Papillomatosis

Olya Polishchuk

Mary Wyers, M.D.

Children's Memorial Hospital

Abstract

14 year old male with hoarseness

Keywords

papillomatosis, papilloma, laryngeal papilloma CT, 576

Publication Date: 2004-06-16

History

14 year old male with hoarseness

Findings

Plain film (images 1-2): Solid and cavitary pulmonary nodules in both lungs.

CT (images 3-8): The lungs demonstrate widespread solid and cavitating nodular lesions which are more pronounced on the right than the left. Interstitial infiltrates which appear partially nodular are also present in the medial aspects of both lower lobes.

Diagnosis

Papillomatosis

Differential

Cavitary and nodular lesions: infection, septic emboli, collagen vascular or inflammitory etiologies such as Wegener's granulomatosis.

Discussion

Papillomatosis is the most common tumor found in the larynx in childhood. Papillomatosis is caused by members of the human papillomavirus family. At least 50% of affected children have mothers with condyloma acuminata caused by the human papillomavirus, but most infants born to mothers who have genital papillomavirus infection do not develop papillomatosis.

Papillomatosis is characterized by the presence of small or bulky nodules occuring first in the larynx, along the anterior commissure and anterior vocal cords. Lesions may also be found elsewhere in the larynx and pharynx. The nodules are epithelial but contain a fibrovascular core. Hoarseness in the most common presenting symptom. In less than 20% of cases, the lesions may enlarge, recur, and spread distally into the tracheobronchial tree and ultimately into the lungs, as in this case. Airway obstruction, hemorrhage, and rarely malignant degeneration complicate the course. There is no universally successful therapy, but in most cases lesions can be controlled by laser surgery. Spontaneous resolution of the lesions often occurs in children.

References

Kuhn, J.P., Slovis, T.L., Haller, J.O., CAFFEY'S PEDIATRIC DIAGNOSTIC IMAGING, Elsevier, Inc., 2004, 812-813