Laryngeal papilloma presenting as steroid-dependent asthma in a 3-year-old child without recurrent stridor

Upper airway obstruction is well described as a cause of apparent asthma. However, it can be very difficult to diagnose in young children. This 3-year-old male presented with a 1-year history of severe recurrent wheezing with six emergency room visits in the previous 5 months. Cromolyn, inhaled corticosteroids, and frequent predinisolone bursts had not controlled the wheezing. There was no history of barky cough, croup, or stridor. His physical examination was notable for marked nasal obstruction. At initial presentation, his lungs were normal with no wheezing or stridor. Soft tissue neck X-ray films suggested the presence of a subglottic mass. A large solitary papilloma was found on bronchoscopy. After surgical removal, there was no further wheezing noted by either the parents or his physicians. Laryngeal papillomatosis may mimic asthma in the absence of symptoms of hoarseness, croup, or stridor. It should be particularly considered in 2 to 4-year-old children with recurrent wheezing that is poorly responsive to aggressive therapy including oral corticosteroids.

Childhood obstructive sleep apnoea syndrome due to nasopharyngeal viral papillomatosis

We present a case of obstructive sleep apnoea in a child that is caused by papillomatosis of the post-nasal space.

Echocardographic features of papillary fibroelastoma and their consequences and management

Thirty-five percent of patients (5 of 15) were diagnosed with ischemic stroke from left-sided papillary fibroelastomas by diagnosis of exclusion, whereas 40% of patients (6 of 15) did not have ischemic stroke.

Congenital Becker's nevus with a familial association

Becker's nevus is a unilateral, hyperpigmented cutaneous hamartoma usually with hypertrichosis. It occurs predominantly in boys, becoming apparent during adolescence, although several cases of congenital Becker's nevus have been reported. Rarely it may be familial and as such is transmitted in an autosomal dominant pattern. We report a 16-month-old black boy with a hyperpigmented patch on his right shoulder and upper pectoral area that extended down his arm. The patient's father has a similar lesion with hair on his left shoulder which has been present since childhood. Histology of the child's lesion was consistent with Becker's nevus. We believe this to be the first reported case of a congenital Becker's nevus with a familial association.

Papillomatosis of the gallbladder in metachromatic leukodystrophy

A 2-year-old boy who presented with a cystic gallbladder mass was found histologically to have metachromatic leukodystrophy. Diffuse hyperplasia of the gallbladder mucosa, multiple tendrillar fronds extending into the lumen, extensive papillomatosis, and the presence of large numbers of macrophages bearing metachromatic material confirmed the diagnosis. The child developed progressive degeneration of the central nervous system, refractory bronchopneumonia, and generalized muscular atrophy. A computed tomographic scan of the brain demonstrated hypodense areas of white matter suggestive of demyelination. This report describes the rare association of gallbladder papillomatosis with a storage disorder and reviews the relevant literature.

Mastication of verruca vulgaris associated with esophageal papilloma: HPV-45 sequences detected in oral and cutaneous tissues

Human papillomaviruses (HPVs) are double-stranded, circular, epitheliotropic DNA viruses of which nearly 70 types have been identified. Specific HPV types exhibit a predilection to infect certain sites; however, occurrence is not unique or restricted to these sites. HPV typing may also be helpful in determining the oncogenic potential of HPV lesions. The most common HPV types, 6 and 11, are associated with benign mucosal lesions, whereas types 18, 16, 31, and 33 are thought to confer a high rate of malignant transformation. We describe a patient with both palmar verrucae and esophageal papillomatosis that proved to be HPV type 45 by polymerase chain reaction. HPV 45 has a high homology to HPV 18 and is a member of the relatively new "high-risk" mucosal HPV family in terms of cervical oncogenic potential. To our knowledge, HPV 45 has never been reported in cutaneous warts or esophageal lesions.

Benign papilloma of the cervix in childhood: immunohistochemical findings and review of the literature

Papillomas of the genital region are rare benign tumours causing sanguineous vaginal discharge in prepubertal girls. We report on a papilloma of the cervix in a 2-year-old girl. We characterize the tumour immunohistochemically and give a brief review about the current literature.

CONCLUSION

Genital tract papillomas are benign differentiated tumours of probable Müllerian origin with a good prognosis even after tumour recurrence. Local excision is adequate for treatment.

Low-risk human papillomavirus types 6 and 11 associated with carcinomas of the genital and upper aero-digestive tract

BACKGROUND

Human papillomavirus (HPVs) types 6 and 11, are frequently found in non-malignant anogenital condylomas and laryngeal papillomas. However, in an ongoing epidemiological study in Argentina in which 163 anogenital and aero-respiratory cancer biopsies were analyzed, several cases infected with low-risk HPVs could be detected.

METHODS

Tumor samples were analyzed by Southern blot hybridization, using HPVs 6, 11, 16, 18, 30, 31, 33 and 35 as probes, and polymerase chain reaction (PCR) with type-specific primers and probes.

RESULTS

Four invasive carcinomas containing HPV 6 or 11 could be detected (2.4%) by Southern blot technique. HPV 6 DNA was found in a penile carcinoma, a groin carcinoma, and in a tonsillar carcinoma. One cervical carcinoma harbored HPV 11 DNA. Using HPVs 6, 11, 16, 18 and 33 anticontamination primers and probes in PCR, no additional high-risk HPV types could be detected in these four cancers.

CONCLUSION

This report shows the presence of low-risk HPVs (HPV 6 and 11) associated to malignant tumors in a frequency higher than usually observed. The data raise questions about which are the circumstances which may favor low-risk HPV related oncogenesis.

Circumferential squamocellular papilloma of the cervical esophagus, a rare cause of dysphagia. A case report

A case report of a patient with circumferential benign squamous cell papilloma of the cervical esophagus is presented. The location, appearance and symptoms of the lesion are unusual, and the etiology and treatment are discussed. The case is important for otorhinolaryngologists, because the widely used method to examine the upper gastrointestinal tract, fiberesophagogastroscopy, does not offer optimum conditions to investigate the proximal esophagus. The rigid hypopharyngoesophagoscopy under general anesthesia is the method of choice for this region, a method familiar to otorhinolaryngologists.

Sudden death caused by laryngeal papillomatosis

Laryngeal papillomatosis (LP) is the most frequent benign neoplasm of the larynx. Clinically it causes hoarseness and upper airway obstruction. Though the LP has the potential to endanger life by asphyxiation, this unfortunate outcome is extremely rare. We report the case of a 19-year-old female who suddenly died of asphyxiation caused by massive LP.

Biliary papillomatosis

Biliary papillomatosis is a rare clinicopathological condition characterized by multiple papillary adenomas involving extensive areas of the biliary tree1. The pathophysiology, clinical features and management of this condition are not well understood. Experience of six patients with biliary papillomatosis is reported.

Malignant acanthosis nigricans with florid papillary oral lesions

Acanthosis nigricans is a distinctive skin disease of importance, because it has served as an external marker for a variety of systemic disorders including endocrinopathies, and malignant tumors of internal organs. It typically appears as hyperpigmented, roughened plaques of velvety consistency and infrequently as verruca-like papillations. The oral cavity and lips can be affected by florid papillary growths. Because of its rarity and nonspecific microscopic appearance, clinical recognition of acanthosis nigricans continues to be a challenge. A case of mucocutaneous "malignant" acanthosis nigricans is presented in which pigmented skin lesions led to the discovery of a gastric adenocarcinoma, which in turn was followed by the appearance of massive oral papillomatosis. No effective treatment was found.

Intraductal papilloma as a cause of a parotid duct cyst. A case report

A case is presented of a rare intraductal papilloma being found simultaneously with a parotid duct cyst, which is a relatively common parotid disorder. The papilloma most probably played a significant role in the obstruction of the duct and thus caused the ductal cyst. Intraductal papillomas have been mostly described in minor salivary glands, but are rare in the parotid gland.

An unusual reason for obstructive sleep apnea in a boy with hemophilia B: supraglottic papilloma

An unusual cause of obstructive sleep apnea in a boy with hemophilia B who was urgently intubated during the night because of suspected bleeding into the airway is analysed. The cause of airway obstruction was a floating papilloma hanging from false cord. At inspirium the tumor was moving immediately above the vocal cords. This was manifested during sleep by noisy snoring and numerous apneic pauses. When the child was awake he had no respiratory problems. After the tumor was removed, the boy breathed freely during sleep. However, the papillomas recur in various parts of the larynx and repeated surgical treatment by factor IX replacement: therapy is necessary.

Focal dermal hypoplasia (Goltz syndrome) associated with multiple giant papillomas

We report a case of focal dermal hypoplasia (FDH) with multiple giant papillomas on nonperimucosal areas. The patient had had cribriform hyperpigmented and depigmented plaques on the trunk and extremities since birth. There were also hypoplastic skin lesions on the right arm, left elbow and right thigh. The multiple giant papillomas began to appear, when she was 22 years old, on the trunk and extremities. Cryotherapy was effective in controlling them.

[Transitional cell papilloma of the ureter causing uretero-hydronephrosis in a child]

A case of transitional cell papilloma of the ureter is reported in a seven-year-old boy who had a history of left flank pain, involuntary voiding and nocturnal enuresis, and was found to have ureterohydronephrosis of a solitary left kidney and renal insufficiency. Renal function and morphology were restored by cutaneous loop ureterostomy, neoureterocystostomy and ureterostomy closure in a staged repair.

The successful removal of a bleeding intracranial tumour in a severe haemophiliac using an adjusted dose continuous infusion of monoclonal factor VIII

Ten per cent of patients with haemophilia A develop intracranial haemorrhage (ICH) with a mortality rate of 30% and an incidence of psycho-neurological sequelae in 50% of survivors. ICH may be spontaneous or in association with trauma and other pathology. The generally recommended management is conservative replacement therapy using bolus injections of factor VIII and no neurosurgical intervention. Adjusted dose continuous infusion therapy provides an alternative method of factor VIII administration that is simple, more cost effective and safer through the maintenance of stable plasma VIII:C levels. This method has been successfully used to cover general surgery and the conservative treatment of subarachnoid haemorrhage but is not widely used due to unfamiliarity with the technique. This paper describes the use of continuous infusion of factor VIII concentrates to cover the successful neurosurgical management of a young man with severe haemophilia A who presented with an ICH associated with a bleeding choroid plexus tumour. Surgery was complicated by the development of a factor VIII inhibitor which disappeared following treatment with an immune-tolerance induction programme.

Metachromatic leukodystrophy and coincidental finding of papillomatosis of the gallbladder. A case report

In this case report we describe the coincidental finding of polyps in the gallbladder by ultrasound investigation in a six-year-old girl, known to have metachromatic leukodystrophy. The investigation was carried out because of suspicion of abdominal trauma after falling down the stairs and finding elevated serum amylase.

[Laryngeal papillomatosis in children: therapeutic problems apropos of 39 cases at the Lomé University Hospital Center]

The retrospective study about 39 cases of laryngeal papillomatosis emphasizes the management difficulties due to slenderness of therapeutical resources, delayed consultations because of health under education of the community and patients' discouragement during treatment of such a relapsing disease. Consequently, tracheostomy was needed immediately (25.64%), breaking of the voice (48.72%) was noted as well as school backwardness. The use of laser and interferon in laryngeal papillomatosis treatment is for the future in Togo.

Human papilloma virus associated with solitary squamous papilloma complicated by bronchiectasis and bronchial stenosis

A 28-year-old man presented with recurrent pneumonias for 6 years. Chest radiograph and computed tomography showed localized bronchiectasis of the anterior segment of the left upper lobe. Bronchoscopy showed bronchial stenosis without an endobronchial lesion. After 6 weeks of antibiotic treatment, the patient had a recurrent pneumonia and underwent left upper lobectomy that showed a solitary squamous papilloma. In situ hybridization studies of the papilloma were reactive for human papilloma virus subtypes 6/11.

Oral florid papillomatosis and leukoplakia of the esophagus associated with keratoderma and showing transepidermal elimination

A 37-year-old male presented with a cauliflower-like tumor in the right buccal mucosa, leukoplakia of the tongue and esophagus, and keratotic papules or plaques on the extremities including bilateral palms and soles, associated with borderline diabetes mellitus and a repeated history of infections. A multi-system keratinizing abnormality was suspected, although no distinct disease category has been found showing similar involvements.

Prenatal sonographic diagnosis of a third ventricle choroid plexus papilloma

We report a case of fetal hydrocephalus secondary to a third ventricle choroid plexus papilloma detected by ultrasound at 33 weeks' gestation. The prenatal sonographic and colour flow Doppler findings of this rare fetal intracranial tumour are discussed.

Lhermitte-Duclos disease and Cowden's syndrome in an adolescent patient. Case report

Recent reports of seven cases of Lhermitte-Duclos disease occurring in adult patients with Cowden's syndrome (multiple hamartoma syndrome) strongly suggest that Lhermitte-Duclos disease is one of the types of neoplasia that characterize this syndrome. A case of Lhermitte-Duclos disease is reported in a 16-year-old girl with craniomegaly, choroidal hamartoma, and conjunctival papilloma of the right eye, and a history of bilateral multinodular adenomatous goiter and cystic hygroma. These findings strongly suggest a diagnosis of Cowden's syndrome. Although the syndrome traditionally has been defined by mucocutaneous criteria, it typically also involves hamartomas and neoplasia of internal organs, most commonly in the thyroid, breast, and female genitourinary tract. Because the mucocutaneous features may develop several decades after birth, the present case both supports the previously reported association between Lhermitte-Duclos disease and Cowden's syndrome and highlights the need for long-term follow-up monitoring of a pediatric patient with Lhermitte-Duclos disease because of the risk of malignancies associated with Cowden's syndrome.

Recurrent respiratory papillomatosis: juvenile versus adult forms

Recurrent respiratory papillomatosis (RRP) has been described to have a juvenile or aggressive form and an adult or less aggressive form. However, the aggressive form may occur in an adult and vice versa. Some authors have reported a quiescence in the juvenile form with the onset of puberty. In order to further characterize these two forms of RRP and to analyze the effects of puberty, we reviewed the records of 32 patients treated for RRP at our institution over a 10-year period. We found that the aggressive form typically occurs in the very youngest of patients (average of 2 years old as compared to an average of 17 years old in the less aggressive form). Although subglottic involvement universally occurred in our group with aggressive disease, approximately 40% developed subglottic disease very early as compared with 20% of patients with less aggressive disease. Additionally, our data do not support the theory of spontaneous regression with the onset of puberty. These and other findings will be discussed in detail. We also propose a new classification for RRP to eliminate confusion.

Confluent and reticulated papillomatosis: a case with concurrent acanthosis nigricans associated with obesity and insulin resistance

A 19-year-old Japanese man with confluent and reticulated papillomatosis (CRP) is presented. He was an obese and dark-complexioned man, who had impaired glucose tolerance and hyperinsulinemia. The clinical and histological findings were consistent with the diagnosis of CRP. He also had acanthosis nigricans (AN) on his axillae and nape. Neither spores nor hyphae were detected from scales; antifungal treatment had no benefit. Although the reduction of his weight was unsuccessful, oral etretinate therapy resulted in considerable improvement of both CRP and AN. We reviewed previous case reports in terms of the relation between CRP and AN. Although the two conditions are usually differentiated because of their distinctive clinical features, a close relationship was noted between CRP and AN.

Oral manifestations in HIV-infected patients: diagnosis and management

Oral lesions have been observed since the beginning of the AIDS epidemic. The number of HIV-infected patients is still increasing, especially in the heterosexual population. Oral diseases in HIV-infected patients are often more difficult to diagnose because the clinical presentations may differ from the same diseases in HIV-negative patients. HIV-associated oral lesions have diagnostic, prognostic, and therapeutic impact. Approximately 10% of the HIV-infected population will have oral manifestations as a first sign of their disease. In HIV-infected men oral hairy leukoplakia and oral candidiasis are useful markers for disease progression. This article summarizes the oral manifestations and the management of oral health in persons with HIV infection.

Biliary papillomatosis with the point mutation of K-ras gene arising in congenital choledochal cyst

Biliary papillomatosis is a rare entity. A case of biliary papillomatosis associated with congenital choledochal cyst and intrahepatic gallstones is reported here. Percutaneous transhepatic cholangioscopy revealed multiple papillary lesions of the right intrahepatic duct and the common bile duct. Microscopically, the papillary mucosal lesion showed papillary proliferations of bile duct epithelial cells with mild atypia. Furthermore, a point mutation at codon 12 of the K-ras oncogene was found in the papillary lesion. To the best of our knowledge, this is the first case of biliary papillomatosis arising in congenital choledochal cyst. Although the pathogenesis of biliary papillomatosis in our case was unclear, biliary irritation associated with choledochal cyst may be related to biliary papillomatosis with point mutation at codon 12 of K-ras gene.

[A new cases of transitional cell papilloma of the bladder, inverted type]

We report on a 75-year-old male patient with inverted transitional cell papilloma located on the right side of the bladder, behind the prostate lobe. It was a large (4 x 4 x 0.9 cm) exophytic, papillary tumor with a wide base and all the gross features of a typical transitional cell tumor of the bladder. The presenting symptom was gross hematuria and treatment was by transurethral resection. The literature is briefly reviewed.

Inverting papilloma of the head and neck: the UCLA update

Inverting papilloma of the nose and paranasal sinuses is a benign disease with malignant potential. This disease is characterized by multiple recurrences, especially after minimal operative therapy. Controversy exists over the most appropriate treatment for this rare tumor. This review presents an update of the UCLA experience with inverting papilloma over the past four decades along with a review of the literature. A retrospective study of 61 patients seen at the UCLA Medical Center was conducted. The mean age at presentation was 63 years, with a male-to-female ratio of 2:1. The most common symptom at presentation was nasal obstruction (71%), followed by epistaxis (27%). Seventeen percent of the patients in this series either had concurrent squamous cell carcinoma of the nose or paranasal sinuses, or it developed. Patients treated with a lateral rhinotomy and medial maxillectomy had a recurrence rate of 30 percent. Those treated with a less aggressive operation had a recurrence rate of 71 percent. Despite a trend for a more conservative sinus operation in recent literature, we continue to advocate a lateral rhinotomy and medial maxillectomy as the treatment of choice for inverting papilloma of the head and neck.

Vulvar squamous papillomatosis and human papillomavirus infection. A polymerase chain reaction study

Squamous papillae of the vulvar vestibule and introitus are quite a common clinical finding, however their origin is uncertain. They were formerly described as a normal variant of the mucosal epithelium, but recently they have been attributed to human papillomavirus (HPV) infection. Eight women with clinical findings compatible with a diagnosis of vulvar squamous papillomatosis were studied. All were free of other clinically evident HPV-related diseases. Vulvar scrapes and biopsy specimens were collected and used for DNA extraction and microscopic examination. DNA extracted from vulvar scrapings and from paraffin-embedded tissue was subjected to polymerase chain reaction (PCR). The reactions were performed with two sets of primers designed for the amplification of numerous HPV genotypes including those most commonly encountered in the genital area. Histological examination failed to reveal clear-cut signs of HPV infection in any subject. The PCR on the DNA extracted from vulvar scrapings revealed HPV infection in two cases. PCR performed on the DNA extracted from the paraffin-embedded tissue failed to detect HPV-DNA in any case. A 6-month follow-up showed no changes in the lesions. These results along with literature data, which is clearly inconsistent, indicated that the presence of HPV is coincident to, rather than causal of, vulvar squamous papillomatosis lesions. Patients with symmetrically distributed, long-standing vulvar papillae should, therefore, be carefully evaluated before starting therapy.

Juvenile laryngeal papillomatosis: a new complication

Extension of juvenile papillomas to the lung parenchyma is unusual. When it occurs, the patient's prognosis worsens because these lesions destroy lung tissue as they grow. Respiratory complications eventually occur in the presence of multiple nodular and cystic lesions due to the attendant parenchymal destruction. We have observed that pneumothorax can occur after the development of cystic pneumatoceles, presumably from the ball valve effect of a nodular lesion (Fig 3).

Clinical exacerbation of systemic lupus erythematosus after photodynamic therapy of laryngotracheal papillomatosis

Photodynamic therapy was used to treat a patient with recurrent laryngotracheal papillomatosis who had a history of systemic lupus erythematosus (SLE). At the time of photoactivation, the patient's SLE was in remission for 2 years. Postoperatively, the patient was not compliant in avoiding sunlight exposure and developed photosensitive skin reactions of his face and hands. In addition, he had clinical activation of his SLE following that exposure.

Papilloma of Bartholin's gland duct cyst: first report of a case

A 50-year-old woman underwent excision of a vaginal cyst. Its distal end lay in the submucosal tissue of the posterior lateral aspect of the vulvar vestibule near the orifice of Bartholin's gland. The caudal wall of the cyst contained a papilloma with an epithelial lining which consisted of columnar and stratified polygonal cells resembling squamous and transitional epithelium. The histochemical attributes of the papillary epithelium were homologous to those of Bartholin's gland. Immunohistochemical studies supported glandular and squamous differentiation. Evolution from a dysontogenetic remnant of Müllerian origin cannot be excluded with certainty, but location and histopathology were consistent with origin from Bartholin's gland duct. The presence of mucin and the absence of a smooth muscle investment exclude derivation from Gartner's duct. Cysts of Bartholin's gland are common, but solid benign tumors are rare. We have been unable to find a report of a papilloma of either vulva or vagina with features similar to those in our patient.

Cutaneous papillomatosis associated with papillomavirus infection in a dog

A 7-year-old female Kerry blue terrier dog developed 20 cutaneous nodules, up to 4 mm in diameter, over the body. Light and electron microscopy demonstrated that they were virus-associated inverted papillomas and they are described because canine skin viral papillomas have not been frequently reported.

Extrahepatic biliary papillomatosis occurring after removal of a dysplastic gall bladder

A case is presented of a woman who developed obstructive jaundice secondary to dysplastic mucinous papillomatosis two years after she had undergone cholecystectomy and exploration of the common bile duct. The gall bladder was dysplastic. It is suggested that the dysplastic glands removed from the common bile duct at the second operation either represented seedlings from dysplastic areas of the gall bladder or were a manifestation of dysplastic field change.