José Duro da Costa

Recurrent respiratory papillomatosis of the airway: The experience of an endoscopic unit

INTRODUCTION Recurrent respiratory papillomatosis (RPP) is a rare benign neoplasm caused by human papillomavirus (HPV). RPP is characterized by recurrent proliferation of the papillomata in the respiratory tract. OBJECTIVES AND METHODS Retrospective analysis of all adult patients with diagnosis of recurrent respiratory papillomatosis admitted to our endoscopic unit between 2000 and 2013 with histological proved papillomatosis. RESULTS Four patients were included (3 women) with an average age of 53±19 years (27-72). Before endoscopy unit admission, all the patients have been previously submitted to surgical removal of the papillomas with a median number of surgeries per patient of 6.5. These patients were submitted to therapeutic endoscopy and the most frequent endoscopic treatments were Laser YAG and local injection of cidofovir. All the patients treated with cidofovir presented complete remission of the disease. The median follow-up was 6 years: 2 presented malignant transformation to epidermoid carcinoma and 1 had severe dysplasia on the histological examination. We describe the four cases due to different forms of presentation. CONCLUSION Papillomatosis of the airway is a rare condition predisposing to malignant transformation. RRP tends to recur and repeated surgeries are needed to remove papillomatas. Endoscopic treatment is important for the removal of the papillomas that are not accessible via laryngoscopy (YAG Laser, cryotherapy, etc.) and for resistant moderate/severe cases of RPP because it allows intralesional administration of adjuvant therapy like cidofovir.

Schwannoma endobronquial que involucra la carina

A 69-years-old male patient, non-smoker, with exertional dyspnea for the last 6 months, underwent a chest CT scan that revealed a large tumor mass under the carina with endobronchial involvement and obstruction of both main bronchi (Fig. 1a). Bronchoscopy showed two lobulated endobronchial masses protruding on each side of the main carina, with a bright, smooth, and highly vascularized surface. The masses extended 3 cm to the proximal segment of both main bronchi, producing a 90% bronchial lumen obstruction (Fig. 1b). The endobronchial component was treated with LASER photocoagulation and mechanical resection with significant desobstruction and symptom improvement. Histopathology revealed a benign schwannoma (fusiform cells with S100 expression). Definitive treatment consisted of carinal resection with reconstruction of a neocarina between the trachea and right and left main bronchi. Bronchoscopy 18 months after surgery showed a narrow right upper bronchus, straight intermediate bronchus, a S-shaped neocarina with a shifted left main bronchus (Fig. 1c and 1d). Endobronchial schwannoma is a rare entity, accounting for just 2% of benign tracheobronchial tumors. These tumors may affect any part of the tracheobronchial tree, with intra or extraluminal involvement.1 Clinical presentation depends on the tumor size and location. Treatment consists of surgical resection, especially in tumors with extraluminal extension.2