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Pulmonary Procedures |

Multiple Tracheal Squamous Papillomas in an Adult Treated With Cryotherapy

Askin Uysal, MD; Shawn Milligan, MD; Micheal Owens, MD; Adam Wellikoff, MD; Cesar Liendo, MD; Cindy Trinh, MD
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VA Overton Brooks Medical Center, Shreveport, LA


Chest. 2013;144(4_MeetingAbstracts):799A. doi:10.1378/chest.1705298
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Abstract

SESSION TITLE: Bronchoscopy and Interventional Procedures Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: To review use of cryotherapy for treatment of intrabronchial papillomas

METHODS: This patient had oxygen-dependent COPD, FEV1 1.25 (37%). He came to Primary Care Clinic with increasing dyspnea and blood streaked sputum. He was treated with outpatient antibiotics for bronchitis. A CXR showed a possible small lung nodule. A CT chest demonstrated multiple tracheal masses. There were no lesions suggestive of recurrent respiratory papillomatosis within the lung parenchyma.

RESULTS: . A bronchoscopy revealed several smooth papillomas arising in the trachea and extending to the right main stem airway. The largest papilloma caused an approximate 30% narrowing of the tracheal lumen. There were no papillomas in the oropharynx or vocal cords. Biopsies were obtained used electrocautery forceps to minimize bleeding. The biopsy was positive for benign squamous papilloma. There were no viral inclusions. To remove the obstructing papillomas, the patient had a fiberoptic bronchoscopy via an endotracheal tube. Cryotherapy was used to destroy the tumors. The papillomas were soft and were easily frozen and destroyed with repeated cycles of cryotherapy. There was minimal bleeding. After the procedure, the patient immediately noted an improvement in his dyspnea.

CONCLUSIONS: : Our patient had no prior history of papillomas within the upper or lower respiratory system. These findings are most consistent with adult onset benign papillomas occurring within the central airways. These papillomas are usually single. Multiple lesions such as in our patient have only occasionally been described. This diagnosis is distinct from recurrent respiratory papillomatosis occurring in childhood. However, both forms of papillomas may be due to human papillomavirus infection.

CLINICAL IMPLICATIONS: To prevent recurrence, surgical resection should be considered. However, our patient had multiple lesions and was not considered a surgical candidate due to his severe COPD. Cryotherapy produced a rapid response with immediate improvement in symptoms. We wish to emphasize that cryotherapy was a safe modality that can result in a rapid response in patients that are not surgical candidates. However, cryotherapy is not curative and the papillomas may recur. Therefore, our patient will monitored for evidence of recurrent tumors.

DISCLOSURE: The following authors have nothing to disclose: Askin Uysal, Shawn Milligan, Micheal Owens, Adam Wellikoff, Cesar Liendo, Cindy Trinh

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