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Glisinski K, Kurman JS, Spandorfer A, Pastis NJ, Murgu S, Cheng GZ. Photodynamic therapy for the treatment of tracheobronchial papillomatosis: A multicenter experience. Photodiagnosis Photodyn Ther 2020; 30:101711. [PMID: 32145373 DOI: 10.1016/j.pdpdt.2020.101711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Recurrent respiratory papillomatosis (RRP) causes mucosal wart-like growths of the upper aerodigestive tract, which can undergo malignant transformation. These tumors are difficult to treat, often requiring repeated debridement, which can be associated with high morbidity. Photodynamic therapy (PDT) uses a photosensitizing medication and a topically applied light source to treat early stage endobronchial lung cancer. Most data on the use of PDT in RRP pertain to laryngeal disease. Our objective was to evaluate the effectiveness of PDT in treating RRP involving the lower respiratory tract. METHODS We performed a retrospective multicenter review of adult patients who had a diagnosis of RRP involving the lower airways. We documented details of their disease, treatments, and outcomes. RESULTS Eight patients underwent PDT for ten RRP lesions. Lesions were located in the trachea and more distal airways. Pathology showed malignant conversion to squamous cell carcinoma in half of the cases. All patient underwent debulking and multimodal treatment concurrently with PDT. Treatment was successful in seven patients with improvement in luminal size. Duration of disease-free recurrence ranged from 4 to 33 months. Five of eight patients have sustained ongoing treatment effect, ranging from 10 to 33 months. Most patient had improved quality of life (83 %) and a reduction in interventions (87 %) after PDT. Complications were minimal. CONCLUSION PDT can be a safe and effective tool when treating RRP of the lower respiratory tract, including lesions with malignant transformation. A multimodal treatment approach is associated with improved outcomes. Further prospective studies are needed to fully determine its effectiveness.
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Affiliation(s)
- Kristen Glisinski
- Duke University Medical Center, Department of Pulmonary, Allergy, & Critical Care, Durham, NC, United States.
| | - Jonathan S Kurman
- Medical College of Wisconsin, Division of Pulmonary & Critical Care, Milwaukee, WI, United States
| | - Adam Spandorfer
- Medical University of South Carolina, Department of Pulmonary & Critical Care, Charleston, SC, United States
| | - Nicholas J Pastis
- Medical University of South Carolina, Department of Pulmonary & Critical Care, Charleston, SC, United States
| | - Septimiu Murgu
- University of Chicago, Department of Pulmonary & Critical Care, Chicago, IL, United States
| | - George Z Cheng
- University of California San Diego, Division of Pulmonary, Critical Care, & Sleep Medicine, La Jolla, CA, United States
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Papiris SA, Malagari K, Manali ED, Kolilekas L, Triantafillidou C, Baou K, Rontogianni D, Bouros D, Kagouridis K. Bronchiolitis: adopting a unifying definition and a comprehensive etiological classification. Expert Rev Respir Med 2014; 7:289-306. [PMID: 23734650 DOI: 10.1586/ers.13.21] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bronchiolitis is an inflammatory and potentially fibrosing condition affecting mainly the intralobular conducting and transitional small airways. Secondary bronchiolitis participates in disease process of the airways and/or the surrounding lobular structures in the setting of several already defined clinical entities, mostly of known etiology, and occurs commonly. Primary or idiopathic bronchiolitis dominates and characterizes distinct clinical entities, all of unknown etiology, and occurs rarely. Secondary bronchiolitis regards infections, hypersensitivity disorders, the whole spectrum of smoking-related disorders, toxic fumes and gas inhalation, chronic aspiration, particle inhalation, drug-induced bronchiolar toxicities, sarcoidosis and neoplasms. Idiopathic or primary bronchiolitis defines clinicopathologic entities sufficiently different to be designated as separate disease entities and include cryptogenic constrictive bronchiolitis, diffuse panbronchiolitis, diffuse idiopathic pulmonary neuroendocrine cell hyperplasia, neuroendocrine hyperplasia in infants, bronchiolitis obliterans syndrome in lung and allogeneic hematopoietic cell transplantation, connective tissue disorders, inflammatory bowel disease and bronchiolitis obliterans organizing pneumonia. Most of the above are pathological descriptions used as clinical diagnosis. Acute bronchiolitis, though potentially life threatening, usually regresses. Any etiology chronic bronchiolitis contributes to morbidity and/or mortality if it persists and/or progresses to diffuse airway narrowing and distortion or complete obliteration. Bronchiolitis in specific settings leads to bronchiolectasis, resulting in bronchiectasis.
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Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Devakonda A, Raoof S, Sung A, Travis WD, Naidich D. Bronchiolar disorders: a clinical-radiological diagnostic algorithm. Chest 2010; 137:938-51. [PMID: 20371529 DOI: 10.1378/chest.09-0800] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Bronchiolar disorders are generally difficult to diagnose because most patients present with nonspecific respiratory symptoms of variable duration and severity. A detailed clinical history may point toward a specific diagnosis. Pertinent clinical questions include history of smoking, collagen vascular disease, inhalational injury, medication usage, and organ transplant. It is important also to evaluate possible systemic and pulmonary signs of infection, evidence of air trapping, and high-pitched expiratory wheezing, which may suggest small airways involvement. In this context, pulmonary function tests and plain chest radiographs may demonstrate abnormalities; however, they rarely prove sufficiently specific to obviate bronchoscopic or surgical biopsy. Given these limitations, in our experience, high-resolution CT (HRCT) scanning of the chest often proves to be the most important diagnostic tool to guide diagnosis in these difficult cases, because different subtypes of bronchiolar disorders may present with characteristic image findings. Three distinct HRCT patterns in particular are of value in assisting differential diagnosis. A tree-in-bud pattern of well-defined nodules is seen primarily as a result of infectious processes. Ill-defined centrilobular ground-glass nodules point toward respiratory bronchiolitis when localized in upper lobes in smokers or subacute hypersensitivity pneumonitis when more diffuse. Finally, a pattern of mosaic attenuation, especially when seen on expiratory images, is consistent with air-trapping characteristic of bronchiolitis obliterans or constrictive bronchiolitis. Based on an appreciation of the critical role played by HRCT scanning, this article provides clinicians with a practical algorithmic approach to the diagnosis of bronchiolar disorders.
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Affiliation(s)
- Arun Devakonda
- Division of Pulmonary and Critical Care Medicine, New York Methodist Hospital, 506 Sixth St, Brooklyn, NY 11215, USA
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Gélinas JF, Manoukian J, Côté A. Lung involvement in juvenile onset recurrent respiratory papillomatosis: a systematic review of the literature. Int J Pediatr Otorhinolaryngol 2008; 72:433-52. [PMID: 18281102 DOI: 10.1016/j.ijporl.2007.12.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Accepted: 12/20/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Determine the exact incidence of pulmonary involvement in recurrent respiratory papillomatosis (RRP); explore available treatments and their effectiveness; determine the characteristics of cases that progress to lung cancer. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Library databases between 1966 and 2007; reference lists of retrieved publication. STUDY SELECTION Studies investigating recurrent respiratory papillomatosis with lung involvement. Age limited to 20 years of age to qualify for the diagnosis of juvenile-onset RRP. DATA EXTRACTION Data pertaining to study design, population demographics, risk factors, site of involvement, investigation including the determination of the human papillomavirus type, treatment, and outcomes including the development of cancer. DATA SYNTHESIS No randomized control trials were retrieved. Hundred and one studies met our inclusion criteria (23 cohorts, 4 case series, 72 case reports, 2 open trials) with 161 cases of lung involvement identified. From the cohort studies we could estimate the incidence of lung involvement in RRP at 3.3%. The incidence of cancer in cases with lung involvement was 16%. We could not draw conclusions regarding treatment effectiveness in lung involvement, as that was not evaluated except in case studies. It would nevertheless appear that Interferon is not effective and the use of intravenous Cidofovir needs to be better evaluated. CONCLUSION Well-designed, hypothesis-driven randomized control trials and prospective cohort studies are warranted to improve our understanding of the mechanisms underlying the development of lung involvement in RRP, the risks associated with different HPV types, the efficacy of potential therapeutic options as well as the risk of progression to cancer.
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Affiliation(s)
- Jean-François Gélinas
- Respiratory Medicine Division and Otolaryngology Division, The Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, D-380, Montreal, Canada H3H 1P3
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Silver RD, Rimell FL, Adams GL, Derkay CS, Hester R. Diagnosis and management of pulmonary metastasis from recurrent respiratory papillomatosis. Otolaryngol Head Neck Surg 2004; 129:622-9. [PMID: 14663426 DOI: 10.1016/j.otohns.2003.08.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We sought to review the current and proposed management, as well as bring about discussion, of managing the patient with distal tracheal and pulmonary parenchymal involvement by recurrent respiratory papillomatosis (RRP). DESIGN, SETTING, AND PATIENTS We conducted a review of 6 patients with pulmonary metastasis from RRP at 3 academic tertiary care hospitals. Interventions included surgical and medical management with antiviral, chemotherapeutic, and/or immune-modulating agents. RESULTS Although treatment with alpha-2-beta interferon, isotretinoin, and methotrexate have not proved to eradicate pulmonary involvement by RRP, possible epithelial stabilization and slowing of disease progression are noted. CONCLUSIONS The rates of distal tracheal and pulmonary metastasis as seen in our cohort were higher than previously reported. Approximately 12% of our patients with RRP have distal tracheal spread and as many as 7% of all patients with RRP at our institutions have pulmonary dissemination. Also, high suspicion for malignant conversion to squamous carcinoma in the patient with pulmonary spread should be maintained. In addition, aggressive treatment, although not proved to eradicate the pulmonary disease, should be undertaken due to the high morbidity and mortality associated with pulmonary dissemination of RRP in our cohort.
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Affiliation(s)
- Robert D Silver
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN 55455, USA
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Giménez A, Franquet T, Prats R, Estrada P, Villalba J, Bagué S. Unusual primary lung tumors: a radiologic-pathologic overview. Radiographics 2002; 22:601-19. [PMID: 12006690 DOI: 10.1148/radiographics.22.3.g02ma25601] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although the great majority of lung carcinomas are histologically characterized as adenocarcinoma, squamous cell carcinoma, large cell undifferentiated carcinoma, or small cell carcinoma, a variety of rare benign and malignant lung tumors may sporadically affect the lung. Several nonneoplastic tumorlike lesions are seen infrequently but are also part of the differential diagnosis for lung masses. Conventional radiographic findings, although of limited value in the diagnosis of these entities, should be examined carefully when lung tumors are suspected. Computed tomography (CT) is well suited for making a definitive diagnosis of some disease processes. CT helps determine the location and features of the lesions and depicts associated findings to help document the extent of disease. The differential diagnosis can be narrowed when there are typical CT features (eg, the presence of fat in lipoid pneumonia). Although unusual primary lung tumors are difficult to diagnose on the basis of imaging findings alone because such findings are nonspecific in the majority of cases, cross-sectional imaging can play an important role in the diagnostic work-up of these unusual tumors by delineating their extent and directing the radiologist or bronchoscopist to the appropriate biopsy site.
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Affiliation(s)
- Ana Giménez
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni M. Claret 167, 08025 Barcelona, Spain.
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Harada H, Miura K, Tsutsui Y, Mineta H, Urano M, Abe M, Kuroda M, Kasahara M. Solitary squamous cell papilloma of the lung in a 40-year-old woman with recurrent laryngeal papillomatosis. Pathol Int 2000; 50:431-9. [PMID: 10849335 DOI: 10.1046/j.1440-1827.2000.01055.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A rare case of recurrent respiratory papillomatosis (RRP) is reported with a review of the literature. A 40-year-old Japanese woman had suffered from RRP since 1 year of age. She developed a pulmonary squamous papilloma with a thin-walled cavity, which was suspected as being lung carcinoma. The trachea and bronchi around the tumor were intact, and no malignant transformation was present. Two types of human papillomavirus, 6 and 16, were detected, both in the laryngeal and pulmonary papillomas by in situ hybridization and the polymerase chain reaction method. To date, only 40 cases of juvenile laryngeal papilloma with pulmonary involvement have been reported in the English literature.
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Affiliation(s)
- H Harada
- Division of Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Magid MS, Chen YT, Soslow RA, Boulad F, Kernan NA, Szabolcs P. Juvenile-onset recurrent respiratory papillomatosis involving the lung: A case report and review of the literature. Pediatr Dev Pathol 1998; 1:157-63. [PMID: 9507042 DOI: 10.1007/s100249900021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- M S Magid
- Department of Pathology, The New York Hospital-Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA
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Kessel D. PHOTODYNAMIC THERAPY OF NEOPLASTIC DISEASE. Oral Maxillofac Surg Clin North Am 1997. [DOI: 10.1016/s1042-3699(20)30978-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Juvenile-onset recurrent respiratory papillomatosis is a vertically transmitted disease caused by members of the human papilloma virus family. Characterized by the relentless growth of papillomatous lesions of the larynx, recurrent respiratory papillomatosis imposes significant morbidity on patients and strain on their families. Surgical excision of the papillomata remains the mainstay of therapy, but human papilloma virus DNA persists in adjacent, normal-appearing mucosa and likely serves as a reservoir for viral reseeding. Despite multiple adjuvant treatment modalities, a cure for recurrent respiratory papillomatosis remains elusive. Most afflicted patients eventually enter spontaneous remission, but some endure several hundred surgical procedures before this welcome respite.
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Affiliation(s)
- N M Bauman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa College of Medicine, Iowa City, USA
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Orphanidou D, Dimakou K, Latsi P, Gaga M, Toumbis M, Rasidakis A, Jordanoglou J. Recurrent respiratory papillomatosis with malignant transformation in a young adult. Respir Med 1996; 90:53-5. [PMID: 8857327 DOI: 10.1016/s0954-6111(96)90245-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The term 'papilloma' was first used by Mackenzie 100 years ago, who claimed that this was the most benign tumour of the larynx. Today papillomas are considered to be caused by the Human Papilloma Virus group (H.P.V.). The majority of patients suffering from this disease which is also referred to as 'recurrent respiratory papillomatosis' require multiple surgical operations for tumour removal. Malignant transformation of papillomas, which is a rare condition, is considered to occur mainly to irradiated patients. The following report describes the case of a male patient, with a history of vocal cord papillomas since his first year of age, who developed bronchial and pulmonary spread of the disease. He died at the age of 26 years because of squamous cell carcinoma which was related to the malignant transformation of the pulmonary papillomas.
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Affiliation(s)
- D Orphanidou
- Respiratory Medicine Department, School of Medicine, Athens University, Greece
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Schaab K, Verdile VP. Solitary papilloma of the larynx as the precipitant of sudden death. Am J Emerg Med 1994; 12:605-7. [PMID: 8060416 DOI: 10.1016/0735-6757(94)90282-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Patel SR, DeBoer G, Mehta AC. Current role of laser therapy in thoracic diseases. Indian J Thorac Cardiovasc Surg 1993. [DOI: 10.1007/bf02666027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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