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Recurrent Respiratory
Papillomatosis
Pri 陳孟妤/ R3 吳金龍
¾
C.C. : Progressive hoarseness and dyspnea in
recent 2 months
P. I. : 27 y/o man,
◎ MK69, 3y/o, progressive hoarseness and
dyspnea Æ laryngeal papillomatosis Æ
Tracheostomy & T-tube insertion
◎ MK80, 14y/o, obstruction and T-tube reinsertion
◎ MK86/8, 20y/o, LMS & bronchoscopy
◎ MK90/10, 24y/o, LMS & T-tube remove
◎ MK91/4, 93/4, 93/11 LMS
¾
Local Finding
CXR
Operation Finding
Recurrent Respiratory
Papillomatosis
History and Basic Science
¾ 1923, Ullmann, infectious etiology
¾ 1959, Hajek, vertical transmission
¾ 1979, EM, intranuclear virus
¾ 1980, Southern blot hybridization,
HPV DNA in papilloma
¾ 1982 Mounts et al., HPV type 6, 11
Epidemiology
Juvenile-onset v.s. adult-onset
¾ Risk factors:
1. First-born
2. Teenage mother
3. Vaginal delivery
* Danish birth registry (1974-1993) :
Incidence: 3.6/100,000
RR: 6.9/0.03= 231.4
4. Others
¾
Diagnosis & Clinical Course
¾ Initial presentation: hoarseness, weak cry,
stridor, tachypnea, chest retraction, nasal
flaring
¾ Recurrent lesion require frequent debulking
(tracheostomy for airway protection)
¾ Extralaryngeal spread
¾ Malignant transformation
Surgical Treatment
¾
¾
¾
Cold steel
CO2 laser
Microdebrider
Adjuvant Medical Therapy
¾ Interferon-α2a
¾ Retinoic acid
¾ Photodynamic therapy
¾ Indol-3-carbinol/diindolylmethane (I3C/DIM)
¾ Cidofovir
¾ Vaccine research
¾ Antireflux medication
Thanks for your attention