SESSION TYPE: Bronchology Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Recurrent Respiratory Papillomatosis (RRP) is an uncommon but potentially life-threatening viral disease. RRP is caused by human papillomavirus (HPV) types 6 and 11 and is characterized by the proliferation of benign squamous papillomas within the aerodigestive tract. Clinical features include hoarseness, stridor, chronic cough, recurrent pneumonia, dyspnea, dysphagia, acute respiratory distress or airway obstruction. Several therapies have been investigated, tried and showed promise, but there remains no ‘cure’ yet. There is an enormous hope for prevention of RRP through quadrivalent HPV vaccination.
CASE PRESENTATION: 58 years old female was admitted for exertional dyspnea and stridor. CT chest revealed interval enlargement of multiple tracheal masses extending from the level of thyroid to the thoracic inlet causing significant airway obstruction. The patient had a history of papillomatosis and had undergone treatment 30 years ago at an outside facility and debulking and laser photocoagulation about 6 years ago but did not follow up. A rigid bronchoscopy was performed with debulking and removal of lesions. Subsequently, Argon Plasma Coagulation (APC) was performed to the remaining parts of the lesions which were at multiple points of the proximal part of the trachea. Patient’s symptoms improved and she was discharged with follow up.
DISCUSSION: Surgical debulking is the mainstay of treatment but adjunctive therapy which is still under evaluation is necessary for some patients. The goals of therapy are complete removal of papillomas or reduction in burden in extensive disease, creation of patent airway, increasing the time interval between surgical procedures with preservation of normal structures and avoiding complications. The methods of surgical removal have advanced from ‘cold instruments’ to laser therapy with CO2 being the most widely used. Emerging methods include microdebriders and APC.
CONCLUSIONS: Although it is a benign disease, RRP is challenging as it has an unpredictable course, tends to recur and spread, and can rarely undergo malignant conversion. We used APC as adjuvant to debulking with good results. The advantages of APC include low risk of perforation and damage of cartilage, no carbonization or vaporization of tissue and non contact use with better visibility. Thus, APC is an alternative therapy with excellent result for treatment of RRP, especially in lower airway and has promise to evolve further with time.
1) Recurrent respiratory papillomatosis: a review. Derkay CS, Wiatrak B. Laryngoscope. 2008 Jul;118(7):1236-47.
2) Treatment of recurrent respiratory papillomatosis with argon plasma coagulation. Bergler W, Hönig M, Götte K, Petroianu G, Hörmann K. J Laryngol Otol. 1997 Apr;111(4):381-4.
DISCLOSURE: The following authors have nothing to disclose: Rohit Gupta, Sanjay Dogra, Nader Mina
No Product/Research Disclosure InformationWayne State University/Detroit Medical Center, Detroit, MI