Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

CHEST
Year
: 2004  |  Volume : 14  |  Issue : 2  |  Page : 193--195

Case report-solitary squamous papilloma of bronchus


P Jagmohan, M Sinha, MK Mittal, BB Thukral 
 Department of Radiodiagnosis, Safdarjang Hospital, New Delhi-110029, India

Correspondence Address:
M K Mittal
471, Laxmi Bai Nagar, New Delhi-110023
India




How to cite this article:
Jagmohan P, Sinha M, Mittal M K, Thukral B B. Case report-solitary squamous papilloma of bronchus.Indian J Radiol Imaging 2004;14:193-195


How to cite this URL:
Jagmohan P, Sinha M, Mittal M K, Thukral B B. Case report-solitary squamous papilloma of bronchus. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Nov 18 ];14:193-195
Available from: http://www.ijri.org/text.asp?2004/14/2/193/28587


Full Text

 Introduction



Squamous papillomas commonly arise in the larynx but are rare in the lower respiratory tract, especially the bronchi. Solitary squamous papilloma arising in the bronchus is one of the rarest pulmonary tumors. This report documents a patient with squamous papilloma of bronchus presenting as obstructive collapse of lung.

 Case Report



A sixteen year old male presented with a four month history of fever, cough with expectoration and dull ache in right side of chest. On examination, clubbing of fingers, decreased respiratory movements, decreased vocal fremitus and absent breath sounds on right side of chest were detected.

A chest radiograph showed multiple cysts of varying sizes in the right upper and mid-zone with ill defined opacities in the right lower zone silhouetting the raised right dome of diaphragm.

CT performed subsequently revealed a non homogenously enhancing intraluminal mass obliterating the right main bronchus extending from carina to bronchus intermedius. Multiple thin walled cysts of varying sizes predominantly in right middle lobe and obstructive collapse of right lower lobe were also seen. Larynx, trachea, left bronchus and left lung field revealed no mass lesion.

On bronchoscopy a fleshy friable growth occluding the right main bronchus was seen. Bronchoscope could not be negotiated beyond the growth. Remaining airway was normal. Biopsy taken from the mass was sent for histopathological examination and showed hyperplastic squamous epithelium, marked keratosis and fungation. Moderate dysplastic changes were seen in some places suggestive of a squamous papilloma with malignant degeneration.

 Discussion



Lower respiratory tract papillomas were classified by Drennan and Douglas with regard to pathology. Their three categories are

Multiple papillomas Inflammatory polyps Solitary papilloma [1]

Of these multiple squamous papillomas are the most common, affecting larynx, trachea and bronchi in decreasing order of frequency. Usually seen in children and young adults, the characteristic feature of the lesions is a tendency to regress spontaneously. These have a firm association with human papilloma virus (HPV) infection.

Inflammatory polyps are not associated with HPV. These arise in the chronically inflamed mucosa of patients with a history of chronic respiratory infection, foreign body or corrosive inhalation. These are covered by respiratory ciliated epithelium and the fibrous core shows stromal oedema and inflammatory cells infiltration.

Solitary squamous papillomas are the rarest type. Only five cases were reported in a series of 15,000 bronchoscopies by Barzo [2]. The earliest case of a bronchial papilloma was reported by Seigert in 1892. However the tumor, which occurred at the tracheal bifurcation, was densely infiltrated with inflammatory cells and oedema and was probably a solitary inflammatory polyp. Cases reported subsequently by Minneto and Garbagni, Ashmore, and Freant and Sawyers either showed inflammatory infiltrate, mixed or columnar epithelium or lacked a full histological description. The earliest cases of solitary squamous papillomas were reported by Gardiol in 1959 [3].

The highest prevalence is reported in males in the fifth and sixth decades with the youngest patient being 28 years [4].

Flieder et al showed that HPV DNA was detected in 71% solitary squamous papillomas using in situ hybridization [5]. Katial et al speculated that the virus is acquired through aspiration of infected secretions of sexually active young males, which accounts for the late clinical presentation [6]. However the exact pathophysiology of solitary squamous papilloma has not been determined and its relationship with HPV is by no means conclusive.

The papillomas arise from normal bronchial epithelium and are usually located in lobar or segmental bronchi where they appear grossly as filiform or finely corrugated tumors 0.5-1.5 cm in diameter. Most consist of mature squamous epithelium lining thin fibrovascular cores. Cytologic atypia and carcinoma in situ may also be seen, either in the papilloma itself or in the adjacent airway. Occasionally clearly invasive carcinoma is present. Spencer reported presence of carcinoma in situ in two out of four patients. Malignant transformation is more common in older patients and a probable role for HPV type 11 has been reported [7].

The clinical history is characteristically short, lasting a few months to a year or two during which time the patient suffers from intermittent attacks of cough and dyspnea. A history of repeated or unresolved pneumonia or occasionally haemoptysis may be obtained.

The radiological manifestations depend on the size and location of the papilloma. Many of those that occur in the trachea or main bronchi measure less that one cm in diameter and are not detected on the chest radiograph. When radiologic and CT findings are evident, they usually consist of a polypoid mass projecting in the airway lumen. Partial bronchial obstruction may result in reflex vasoconstriction leading to decreased perfusion and hyperlucency of the affected lung or lobe. Complete obstruction is manifested by atelectasis and obstructive pneumonitis.

It is of interest to note that in our report the patient was much younger than in the other recorded case reports. Additionally the malignant degeneration seen in the patient has generally been described in much older patients.

Solitary squamous papilloma of the bronchus, a very rare tumor occurs predominantly in men of the same age group as those developing bronchial carcinoma and presents with similar symptoms. A correct preoperative diagnosis allows a conservative surgery and a better prognosis to patients.

References

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