Kashima H, Mounts P, Leventhal B, Hruban R H
Department of Otolaryngology-Head, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Ann Otol Rhinol Laryngol. 1993 Aug;102(8 Pt 1):580-3. doi: 10.1177/000348949310200802.
Florid and widespread respiratory papillomatosis is a devastating disorder in a subset of patients with recurrent respiratory papillomatosis, and it poses a major dilemma for the patient and the surgeon. Contrary to common belief, the distribution of papilloma lesions is not random, but follows a predictable pattern, with lesions occurring at anatomic sites in which ciliated and squamous epithelia are juxtaposed. The predominant sites of disease in recurrent respiratory papillomatosis are the limen vestibuli, the nasopharyngeal surface of the soft palate, the midzone of the laryngeal surface of the epiglottis, the upper and lower margins of the ventricle, the undersurface of the vocal folds, the carina, and bronchial spurs. These sites have the common histologic feature of a squamociliary junction. Papillomata also occur at the tracheostomy tract and at the midthoracic trachea in patients with tracheostomies. At the latter sites, abrasion injury to ciliated epithelium heals with metaplastic squamous epithelium and creates an iatrogenic squamociliary junction. The apparent preferential localization of papilloma at squamociliary junctions has at least 2 implications: first, that detection of occult asymptomatic papillomata is enhanced by careful examination of squamociliary junctions, and, second, that iatrogenic papilloma "implantation" is preventable by avoiding injury to nondiseased squamous and ciliated epithelia.
florid和广泛的呼吸道乳头状瘤病是复发性呼吸道乳头状瘤病患者亚组中的一种毁灭性疾病，它给患者和外科医生带来了重大难题。与普遍看法相反，乳头状瘤病变的分布并非随机，而是遵循可预测的模式，病变发生在纤毛上皮和鳞状上皮并列的解剖部位。复发性呼吸道乳头状瘤病的主要发病部位是前庭裂、软腭的鼻咽面、会厌喉面的中部、室带的上下边缘、声带的下面、隆突和支气管嵴。这些部位具有鳞状纤毛交界处的共同组织学特征。乳头状瘤也发生在气管切开患者的气管造口处和胸段气管中部。在后者部位，纤毛上皮的擦伤损伤由化生的鳞状上皮愈合，并形成医源性鳞状纤毛交界处。乳头状瘤在鳞状纤毛交界处的明显优先定位至少有两个含义：第一，通过仔细检查鳞状纤毛交界处可提高隐匿性无症状乳头状瘤的检出率；第二，通过避免对未患病的鳞状上皮和纤毛上皮造成损伤可预防医源性乳头状瘤“植入”。
