Papillomatosis of the Respiratory Tract: Upper Airway Obstruction and Carcinoma

Immimoperoxidase Localization of Human Papillomavirus in Laryngeal Papillomas

“…A peroxidase-antiperoxidase (PAP) technique has recently been used to demonstrate human papillomavirus (HPV) in cutaneous verrucae and mucosal condylomata [5], HPV is one of the few viruses known to induce papillary hyperplasia of squamous epithelium in man: most of these verrucae or papillomas are be nign, with some undergoing spontaneous re gression. There are occasional cases in which malignant transformation has been reported [6,7], Our interest in HPV stems from the relatively large number of patients with squamous papillomas of the upper respiratory tract, particularly the larynx, treated at the Children's Hospital Medical Center. Although a viral etiology has long been suspected for these juvenile laryngeal papillomas [8][9][10][11], HPV has not yet been convincingly isolated in vitro and localization of viral particles by ultrastructure has been sporadic at best [12][13][14][15], We report a rapid and sensitive method for detection of HPV in laryngeal pa pillomas using a PAP technique with immunospecificity against the genus-specific (com mon) antigen(s); the role of this technique in the future investigation of laryngeal papillo matosis is discussed.…”

Juvenile laryngeal papillomatosis with pulmonary parenchymal spread

“…No radiographic findings were reported in one case [6]. Any signs or symptoms that might be caused by lung involvement tend to be attributed to the laryngeal disease unless infection supervenes [2,10]. Digital clubbing has been observed [3,16].…”

“…Less typical presentations have included consolidation [2], a large solitary mass [7], and bronchiectasis [1,15]. Bronchiectasis may reflect endobronchial papillomatosis [9,16].…”

“…There is strong evidence for a viral etiology [4,12]. The initial presentation is hoarseness or abnormal cry, progressing to include cough, dyspnea, and stridor as the papillomas spread or enlarge [2,4]. Although distal extension of papillomas into the trachea and bronchi occasionally occurs [2], lung parenchymal spread is uncommon.…”

“…The initial presentation is hoarseness or abnormal cry, progressing to include cough, dyspnea, and stridor as the papillomas spread or enlarge [2,4]. Although distal extension of papillomas into the trachea and bronchi occasionally occurs [2], lung parenchymal spread is uncommon. The mechanism of intraparenchymal spread is unknown, but peripheral seeding [11] and multicentric origin of papillomas [•5] are postulated causes.…”