Laryngeal papillomatosis malignancy in adulthood

Introduction: Laryngo-tracheo-bronchial papillomatosis is a benign pathology that usually affects children and adolescents. It is caused by human papillomavirus (HPV) infection in the aerodigestive tract. In children, vertical transmission is the main cause and can occur during childbirth or intrauterine. Papillomas appear as single or multiple, exophytic, sessile or pedunculated nodules, usually limited to the larynx. They are usually lesions that recur frequently. Despite being a benign disease, dysplasia and malignant transformation can occur. The incidence of malignant transformation of papillomas to squamous cell carcinoma is estimated to occur in 3-7% of adults, usually in patients with previous dissemination to the tracheobronchial tree. After the malignant transformation of papillomas to squamous cell carcinoma, the usual oncological treatment for lung neoplasms is carried out according to their histological subtype, oncodrives and oncological stage. There are no reports in the literature of a different treatment for lung neoplasm of this type of etiology.

Objective: To report the experience of a patient with recurrent laryngeal papillomatosis malignancy in adulthood. Case report: GGC, 45 years old, with upper airway papillomatosis since childhood with several surgical approaches to papillomatous lesions in the upper airway. At a routine check-up, she was diagnosed on 03/05/2021 with squamous cell carcinoma (SCC) of the lung (pT1bN2-single chain 7 = stage III), treated with left lower lobectomy and mediastinal lymphadenectomy followed by adjuvant chemotherapy with carboplatin and paclitaxel (03/31/2024- 07/15/2021). During the follow-up, a suspicious contralateral nodule was observed growing and a re-biopsy was chosen. Pathological anatomy confirmed a recurrence of the disease (lung SCC) whose PDL1 analysis showed 40% on 27/07/2021. In a decision shared with the patient, who refused to undergo chemotherapy again, first-line immunotherapy with pembrolizumab alone was started, with good disease control and no signs of relapse to date. The patient is not a carrier of genetic mutations that justify the higher risk of developing neoplasms (p53 analysis 28/02/2022-VUS).

Conclusion: We should advise patients with airway papillomatosis that is necessary to check with an otorhinolaryngologist and pulmonologist. This will help us to better monitor the complications of this underlying pathology, such as neoplasia or necrotizi

Corresponding author: Renata Mendonça Lemos (e-mail: remendonca95@gmail.com).