis. In one case the breast with papillomatosis adenosis. In one case the breast with papillomatosis has remained free of carcinoma, but at the time of biopsy the patient had secretory carcinoma of the other breast. Papillomatous changes were not observed in the breast with carcinoma. Another woman had lobular carcinoma in situ coexisting with juvenile papillomatosis. After an average follow-up of 8 years, no subsequent carcinoma has been found. Thus, there appears to be little risk for early onset of carcinoma, but without additional follow-up the long-term assessment of this disorder remains uncertain. We recommend that a patient with juvenile papillomatosis have a thorough clinical examination of the breasts at least once a year.

Juvenile papillomatosis (Swiss cheese disease) of the breast

Juvenile papillomatosis (Swiss cheese disease) of the breast

Autogenous vaccine treatment of juvenile laryngeal papillomatosis

Seventeen cases of juvenile laryngeal papillomatosis have been seen and treated with microlaryngoscopy, removal of papillomas, and administering of autogenous vaccine. Holinger's original findings could be confirmed. The operation frequency of 9 patients was significantly reduced, 5 were improved, and 3 unchanged. In no case was an undesirable reaction to the vaccine observed. Electron microscopy showed no virus-like particles in the papilloma but a section of a vulvar wart did show the virus.

The treatment of juvenile multiple laryngeal papillomatosis by suction diathermy

Ten cases of laryngeal papillomatosis treated by suction diathermy are described. The results of this treatment compare favourably with other far more expensive techniques. It is emphasised that proper paediatric anaesthesia is most important.

Malignant degeneration of nonirradiated juvenile laryngeal papillomatosis.

Malignant degeneration in nonirradiated juvenile laryngeal papillomatosis is exceedingly rare. Review of the world literature reveals one case in the English literature and two in the German literature. A 23-year-old patient, representing the youngest reported case in English literature, is presented.

Management of juvenile laryngeal papilloma: further observations.

AbstractTwenty‐two patients with juvenile laryngeal papillomatosis were treated over a five‐year period at The University of Tennessee, using a combination of microsurgical removal and administration of autogenous papilloma vaccine. Twelve patients were classified as having a favorable result. Six were improved, and three were unimproved; one patient was lost to follow‐up. Nine patients have been free of disease for greater than one year. Histologic differences in papillomata removed from patients before and after treatment with the vaccine are reported as are the results of studies attempting to show immunologic response by the gel diffusion and lymphocytic transformation techniques. No conclusions are made as a result of the histologic and immunologic studies. There were no treatment controls other than the response of the individual patient; therefore, no definite conclusions are made concerning this mode of therapy. It is suggested that the results of this clinical study are such that they would tend to indicate that this is a most useful treatment regime.

Immunotherapy of Condyloma Acuminata

<h3>To the Editor.—</h3> The development of juvenile papillomatosis of the larynx has been one of many enigmas of medicine. The recent article by Cook and colleagues, "Maternal condylomata linked to lesions in babies" in MEDICAL NEWS (224:1475, 1973), reporting the increased chance of the development of papillomatosis of the larynx in children of pregnant women with<i>Condylomata acuminata</i>at the time of delivery suggested to us that a note of reminder of a valuable means of therapy would be most timely. Immunotherapy for the treatment of warts, eg, of the genital area, such as<i>C acuminata</i>, by autogenous vaccine was described as early as 1944 by Biberstein.¹However, until the recent report by Powell et al,²it had apparently fallen into disuse. In the present communication, we report the treatment of<i>C acuminata</i>of the perineum of a 26-year-old woman. Wart tissue was obtained in sterile saline from the

A complicated case of juvenile laryngeal papillomatosis.

A complicated case of juvenile laryngeal papillomatosis.

Cryosurgical treatment of juvenile laryngeal papillomatosis. An eight year experience.

Cryosurgical treatment of juvenile laryngeal papillomatosis. An eight year experience.

Analysis of an autogenous vaccine in the treatment of juvenile papillomatosis of the larynx.

Analysis of an autogenous vaccine in the treatment of juvenile papillomatosis of the larynx.

Laryngeal papillomatosis.

A series of 107 cases of juvenile laryngeal papillomatosis, comprising only children, treated personally in the years 1947–64 with a follow-up of some years, is presented. Some problems concerning laryngeal papillomatosis such as onset of symptoms, influence of living conditions, influence of endocrine factors, and therapeutic procedures are discussed.The rationale of intralaryngeal, submucous injections of estradiol into the base of removed growths is shown. The favourable, restraining effect of estradiol on papillomatosis is most probably not a specific endocrine but a local connective tissue response which increases the local resistance of tissue to a viral infection.The results of such treatment are shown to be very good, in the long run, for all cases of papillomatosis. They were cured in the great majority of cases; in the remaining cases the papillomatous process was rendered inactive and strictly localized. The functional results were also very good.Arguments for the viral etiology of laryngeal papillomatosis and their counter-arguments are presented. In the author's own virologic studies of 23 previously untreated papilloma cases occurring in children of 3–12 years no definite growth of viruses was obtained when inoculating with suspension of papillomatous tissue the following tissue cultures: human embryo fibroblasts, human thyroid and embryonal bovine kidney.