Respiratory Endoscopy and Head and Neck Surgery Service at Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil.
Circulating Biomarkers Laboratory, Pathology Department, Medical Sciences Faculty, State University of Rio de Janeiro (UERJ), Brazil.
Oral Oncol. 2021 Oct;121:105398. doi: 10.1016/j.oraloncology.2021.105398. Epub 2021 Jun 22.
Neoplasms induced by human papillomavirus (HPV) infection are generally associated to high-risk HPV types. Recurrent respiratory papillomatosis (RRP) is a rare and chronic HPV-related disease characterized by papillomatous lesions in the respiratory tract, usually affecting larynx. RRP rarely comprises malignant transformation since the low-risk HPV-6 and/or HPV-11 are the most commonly found in the disease. We described a case of one adult-onset RRP (29-year-old, female) with HPV-6 infection affecting vocal folds and extra-laryngeal sites. Computed tomographic scan of the chest revealed papillomatosis with pulmonary spread showing multiple nodules and cavities. Lung involvement later progressed to squamous cell carcinoma of the lung. Patient's pregnancy during investigations may have accelerated lung carcinoma development due to immunological changes. Immunohistochemistry revealed PD-L1 high expression in tumor biopsy and, after pregnancy, the oncology treatment included a combination of pembrolizumab (PD-L1 inhibitor) to chemotherapy and also radiotherapy, showing considerable results. Patient died due to lung cancer complications 15 months after cancer diagnosis. RRP management associated with lung involvement and poor prognostic outcome, such as lung carcinoma, is still a big challenge. In this report, we described the clinical and treatment course of RRP progression to highlight the need for attention to future patients.
人乳头瘤病毒（HPV）感染引起的肿瘤通常与高危 HPV 类型相关。复发性呼吸道乳头瘤病（RRP）是一种罕见的慢性 HPV 相关疾病，其特征是呼吸道出现乳头状病变，通常影响喉部。RRP 很少发生恶性转化，因为低危 HPV-6 和/或 HPV-11 是该病中最常见的。我们描述了一例成人发病的 RRP（29 岁，女性），HPV-6 感染影响声带和喉外部位。胸部计算机断层扫描显示乳头状瘤病伴肺播散，表现为多个结节和空洞。肺受累后来进展为肺鳞状细胞癌。患者在检查期间怀孕可能由于免疫变化加速了肺癌的发展。免疫组化显示肿瘤活检中 PD-L1 高表达，怀孕后，肿瘤治疗包括 PD-L1 抑制剂 pembrolizumab 联合化疗和放疗，取得了相当大的效果。患者在癌症诊断后 15 个月因肺癌并发症死亡。RRP 伴肺受累和预后不良（如肺癌）的管理仍然是一个巨大挑战。在本报告中，我们描述了 RRP 进展为肺癌的临床和治疗过程，以强调对未来患者的关注。
