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Weekly Chest CasesArchive of Old Cases

Case No : 381 Date 2005-02-12

  • Courtesy of Chang Hyun Lee, M.D., Kun Young Lim, M.D., Hyun Ju / Seoul National University Hospital, Seoul, Korea
  • Age/Sex 49 / F
  • Chief ComplaintCough
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Tracheobronchial papillpmatosis (Squamous papilloma with koilocytotic atypia)
Radiologic Findings
Neck lateral view shows soft tissue opacities in the tracheal column. Chest CT scan shows endotracheal polypoid masses along the tracheal wall. Chest CT at lung windows shows a nodule with cavitation in the right middle lobe and bronchiectasis in the right middle lobe and lingular segment. Sagittal reconstruction CT scan shows polypoid masses nearly obstructing trachea.
Brief Review
Squamous cell papilloma is the most common benign tracheal tumor. It represents an abnormal proliferation of squamous epithelium, which may be sessile, papillary, lobulated, or polypoid. Solitary papilloma is associated with smoking and is most common in adults. The condition of multiple papillomas (i.e., papillomatosis) usually begins in human papillomavirus infection. On CT a solitary papilloma appears as a well-circumscribed nodule that is confined to the tracheal wall and projects into the tracheal lumen; it often shows acute angles where it contacts the tracheal wall. Tracheal cartilage is unaffected. Papillomatosis is characterized by numerous nodules involving the entire length of the trachea.
Papillomatosis is almost invariably confined to the larynx, but in a small minority of patients one or more papillomas are found in the trachea and bronchi, where they may cause atelectasis and bronchiectasis. The trachea is almost always involved when distal spread occurs. Tracheobronchial spread is associated with instrumentation for resection of laryngeal lesions. Even more rarely, the papillomas are present in the lung and are seen as multiple small, widely scattered, well-defined round pulmonary nodules, frequently with cavitation.
Bronchoscopic excision of tracheal or bronchial papillomas has been the treatment of choice, but the lesions recur following resection in more than 90% of patients. Malignant degeneration of pulmonary lesions may occur, leading to squamous cell carcinoma. Solitary papilloma occasionally occurs in adults, usually middle-aged men, in the absence of prior laryngeal lesions. They are usually less than 1.5cm in diameter and are most commonly found in a lobar or segmental bronchus. They may result in bronchial obstruction, and symptoms include cough and hemoptysis.Other benign tracheal tumors include hamartoma and tumors of mesenchymal origin.
References
1. Webb WR, Higgins CB. Thoracic Imaging. Philadelphia: Lippincott Williams & Wilkins, 2005:512.

2. Glazer G, Webb WR, Sides DM. Adult-onset disseminated tracheobronchial papillomatosis: CT features. J Comput Assist Tomogr 1994; 18:640-642.

3. Naka Y, Nakao K, Hamaji Y, et al. Solitary squamous cell papilloma of the trachea. Ann Thorac Surg 1993; 55:189-193.
Keywords
Airway, Benign tumor,

No. of Applicants : 37

▶ Correct Answer : 24/37,  64.9%
  • - Apollo Firstmed Hospitals, Chennai,India RG Gopinath
  • - ASL BOLOGNA Maggiore Hospital, Bologna, Italy Marcellino Burzi
  • - CH-luneville.France Nicolas Michel
  • - CHU Nancy-Brabois, France Denis Regent
  • - CIM Saint Dizier, France JC Leclerc
  • - Dong-A University Hospital, Korea Ki-Nam Lee
  • - European Hospital, Paris, France Rached Triki
  • - Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
  • - Gwangmyoung Sung-Ae Hospital, Korea Jiyong Rhee
  • - Hangang SacredHeart Hospital, Korea Eil Seong Lee
  • - Hanyang University Hospital, Seoul, Korea Yo Won Choi
  • - Hospital de la Marina Baixa. Villajoyosa. Spain Carlos F. Munoz-Nunez
  • - Jinju Jeil Hospital, Korea Hyung-Gon Llee
  • - Max Hospital, Delhi, India Vickrant Malhotra
  • - Monaldi Hospital, Naples, Italy Gaetano Rea
  • - OBP, Russia Dasha Lepikhina
  • - Ping Tung Christian Hospital,Taiwan Jun-Jun Yeh
  • - Sanggye Baek Hospital, Inje University, Korea Yun-jung Lim
  • - Sanggye Paik Hospital, Inje University, Korea Mi Jin Kang
  • - Seoul National University Hospital, Korea Seung Hong Choi
  • - Seoul National University Hospital, Korea Dae Sik Kim
  • - Sharma Clinic, Jaipur, India Dinesh Sharma
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - Wagga Medical Imaging, NSW, Australia Rashid Hashmi
▶ Semi-Correct Answer : 5/37,  13.5%
  • - Annecy Hospital, France Gilles Genin
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Sweida National Hospital, Syria Marwan Al Chami
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