Tumor risk markers in recurrent respiratory papillomatosis

Abstract Objectives: This study aims to investigate the pattern of immunoexpression of proteins p16, p53 and Ki-67 in RRP, as well as to evaluate its influence on the number of surgeries that patients have undergone to date and to analyze the benefit of immunohistochemistry in this disease. Methods: Clinical-demographic data and tumor samples were obtained from 33 patients with RRP. The expression of proteins p16, p53 and Ki-67 was analyzed by immunohistochemical method. Results: Most patients had already undergone more than one surgery. The p16 marker was negative in 24.2% of the cases, with little positivity in 27.3% of the cases, moderate in 36.4% and intense in 12.1%. The p53 marker was positive in all cases, with little immunoexpression in 39.4% of cases, moderate in 36.4% and intense in 24.2%. The Ki-67 marker showed nuclear positivity in all lesions, although in varying degrees, with a mean proliferative index ±SD (standard deviation) of 51.7±26. Conclusions: The papillomatous lesions had varying degrees of immunoexpression of proteins p16, p53 and Ki-67, but no specific immunohistochemical pattern was observed. It was found, with statistical difference, that the number of surgeries was higher in cases with greater intensity of p53 expression, without correlation with the other markers. The benefit of immunohistochemistry in recurrent respiratory papillomatosis may lie in the prognostic assessment. However, further studies are needed to evaluate the use of this technique for this purpose. Level of evidence:: 4.

Características clínicas y epidemiológicas de la papilomatosis respiratoria recurrente en pacientes pediátricos / Clinical and epidemiological characteristics of recurrent respiratory papillomatosis in pediatric patients

La papilomatosis respiratoria recurrente (PRR) es la segunda causa más frecuente de disfonía durante la infancia, cuyo agente causal más frecuente es el virus del papiloma humano serotipos 6 y 11. Con el objetivo de analizar las características clínicas y epidemiológicas de la PPR en pacientes pediátricos admitidos en el Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga, se realizó un estudio descriptivo transversal de recolección retrospectiva de datos durante el lapso 2011-2016. Entre las características sociodemográficas se encontró una edad promedio para el momento del diagnóstico de 4,4 ± 2,41 años, siendo los más afectados los preescolares (70%) sin predilección por sexo. Como antecedente prenatal, 90% fue producto de parto vaginal y 30% reportaron asma e infección respiratoria baja. Las características clínicas presentes fueron disfonía (90%), disnea (70%) y estridor (60%) y la localización de las lesiones fueron comisura anterior (100%), repliegues vocales (80% derecho y 90% izquierdo) y vestíbulo (40%). Se reportaron 40% de casos de VPH-6 y 10% de VPH-11. El tratamiento fue quirúrgico en el 100% de los casos, de los cuales 50% requirió una segunda poda y 30% tres podas; 10% de los pacientes ameritaron traqueotomía. Este estudio aporta información sobre la importancia de reconocer tempranamente la disfonía persistente, lo que permite disminuir la demora en el diagnóstico de PRR y facilitar un manejo oportuno con menores tasas de recidiva a largo plazo(AU)

Recurrent respiratory papillomatosis (RRP) is the second most frequent cause of dysphonia during childhood; the most frequent causative agent is human papillomavirus serotypes 6 and 11. In order to describe the clinical and epidemiological characteristics of RRP In pediatric admitted to the Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga, a cross-sectional descriptive study was conducted during the 2011-2016 period. The average age of diagnosis was 4.4 ± 2.41 years, with the highest prevalence in preschool children (70%) and with no sex predilection. 90% of patients were product of vaginal delivery and 30% reported asthma and low respiratory infection. The clinical features present were dysphonia (90%), dyspnea (70%) and stridor (60%); location of the lesions were anterior commissure (100%), vocal folds (80% right and 90% left) and vestibule (40%). 40% of patients reported HPV-6 and 10% HPV-11. Treatment was surgical in 100% of cases of which 50% required a second pruning and 30% three pruning; 10% needed a tracheotomy. This study provides information on the importance of early recognition of persistent dysphonia allowing to reduce diagnosis delay of RRP and facilitate timely management with lower rates of long-term recurrence(AU)

Papilomatosis traqueobronquial y pulmonar sin compromiso de la laringe tratada con bevacizumab endovenoso en un niño / Tracheobronchial and pulmonary papillomatosis without involvement of the larynx treated with intravenous Bevacizumab in a child

La papilomatosis respiratoria recurrente es una neoplasia benigna infrecuente que, comúnmente, afecta la vía aérea superior con predilección por la laringe. El compromiso traqueobronquial aislado es muy raro. El diagnóstico y el tratamiento de esta enfermedad constituyen un desafío, debido a su manifestación clínica inespecífica y su naturaleza recurrente. Se presenta a un varón de 6 años con diagnóstico de asma refractario al tratamiento, sin historia ni evidencia de papilomatosis laríngea. El examen endoscópico reveló papilomatosis traqueobronquial extensa, y la tomografia computada, compromiso pulmonar. Recibió terapia adyuvante con bevacizumab endovenoso, con muy buena respuesta. Se alerta a los pediatras para considerar esta rara neoplasia traqueobronquial en todo niño con síntomas de asma atípicos o que no mejoran con el tratamiento médico convencional.

Recurrent respiratory papillomatosis is an infrequent benign neoplasm that commonly affects the upper airway with a predilection for the larynx. Isolated tracheobronchial involvement is very rare. Diagnosis and treatment of this disease is a challenge due to its non-specific clinical manifestation and its recurrent nature. We present a 6-year-old male with a diagnosis of asthma refractory to treatment, without history or evidence of laryngeal papillomatosis. The endoscopic examination revealed extensive tracheobronchial papillomatosis and the computed tomography, pulmonary involvement. He received adjuvant therapy with intravenous Bevacizumab with very good response. We alert pediatricians to consider this rare tracheobronchial neoplasm in all children with atypical asthma symptoms or in those who do not improve with conventional medical treatment.

Vacuna contra el virus papiloma humano como tratamiento para la papilomatosis respiratoria recurrente / Human papilloma virus vaccination treatment for recurrent respiratory papillomatosis

RESUMEN Una de las manifestaciones clínicas del virus papiloma humano (VPH) es la papilomatosis respiratoria recurrente (PRR), que se caracteriza por la proliferación de lesiones epiteliales verrucosas recurrentes en la mucosa respiratoria, pudiendo progresar a obstrucción de vía aérea o presentar transformación maligna. El tratamiento de primera línea quirúrgico, pero dada su alta recurrencia ha tomado peso el tratamiento adyuvante, como la vacuna tetravalente contra VPH. Sin embargo, existe controversia respecto a su eficacia. El objetivo de esta revisión es analizar la efectividad de la vacuna contra VPH como tratamiento adyuvante de la PRR, para lo cual hicimos una revisión de la literatura sobre la efectividad de la vacuna tetravalente contra VPH para PRR, realizando una búsqueda en diversas fuentes: Pubmed, MEDLINE, EMBASE, Cochrane, Google Scholar y Epistemonikos. Se seleccionaron los estudios que responden a la pregunta y se analizaron los datos de los estudios primarios. Se encontraron cinco estudios primarios no aleatorizados, todos a favor de la vacuna como tratamiento. Concluimos con baja certeza de evidencia, que la vacuna es posiblemente efectiva para pacientes con PRR en disminuir el número de recurrencias, aumentar el intervalo entre cirugías, lograr remisión completa o parcial de la enfermedad y aumentar significativamente los títulos de anticuerpos anti-VPH.

ABSTRACT A clinical manifestation of human papillomavirus (HPV) is recurrent respiratory papillomatosis (RRP), characterized by the proliferation of recurrent verrucous epithelial lesions in the respiratory mucosa, which may progress to airway obstruction or malignant transformation. First-line treatment is surgery, but given its high recurrence the use of adjuvant therapy, such as the quadrivalent vaccine, has gained importance. However, there is controversy regarding its effectiveness. To analyze the effectiveness of the HPV vaccine as an adjuvant treatment for RRP a review of the literature on the effectiveness of HPV tetravalent vaccine for RRP was performed by searching databases such as Pubmed, MEDLINE, EMBASE, Cochrane, Google Scholar and Epistemonikos. We selected the studies that answered the question and analyzed the data from all of which supported the vaccine as treatment. None were randomized controlled trials. We conclude, with low certainty of evidence, that the vaccine is possibly effective for RRP in decreasing the number of recurrences, increasing the intersurgical interval, achieving complete or partial remission of disease and significantly increasing anti-HPV antibodies.

Juvenile-onset recurrent respiratory papillomatosis with pulmonary involvement and carcinomatous transformation

Papilloma associated with recurrent respiratory papillomatosis (RRP), caused by human papilloma virus (HPV) infection types 6 and 11, is the most common benign neoplasm of the larynx. The clinical features of RRP vary widely from mild to aggressive forms. RRP in children is known as juvenile-onset recurrent respiratory papillomatosis (JORRP). Its outcome may be poor or even fatal due to the high rate of recurrence and eventual spread to the entire respiratory tract. Pulmonary invasion is reported to occur in 3.3% of patients with RRP, and malignant transformation in 0.5% of patients. We report the case of a 39-year-old female patient with a diagnosis of JORRP from the age of 3 years, with extensive bilateral pulmonary involvement and malignant transformation. Analysis of the papilloma and carcinomatous tissues revealed the presence of HPV type 11, which is associated with rapid and aggressive progression. We discussed the case on the basis of a literature review on pulmonary invasion, malignant transformation, and HPV 11 aggressiveness.

Clinical curative effect and changes of serum immunology of Traditional Chinese Medicine combined with surgical treatment on the adult onset recurrent respiratory papillomatosis / 临床耳鼻咽喉头颈外科杂志

To observe the outcomes of Traditional Chinese Medicine combined with CO_2 laser surgery on the clinical course and serum immunological indexes of Adult onset Recurrent Respiratory Papillomatosis.69 cases of adult recurrent respiratory papilloma patients who enrolled in Beijing Tongren Hospital from September 2014 to March 2016 were divided randomly into two groups.The Chinese medicine surgery group were treated with traditional Chinese medicine combined with CO_2 laser surgery and the surgery group were treated with CO_2 laser surgery alone.All patients were followed up for more than one year.Relapse time and Derkay score were examed and analyzed between two groups before and after treatment.The detection of aperipheral blood immunoglobulin,T cell subsets,percentage of B cell and NK cell and IgG subtype examed every six month.There was no significant difference between two group in Derkay score,lesion recurrence time and the index of immunology before the treatment(>0.05).However,the recurrence time after treatment [(14.11±1.57)months]prolonged than before treatment[(10.85±2.33)months]in the experimental group.The examination of IgG [(1 539.84±388.20)mg/dl],percentage of total T lymphocytes[(85.14±22.24)%],Th cells[(47.34±19.07)%],B lymphocytes[(12.55±5.26)%]in treatment of traditional Chinese medicine was higher than that before treatment of serum IgG [(1 225.14±260.27)mg/dl],T cells [(69.68±11.12)%],Th [(41.97±10.92)%],B lymphocytes[(10.30±5.45)%].The difference was statistically significant(<0.01).The curative effect of traditional Chinese medicine combined with laser surgery for the treatment of adult recurrent respiratory papillomatosis,can effectively prolong the recurrence time of patients,improve their immune cell antiviral ability and be worthy of clinical popularization and application.

Papilomatosis respiratoria recurrente: análisis del impacto económico en el tratamiento quirúrgico / Recurrent respiratory papillomatosis: analysis of the economic impact generated by surgical treatment

Objetivo: Evaluar el impacto económico que genera el tratamiento quirúrgico de la papilomatosis respiratoria recurrente en el tercer nivel de atención. La papilomatosis respiratoria recurrente es una entidad prevalente. El impacto económico que genera se encuentra principalmente en la necesidad de las repetidas intervenciones quirúrgicas que requiere a lo largo de su evolución, además de la morbilidad que ocasiona esta en el paciente. Materiales y métodos: Este estudio se realizó en el Hospital de Especialidades N° 2, Centro Médico Nacional del Noroeste, IMSS. Diseño retrospectivo, observacional, trasversal. Muestreo no probabilístico por serie consecutiva de casos. En la descripción general del estudio, se revisaron los expedientes clínicos de los pacientes con diagnóstico de papilomatosis respiratoria recurrente atendidos en el servicio de esta institución de enero de 2010 a enero de 2012. Se tomaron datos como la edad, sexo, manejo quirúrgico y/o terapia coadyuvante, y costo generado por su atención quirúrgica exclusivamente. Resultados: De un total de 103 expedientes revisados, solo 39 se encontraron completos y cumplieron con los criterios de inclusión: 16 (41%) eran de sexo femenino y 23 (59%), de sexo masculino. Se encontraron 27 casos (69%) juveniles y 12 (30.8%) adultos. Solo 19 casos (48.7%) recibieron terapia coadyuvante. En 15 casos (38.5%) se practicó traqueotomía. El costo directo por intervención quirúrgica de resecciones fue de $322,943.92 (22,190 USD) en el grupo juvenil y de $55,225.33 (3,790 USD) en el grupo adulto. Conclusiones: El tratamiento quirúrgico de la papilomatosis respiratoria recurrente representa una carga financiera y una gran morbilidad tanto para las instituciones de salud como para la familia.

Objective: To evaluate the economic impact generated by surgical treatment of recurrent respiratory papillomatosis in the tertiary care level. Recurrent respiratory papillomatosis is a prevalent entity. The economic impact it generates is mainly due to the need for repeated surgical interventions throughout its progression, in addition to the morbidity it causes to the patient. Materials and methods: This retrospective, observational, cross-sectional study was carried out at the Specialty Hospital No. 2, National Medical Center of the Northwest, Mexican Social Security Institute (IMSS), using a non-probability sampling by consecutive case series. In the general description of the study, clinical records of patients diagnosed with recurrent respiratory papillomatosis treated at this institution from January 2010 to January 2012 were reviewed. Data such as age, gender, surgical management and/or adjuvant therapy, and cost generated by exclusive surgical care, were collected. Results: Out of a total of 103 reviewed files, only 39 were complete and met the inclusion criteria: 16 (41%) were female and 23 (59%) were male. Twenty-seven (27) cases (69%) were juvenile patients and 12 (30.8%) were adults. Only 19 cases (48.7%) received adjuvant therapy. Tracheotomy was performed in 15 cases (38.5%). The direct cost for resection surgery was $322,943.92 (22,190 USD) in the juvenile group and $55,225.33 (3,790 USD) in the adult group. Conclusions: Surgical treatment for recurrent respiratory papillomatosis represents a financial burden and great morbidity for both health institutions and the family.

Papilomatosis respiratoria recurrente en paciente pediátrico: reporte de un caso / Recurrent respiratory papillomatosis in a pediatric patient: case report

La variabilidad genética relacionada al sistema inmune del huésped ha sido propuesta como uno de los factores más influyentes en el desarrollo de enfermedades causadas por HPV. Caso clínico: Reportamos el caso de un niño de 5 años en cuyo estudio por disfonía crónica se encuentra papilomatosis laríngea probablemente adquirida por vía vertical durante el parto. El diagnóstico de papilomatosis laríngea se confirmó con una biopsia tras una primera cirugía orientada a remover los papilomas. Se utilizó el sistema de clasificación Derkay para evaluar la severidad de la papilomatosis. Se realizó genotipificación en biopsia demostrándose HPV-6. Posteriormente mediante tipificación de alelos HLA se demostró homocigosis para los alelos HLA-DQA1*0505, -DQB1*0301, -DRB1*1101. Conclusiones: Se necesitan estudios adicionales que permitan identificar los alelos HLA más prevalentes en población latina y su potencial asociación con la susceptibilidad genética en Papilomatosis Respiratoria Recurrente.

Genetic variability related to the host immune system has been proposed as one of the most influential factors in the development of diseases caused by HPV. Clinical case: We report the case of a 5-year-old child in whom chronic laryngeal papillomatosis, probably acquired vertically during labor, was detected. The diagnosis of laryngeal papillomatosis was confirmed with a biopsy after a first surgery to remove the papillomas. The Derkay classification system was used to assess the severity of papillomatosis. Biopsy genotyping was performed by demonstrating HPV-6. Later, HLA-DQA1 * 0505, -DQB1 * 0301, -DRB1 * 1101 alleles were homozygous for HLA allele typing. Conclusions: Further studies are needed to identify the most prevalent HLA alleles in the Latino population and their potential association with genetic susceptibility in Recurrent Respiratory Papillomatosis.

Correlation between the HPV type and clinical course of juvenile onset recurrent respiratory papillomatosis / 中国耳鼻咽喉头颈外科

OBJECTIVE To study on the influence of human papilloma virus(HPV) type on the clinical course of juvenile onset recurrent respiratory papillomatosis(JORRP).METHODS Fresh tumor specimens of 38 patients were collected and the HPV type of the specimens was detected by flow fluorescent hybridization method.According to the results,children were divided into HPV6 and HPVll positive groups.The clinical data of the two groups were compared.RESULTS Among 38 children with recurrent respiratory papillomatosis,21(55.2％) were infected with HPV6,14(36.8％) were infected with HPVll,and 3(7.9％) were negative for HPV 6 or HPV 11.The proportion of aggressive cases in HPV6 and HPV11 groups were similar.The age of onset,preoperative clinical symptom score,number of anatomic locations,anatomic Derkay/Coltrera score and Dikkers score were significant different between the two groups (P=0.002,0.040,0.023,0.001,0.005,respectively).CONCLUSION JORRP patients with HPV11 infection had the features of smaller onset age,more severe clinical symptoms and broader invasion compared with HPV6 infection.

Papilomatosis respiratoria recurrente. Caso dínico / Recurrent respiratory papillomatosis. Case report

La papilomatosis respiratoria recurrente es una enfermedad rara que se caracteriza por el desarrollo de papilomas en toda la vía aérea. Es causada por el virus del papiloma humano. Su incidencia es de 4 por 100 000 en niños. La forma de transmisión es vertical durante el embarazo o el parto. Hay 130 variedades de virus del papiloma humano, de los cuales los tipos 6 y 11 son los que producen papilomatosis respiratoria recurrente, y especialmente el tipo 11 es el que desarrolla enfermedad más agresiva con recurrencia y progresión en todo el tracto respiratorio y, con menos frecuencia, en la región nasofaríngea. Se presenta un paciente de 7 años de edad con diagnóstico de papilomatosis respiratoria recurrente basado en la radiología y la endoscopía respiratoria, que permitió aislar el virus del papiloma humano tipo 11 en papilomas en laringe y tráquea y en material de lavado broncoalveolar.

Recurrent respiratory papillomatosis (RRP) is a rare condition characterized by recurrent growth of papilloma in the respiratory tract. RRP is caused by human papilloma virus. Its incidence is 4 per 100 000 children. Vertical transmission of the virus during gestation or during delivery is the major route of contracting the disease in children. One hundred and thirty different human papilloma virus types have been identified. Types 6 and 11 are involved in RRP and type 11 develops more aggressive disease with recurrence and progression to the respiratory tract and also nasopharyngeal surface. We present a 7 year old boy with diagnosis of RRP based on radiology and endoscopy.

Recurrent Respiratory Papillomatosis / 대한이비인후과학회지

Recurrent respiratory papillomatosis (RRP) is benign neoplasm caused by human papillomavirus. Although RRP arises in anywhere along the airway, the most common site is larynx. RRP has bimodal onset during either childhood or adulthood. Childhood-onset RRP is presented with more aggressive disease, which is associated with higher recurrence rate and spread to distal airway. At present, there is no single modality to eradicate RRP. The current standard treatment is repeated surgical removal of papilloma and preservation of normal structures as far as possible. When repeated surgery is needed more than 4 times per year or disease involves the distal airway, nonsurgical adjuvant therapies should be considered. Several adjuvant therapies have been tried and some showed effectiveness for advanced RRP. Because of its severe impact on children's heath, latest knowledge of RRP is essential to otolaryngologists. In this review, clinical features and surgical or nonsurgical treatment options will be discussed.

Papilomatosis respiratoria recurrente: Un resumen de los casos pediátricos de Panamá 2003-2013

Introducción: La papilomatosis respiratoria recurrente es una enfermedad rara y benigna, pero con una alta morbilidad por el compromiso de la vía aérea y su potencial de malignización. Material y Métodos: Se realizó un estudio en el Hospital del Niño de Panamá y en el Hospital de Especialidades Pediátricas Omar Torrijos Herrera para describir los casos de los pacientes pediátricos con diagnóstico de papilomatosis respiratoria recurrente en el período de 2003 a 2013. Resultados: Se incluyó un total de 23 expedientes en la revisión, cuyos pacientes correspondían a 56.5% de sexo femenino y 65.2% de procedencia de la capital del país. La mayoría nacieron por parto vaginal y hubo 30.4% casos con antecedente materno de papilomatosis genital. Todos los pacientes presentaron afección laríngea y 8.7% de los niños desarrollaron además afección extra-laríngea. El rango de cirugías totales osciló entre 1 y 36, y un 65.2% requirió tratamiento adyuvante con interferón, cidofovir, o ambos. En el periodo estudiado hubo 13 casos nuevos en 10 años, lo que corresponde aproximadamente a 1.3 casos nuevos cada año. Hubo un fallecimiento durante el periodo de tiempo estudiado por extensión de la enfermedad a los pulmones. Conclusiones: En comparación con dos otras publicaciones anteriores de esta población, las características clínicas coinciden con los casos previos pero hubo una tendencia marcada del aumento de uso de tratamiento adyuvante, especialmente el cidofovir.

Introduction: Recurrent Respiratory Papillomatosis (RRP) is a rare disease characterized by benign lesions in the respiratory tract. RRP presents a significant morbidity among pediatric patients due to its tendency to cause airway obstruction and potential for malignant transformation. Material & Methods: A clinical chart review at 2 urban pediatric centers (Hospital del Niño and Hospital de Especialidades Pediátricas Omar Torrijos Herrera) to describe the cases treated at these institutions between 2003 and 2013. Results: A total of 23 charts were included in this review, with 56.5% of cases occurring among female patients and 65.2% residing in the capital city (Panama City, Panama). The majority of cases were born vaginally and 30.4% had maternal history of genital HPV lesions. All patients had laryngeal lesions, and 8.7% had extra-laryngeal involvement. The range of total surgeries completed was 1 to 36, and 65.2% of patients required adjuvant therapy with interferon, cidofovir, or both. In the study period there were 13 new cases over a 10-year period, which corresponds to approximately 1.3 new cases per year. There was one death in the series due to a case with extensive spread to the lungs. Conclusions: In comparison with two previous publications describing RRP in this population, clinical characteristics coincide with previous years, except for a marked increase in the use of adjuvant treatment, especially cidofovir.

Clinical characteristics and HPV type in recurrent respiratory papillomatosis in Colombia / Características clínicas y genotipo de VPH en papilomatosis respiratoria recurrente en Colombia

Objective. Describe factors associated with aggressive forms of recurrent respiratory papillomatosis (RRP). Materials and methods. One hundred eighty-nine RRP cases diagnosed between 1985 and 2009 were identified in pathological records. HPV was detected by the SPF-10 method with broad spectrum primers, (version 1). Results. 113 patients had only one surgery (less aggressive) and 76, two or more interventions (more aggressive). The likelihood of aggressive lesions decreased with increasing age at diagnosis and HPV-11 was associated with no significant increase in the risk of aggressiveness. Conclusions. The age at diagnosis was the main determinant of RRP aggressiveness.

Objetivo. Describir factores asociados con formas agresivas de papilomatosis respiratoria recurrente (PRR). Material y métodos. Se identificaron 189 casos de PRR diagnosticados entre 1985-2009 en registros patológicos. VPH fue detectado por el método SPF-10 con cebadores de amplio espectro, (versión 1). Resultados. 113 casos presentaron una intervención quirúrgica (menos agresivas) y 76, dos o más intervenciones (más agresivas). La probabilidad de lesiones agresivas disminuyó con el aumento de la edad al momento del diagnóstico y el VPH-11 se asoció con aumento no significativo del riesgo de agresividad. Conclusiones. La edad al momento del diagnóstico fue el principal determinante de la agresividad de PRR.

Benign Laryngeal Disorders / 대한이비인후과학회지

The causes of dysphonia can be classified into two groups, organic and functional. Functional dysphonia includes spasmodic dysphonia, muscle tension dysphonia, mutational dysphonia and conversion dysphonia, etc. The findings of laryngoscopy in these dysphonia are almost normal. Organic dysphonia is caused by anatomical problems in the larynx, especially on the vocal fold. Benign diseases of the vocal folds are common and mainly presented as voice disorders such as hoarseness, harshness, weakness, or even loss of voice. Benign neoplasm of the larynx are very rare condition except papilloma. The most common symptoms are voice change. However, they can be presented as wheezing, dyspnea, discomfort in the throat, or cervical mass depending on the size and location of the tumor. Detailed history taking and thorough laryngeal endoscopic examination are necessary for the appropriate diagnosis and treatment.

Efficacy of Long-term Interferon-alpha Therapy in Adult Patients with Recurrent Respiratory Papillomatosis / 결핵및호흡기질환

BACKGROUND: Since the early 1980s, interferon-alpha (IFN-alpha) has been used as adjuvant therapy in pediatric patients with recurrent respiratory papillomatosis (RRP). However, its efficacy in adults needs to be validated. Since 2002, Samsung Medical Center's guidelines have mandated regular injection of IFN-alpha in patients with RRP to prevent recurrence. To evaluate these guidelines, patient data were investigated. METHODS: Five patients diagnosed as having RRP by bronchoscopy and histopathology were included. After initial bronchoscopic intervention, including laser cauterization, all patients received subcutaneous injection of 6 million units of IFN-alpha every 2 months. Further bronchoscopic intervention was carried out as needed. Patients were regularly evaluated using bronchoscopy or computed tomography. RESULTS: The median age of the patients was 44 years (range 13~68), and the median duration of papillomatosis was 31 years (range 1~45). Three and two patients had juvenile-onset and adult-onset disease, respectively. Two patients had a history of tracheostomy at the time of diagnosis. The median duration of IFN-alpha therapy was 56 months (range 12~66). Two patients showed complete remission at 12 and 36 months after IFN-alpha injection, respectively. The other three patients showed partial remission, and the number of laser therapy sessions was significantly reduced. CONCLUSION: Intermittent IFN-alpha injection is effective in patients with long-standing RRP and can reduce the number of laser therapy sessions required in their treatment.

A Clinical Analysis of Recurrent Respiratory Papillomatosis and Detection of Human Papilloma Virus Using Polymerase Chain Reaction / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recurrent laryngeal papillomatosis (RRP) have been divided into juvenile or aggressive forms, and adult or non-aggressive forms. This study attempted to characterize these two forms of RRP in our series and to detect human papilloma virus (HPV) using polymerase chain reaction (PCR). MATERIALS AND METHOD: Authors reviewed the records of 60 patients treated for RRP over a 16-year period from 1983 to 1999 at the Department of otolaryngology, Pusan National University Hospital. Clinical parameters included sex, age, chief complains, location and type of lesion, tracheotomy state, number of operation, aggressiveness, outcome of treatment and complications after operation. Twenty-three paraffinembedded tissues were selected to PCR using type-specific primer pairs. RESULTS: 1) Subglottic extension, tracheotomy, time of operation and aggressiveness were more common in juvenile form than the adult form. 2) The multiple type was also common in the adult form. 3) Non-aggressive and single types showed better response for treatment. 4) There are no significant differences of cure rate according to age and treatment modality, but preoperative alpha-interferon therapy showed more effective in the case of compromised airway. 5) HPV type 6, 11 in 10 cases(43.5%) were detected out of 23 cases. Most detected cases were non-improvement group. CONCLUSION: The significant difference of treatment results are found in comparison between aggressive and non-aggressive forms and alpha-interferon may be an effective therapy for aggressive respiratory papillomatosis. HPV subtype may be related to the prognosis factor.