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Pulmonary Carcinoma Secondary to Respiratory Papillomatosis FREE TO VIEW

Ebru Unsal, MD; Filiz Çimen, MD; Senem Yazici, MD; Murat Yildiz, MD; Atila Gökcek, MD; Ebru Tatci, MD; Funda Demirag, MD
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Atatürk Chest Diseases and Chest Surgery Training and Research Hospital Department of Chest Diseases, Ankara, Turkey

Chest. 2014;145(3_MeetingAbstracts):304A. doi:10.1378/chest.1781351
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SESSION TITLE: Cancer Case Report Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Recurrent respiratory papillomatosis (RRP) is a common benign neoplasm of the larynx having the risk of malignancy (1). We present the treatment of a rare case as squamous cell lung cancer secondary to recurrent respiratory papillomatosis.

CASE PRESENTATION: A 34 year-old-male patient diagnosed larengeal papillomatosis when he was 6 years old was admitted to the hospital with computed tomographic scan of chest showing 74x70x60 mm mass in the right upper lobe and also cavitary lesion with a diameter of 70x63x64 mm in the right lower lobe (Figure 1,2). Bronchoscopy revealed multiple papilomas disseminating from vocal cords to trachea. Transthoracic needle aspiration biopsy was performed to the lesions and pathology of the mass in the upper lobe was reported as squamous cell carcinoma. The cavitary lesion in the lower lob was reported as squamous epithelium having metaplastic and dysplastic changes without invasion. Mediastinal lymph nodes were sampled and malignancy was not reported. PET showed no distant metastasis. Intensity modulated radiation therapy (IMRT) was performed to treat the tumor in the upper lobe with doses of 200 GY X30:6000 Gy and also follow up for the lesion in the lower lobe was planned. Two months later the patient came to the control, there was radiological regression in the tumor (Figure 3). He has been followed up fo 10 months and free of disease without any local recurrence.

DISCUSSION: In rare cases, recurrent respiratory papillomatosis can extend below the vocal cords into the trachea and main-stem bronchi. However, when it progresses into the lung parenchyma it has the malignancy potential (2-4). In the situation of malignancy, there is no proven treatment. We did not plan to give chemotherapy to the patient because of the viral etiology and also the risk of infection. We treated the tumor in the upper lobe by IMRT technique.

CONCLUSIONS: In conclusion there is no proven effective therapy for this rare disease. To our knowledge; this is the first RRP related pulmonary carcinoma case treated successfully by IMRT.

Reference #1: 1. Donne AJ, Hampson L, Homer JJ, Hampson IN. The role of HPV type in recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2010;74:7-14. 2. Kramer S, Wehunt WD, Stocker JT, Kashima H. Pulmonary manifestations of juvenile laryngotracheal papillomatosis. J Pediatr Radiol 1985;144: 687-694. 3. Sakopoulos A, Kesler KA, Weisberger EC, Turrentine MW, Conces DJ Jr. Surgical management of pulmonary carcinoma secondary to recurrent respiratory papillomatosis. Ann Thorac Surg 1995; 60: 1806-7. 4. Hasegawa Y, Sato N, Niikawa H, Kamata S, Sannohe S, Kurotaki H, Sasaki T, Ebina A. Lung squamous cell carcinoma arising in a patient with adult-onsetrecurrent respiratory papillomatosis. Jpn J Clin Oncol 2013; 43: 78-82. 5. Katsenos S, Becker HD. Recurrent respiratory papillomatosis: a rare chronic disease, difficult to treat, with potential to lung cancer transformation: apropos of two cases and a brief literature review. Case Rep Oncol 2011; 23; 4:162-71.

DISCLOSURE: The following authors have nothing to disclose: Ebru Unsal, Filiz Çimen, Senem Yazici, Murat Yildiz, Atila Gökcek, Ebru Tatci, Funda Demirag

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