Recurrent Respiratory Papillomatosis with Transformation to Squamous Cell Carcinoma: Case Report

Abstract

Laryngeal papillomatosis is a common benign neoplasm in childhood and rare in adults. It represents the initial manifestation of recurrent respiratory papillomatosis, a laryngeal tumor caused by the human papillomavirus (HPV) acquired during childbirth from an infected mother. HPV types 6 and 11 are the most common, characterized by the development of exophytic, verrucous lesions in the upper airways. These lesions tend to recur after treatment, retaining their potential for dissemination and malignant transformation. Oral sex and HPV type 16 have been associated with squamous cell carcinoma of the oropharynx.

We present the case of a 53-year-old woman with a history of vocal cord paresis following resection of laryngeal papillomas four years prior. She currently presents with grade 2 to 3 dyspnea, diaphoresis, dysphonia, weight loss, coughing fits, and mucopurulent sputum. Physical examination revealed an oxygen saturation of 80% with inspiratory wheezing and laryngeal stridor. Flexible nasobronchoscopy showed friable, clustered granulomatous lesions of an exophytic, vegetative type obstructing the upper airway in more than 95% of cases, as well as irregular papillomatous vegetative lesions extending into the trachea. Histopathological analysis revealed moderately differentiated squamous cell carcinoma. This case highlights the high probability of malignant association, estimated between 1% and 4%, demonstrating the need for multimodal treatments applied both in patients with unresectable cancers and those undergoing systemic oncological therapies.